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I am pregnant and have a low platelet count, what should be done?

Q: I am pregnant and through a blood test the doctor found out that I have low platelets in the blood. I am totally disturbed and do not know what to do. The fetus is 3 months 10 days old. Can I take this medicine noniflujuice? I used to bleed normally for the first 3 days and then the remaining days for about two days. Is there any solution to this problem of mine?

A:Platelets (thrombocytes) are a type of blood cells, which are derived in the bone marrow from large cells called megakaryocytes. They are critical for the clotting of blood and have life-span of about 10 days. The normal platelet count ranges from 150,000 - 400,000/mcl and a reduction in platelets is referred to as thrombocytopenia. This may be mild (100,000 - 150,000/mcl), moderate (50,000 - 100,000/mlƒw) or severe (less than 50,000/mcl). Platelets may be low due to: a) increased destruction (immunologic infections, drugs; gestational thrombocytopenia) or utilization (disseminated intra-vascular coagulation; abnormal vasculature as seen in haemolytic uremic syndrome & thrombotic thrombocytopenic purpura), b) decreased production (leukaemia, aplastic anaemia, megaloblastic anaemia, drugs, infections or c) sequestration in the spleen (cirrhosis of liver). Thrombocytopenia is seen in about 7-8% of all pregnancies. Idiopathic thrombocytopenic purpura (ITP) is the presence of isolated thrombocytopenia with a normal bone marrow and the absence of other causes to account for it. ITP is caused by increased peripheral platelet destruction, with most patients having antibodies to specific platelet membrane glycoproteins. This is a cause in about 3% of all thrombocytopenic pregnant women. Its importance lies in the fact that the baby may develop low platelet counts (~12%) due to maternal antibodies crossing the placenta. The more common cause for low platelet counts during pregnancy is pregnancy-induced or gestational thrombocytopenia, which accounts for nearly 70% of all cases. Both ITP and gestational thrombocytopenia are incidental findings discovered when a routine blood test is performed and there are no tests that can distinguish the 2 conditions. Gestational thrombocytopenia may recur in subsequent pregnancies but platelet counts usually return to normal within 2 weeks of delivery. There is virtually no risk of fetal or neonatal thrombocytopenia and the baby does not have any risk of bleeding Spontaneous bleeding does not occur unless platelet counts fall lower than 10,000/mcl while surgery can be done if the platelets are more than 50,000/mcl. No treatment is required if platelets remain above 50,000/mcl and the patient is asymptomatic. Treatment may be instituted if counts fall or there is abnormal bleeding, or any invasive procedure (cesarean delivery or regional anaesthesia) is planned. You can discuss all this with your doctor who would be best placed to advise you.


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