thrombocytopenia

[cyclamen]

Anyone have this while pregnant?  I had to have a second set of labs done to confirm that I do have low platelet counts (130) and I won't get to discuss this with my midwife until my next appointment, which is still a week away.  I googled it ...probably shouldn't have done that!.... and now I'm getting kind of nervous about what it means.  My midwife did think that it's possible it's something that I have in general and not pregnancy related, since when I was younger I tended to bruise easily and get long nosebleeds.

[cynthiamoon]

I've had this condition for over a year (129 then 117 platelet count), but my main doc just kept saying we'll "keep an eye on it" and to report any major symptoms. I've reported bruising, but not much else, and have not been recommended any treatment.

I am planning on discussing this at my first prenatal appt. on Wednesday. It is with a Obstetrician who works closely with the birthing center midwives I'll be using for most of my prenatal care. 

I understand treatment depends on wether it's always been there, or if it's preg. related, but the info online is just confusing, so I am waiting for the appointment to discuss the issue. 

Let's keep each other in the loop, eh? It'll be good to talk to someone going through the same thing. BTW, I am just 6weeks, how about you?

[cynthiamoon]

So my doc says depending on how low my blood count gets during pregnancy (and that most women's do drop at least some) that I may no longer be in the "low-risk" category for the natural birth at a birth center I always thought I wanted. Apparently the risk is excessive bleeding when the placenta separates from the uterine wall, as well as some other things. I got blood drawn and am waiting for results. 

Your appointment is soon right? I hope you get good news. 

[GISDiva]

I'll have to look up my numbers again, but I had/have this as well.  We didn't even know until I was pregnant with my son and had the routine blood test, so we didn't know if that was normal for me or pregnancy-induced or what.  It was watched carefully and I don't think it dropped below 115 that I can remember (definitely not below 100), and we decided that everyone was comfortable with my non-medical birth center plan.  I did have a bit more bleeding than normal, but my midwife was able to control it with...oh shoot, some sort of injection. Forgive me, it was 4.5 years ago...I did pass out for a short time when I got up to go to the bathroom afterwards, but it was short-lived and everything was fine.  It was extra important for me to drink lots and lots of fluids afterwards to get that blood volume back up.

Fast forward to this year.  We decided to try for one more baby, so my doctor tested my blood count to see what my "normal" levels were, and sure enough, they were *just* off the scale of normal.  I just got confirmation that I am indeed pregnant this weekend, so my midwife and I will come up with a plan of attack to see if we can keep those numbers up.  She mentioned last time around that maybe next time we'd try Vitamin K supplements.  Through some reading, I found that sometimes this is caused by sub-par thyroid function, but that doesn't seem to be the case for me, as those tests were OK.  I think it's just the way I'm wired.

Good luck to you both, I hope everything goes well!  Once I reach my first appointment with my midwife, I'm sure it will be a topic of discussion and I can report back any advice I get.

[studentDr]

hi I can understand why you would be anxious, but don't be

low platelets aren't serious unless they are under 50 and you are bleeding (hm labour)

if you are not bleeding then 20 would be the level at which you would need a transfusion

120 is fine.

the head of onclogy was actually quizzing me on it today. tomorrow I will ask my favourite awesome obstetrician how low it can go in pregnancy and what is safe.

. . . . . . alcoholics often have low platelets and don't see them bleeding.

and in pregnancy your blood volume ncreases more than the number of cells In it increases so the result is a dilutional decrease.

[Bokonon]

Originally Posted by studentDr 

hi I can understand why you would be anxious, but don't be
low platelets aren't serious unless they are under 50 and you are bleeding (hm labour)
 

This is not true.

Less than 100k is a symptom of HELLP Syndrome.

http://en.wikipedia.org/wiki/HELLP

OP, I'm glad you and your midwife are keeping an eye on it.  Getting baseline labs is a great idea.

[studentDr]

thanks for bringing that up

platelets from 50 to 100 is only moderate thrombocytopenia and poses little risk to the mother, but platelets must be monitored.

it is when levels get below 50 that it becomes significant, 20 is the figure the haematologists at the hospital where I work quote as the level at which action is required (otr if there is bleeding 50) . my obs and gyne textbooks quote the same figures

also a platelet count of less than 80 is a contraindication to an epidural



for preeclampsia there needs to be

. blood pressure > 160/110mmhg on two readings and protineuria of 2+ or more

. or blood pressure of 140/90 and protineuria of 2+ or one and at least one of
. . . .
. . .
. . . platelets < 100, ALT > 50

low platelets on their own don't indicate preeclampsia.

and for preeclampsia the woman tends to see flashing lights, have liver pain and headaches
Edited by studentDr - 12/10/12 at 10:02am

[Bokonon]

Originally Posted by studentDr 

thanks for bringing that up
platelets from 50 to 100 is only moderate thrombocytopenia and poses little risk to the mother, but platelets must be monitored.
it is when levels get below 50 that it becomes significant, 20 is the figure the haematologists at the hospital where I work quote as the level at which action is required (otr if there is bleeding 50) . my obs and gyne textbooks quote the same figures
also a platelet count of less than 80 is a contraindication to an epidural
for preeclampsia there needs to be
. blood pressure > 160/110mmhg on two readings and protineuria of 2+ or more
. or blood pressure of 140/90 and protineuria of 2+ or one and at least one of
. . . .
. . .
. . . platelets < 100, ALT > 50
low platelets on their own don't indicate preeclampsia.
and for preeclampsia the woman tends to see flashing lights, have liver pain and headaches

Right, pre-e is not HELLP, but HELLP can accompany pre-e.  And that is not correct about preeclampsia and what women "tend" to experience - all cases are different and many are asymptomatic except for elevated blood pressure and proteinuria.  Additionally, the +2 is not diagnostic, as the 24-hour urine sample is preferred over the spot test, since the spot test can vary greatly depending on hydration.

I've had severe preeclampsia twice and never had liver pain.  I only had headaches with my second, and no flashing lights, but I had floaters.  With my first, I had no physical symptoms except swelling, but I was very, very sick.

HELLP is extremely serious.  Thombocytopenia on its own is not as much of a concern, but all symptoms and labs need to be taken account.

[studentDr]

does she have any other abnormal labs ? symptoms ? high blood pressure ? or symptoms ?

I thought all she had was a platelet level of 130 and nothing else

[Bokonon]

Originally Posted by studentDr 

does she have any other abnormal labs ? symptoms ? high blood pressure ? or symptoms ?
I thought all she had was a platelet level of 130 and nothing else

My point is that presenting yourself as a medical professional and telling someone not to worry about a potentially serious pregnancy complication without any additional information based on a few lines from a textbook is irresponsible.

[cynthiamoon]

DEBATE ASIDE; my latest blood platelet count is 142, so I am feeling a lot better about the whole thing. My doc said we'd do a few more tests before the big day, but they think I'll be fine at the birth center.

I asked the BC about bleeding control, and they mentioned they have 3 medications to control post-partum's bleeding, apparently the same as the hospital, and worst case scenario it's a 5 min transfer because they are literally a block down street.

GISDiva: vitamin k, huh? What area of the problem is that supposed to treat? Blood creation or preventing destruction?

[WildKingdom]

Vitamin K will do nothing to help with platelet counts or bleeding from thrombocytopenia. It is a completely different part of the clotting cascade. There is no reason in the world to suggest it or take it, so I'm not sure why your midwife suggested it.

[cyclamen]

Originally Posted by cynthiamoon 

So my doc says depending on how low my blood count gets during pregnancy (and that most women's do drop at least some) that I may no longer be in the "low-risk" category for the natural birth at a birth center I always thought I wanted. Apparently the risk is excessive bleeding when the placenta separates from the uterine wall, as well as some other things. I got blood drawn and am waiting for results. 

Your appointment is soon right? I hope you get good news. 

Hi cynthia - I'm sorry to hear that about the birth center.  I hope your platelet count stays high so you don't get risked out! .... [edit] oh hah, I just scrolled down the thread and saw your platelet count.  Hooray!  I'm glad things are looking good for you.  :)

I'm going to be in the hospital anyhow, but I, too, am worried about being risked out of midwifery care.  I will definitely post back to this thread if I hear anything else from my midwife, who I'm seeing later this week.  I am actually less bruisy now than I normally am, so I'm hoping for good news too. 

Originally Posted by Bokonon 

This is not true.

Less than 100k is a symptom of HELLP Syndrome.

http://en.wikipedia.org/wiki/HELLP

OP, I'm glad you and your midwife are keeping an eye on it.  Getting baseline labs is a great idea.

This is the other thing that I read that made me nervous.  HELLP scares the shit out of me.  I am glad that this is something that my midwives are taking seriously, too.  I'm only 20 weeks - was 12 at the first blood draw and 16 at the second.  They haven't said anything else to me about my blood pressure, etc, and I haven't had any swelling, etc, so that's good.  My appointment is later this week, so hopefully they will be able to give me more information.

[GISDiva]

Originally Posted by WildKingdom 

Vitamin K will do nothing to help with platelet counts or bleeding from thrombocytopenia. It is a completely different part of the clotting cascade. There is no reason in the world to suggest it or take it, so I'm not sure why your midwife suggested it.

It was a very informal conversation as we were watching my friend labor, not a formal consultation.  It was something we were going to look into to see if it would help if I got pregnant again.  I think her thought was that if one part of the process wasn't working, maybe we could make the clotting of what platelets I do have work better.  We may very well decide that it wouldn't help after more research, and we go down a different path.

Cynthiamoon, glad to hear your numbers are looking better!

[WildKingdom]

Originally Posted by GISDiva 

It was a very informal conversation as we were watching my friend labor, not a formal consultation.  It was something we were going to look into to see if it would help if I got pregnant again.  I think her thought was that if one part of the process wasn't working, maybe we could make the clotting of what platelets I do have work better.  We may very well decide that it wouldn't help after more research, and we go down a different path.

Cynthiamoon, glad to hear your numbers are looking better!

Yes, but what I'm saying is you can take as much vitamin k as you can and it won't do squat. Vitamin K has nothing to do with platelet function or platelet aggregation. I certainly don't expect a midwife to have an in depth understanding of the clotting cascade, but for that exact reason she might want to consult with an OB or a hematologist.

[GISDiva]

Originally Posted by WildKingdom 


Yes, but what I'm saying is you can take as much vitamin k as you can and it won't do squat. Vitamin K has nothing to do with platelet function or platelet aggregation. I certainly don't expect a midwife to have an in depth understanding of the clotting cascade, but for that exact reason she might want to consult with an OB or a hematologist.

Thank you for the information!

[cynthiamoon]

Cyclamen, How have you been? 

I am sad to say things are looking down again for me. Now, at 18 weeks, it's dropped to 100 and I am dismayed and worried about what this means. 

It's scary to go from being a healthy, all's well woman to being considered "high risk." I've been instructed to take sesame seed oil because there is some anecdotal evidence that it can help, but I am not very optimistic. There doesn't seem to be any evidence for it.

[GISDiva]

I was wondering too, hope you are well!  Cynthiamoon, I'm sorry to hear that.  My levels fluctuated quite a bit throughout my last pregnancy, so I'm rooting for you...

My midwife took my blood at my first appointment, which was about 9 weeks along and I was pleasantly surprised to see that my count was up to 139.  (It was 117 when I wasn't pregnant.)  We'll see how it goes as I progress though.

I've been trying to find reputable sources of information about what I could do naturally to at least keep things stable, if not "normal".  I've read everything from Vitamin D to Vitamin E, to Vitamin C, to lots of dark green foods, to papaya leaf juice, to kiwi, beet root juice, Omega 3s - and yes, sesame oil, as you said above.  Oy.

I plan on growing lots of kale in my garden this summer and I have a pack of (very expensive) wheatgrass juice cubes in my freezer to throw into my smoothies.  I should probably be taking Omega 3s of some sort anyway, so I need to research that.

[cynthiamoon]

GIS Diva, so far, I haven't found a single clinical study, and not even any observational studies or stats. It's pretty lame. However, as a uni student, I do have access to a bunch of medical journals, so I might hit those over the weekend through online databases. 

[Amila]

I have ITP (idiopathic thrombocytopenia purpura) which means unspecified low platelets. This is an autoimmune thing and usually accompanies another autoimmune thing (I have hashimotos as well) my normal range is 140, and I thinks they got down to 105 in my last pregnancy but it wasn't concerning and I went on to have a normal home birth. Not sure if I will even get tested this time around because it stresses me out too much. I have also heard that its not a problem unless under 50.