Is it normal to have low platelets during pregnancy?

While it is not normal, it is common to have a low platelet count during pregnancy. This happens due to an increase in the production of blood plasma, thereby reducing the number of platelets per volume of blood. This causes a condition called thrombocytopaenia.

Is thrombocytopaenia dangerous?

Yes, thrombocytopaenia can be dangerous during pregnancy, especially since it is hard to diagnose since it rarely shows symptoms. However, if you have symptoms like bleeding gums, excessively bruised skin or a lot of fatigue, consult your doctor immediately.

How To Manage Thrombocytopaenia in the Third Trimester

Thrombocytes or platelets are blood cells that help form clots to prevent bleeding. Thrombocytopaenia is a common condition during pregnancy. This occurs when the pregnant woman’s platelet count drops below 150,000/μL, (the normal range for platelets).

Importance of Platelet Health During Pregnancy

An abnormal platelet count can cause serious complications in pregnancy, which is why is it important to monitor your platelet health.

A low platelet count can cause excessive bleeding during pregnancy and may make it difficult to get an epidural during labour. Moreover, if you have immune thrombocytopaenia, your baby may have low platelets as well.
A high platelet count can lead to blood clots which could block the blood flow from reaching the baby.

Thrombocytopaenia is the second leading cause of blood disorders during pregnancy after anaemia. Thrombocytes are the smallest red blood cells in humans and are responsible for the clotting function. They are released by the bone marrow. The quantity of these cells in your blood is reported in a complete blood count (CBC). thrombocytopaenia can be classified as mild, moderate and severe.

Mild thrombocytopaenia: thrombocytopaenia is classified as mild if the platelet levels are between 101,000 and 140,000 per microlitre of blood.
Moderate thrombocytopaenia: thrombocytopaenia is classified as moderate when the platelet levels are between 51,000 and 100,000 per microlitre of blood.
Severe thrombocytopaenia: thrombocytopaenia is classified as severe when the platelet levels are between 51,000 and 21,000 microlitres of blood.

Causes of Low Platelet Count in Pregnancy

A normal platelet count ranges between 150,000 to 450,000/µL platelets per microlitre of blood. It is normal for the platelet count to fall during pregnancy. This is partly due to haemodilution, a process in which the body produces more blood plasma, thereby reducing the total number of platelets per volume of blood. If this number dips to anywhere between 100,000-150,000/µL, your doctor will want to monitor you closely to avoid the risk of any complications.

Thrombocytopaenia is caused by several reasons including:

Gestational thrombocytopaenia: This is the most common cause of thrombocytopaenia in pregnancy and accounts for about 70% of thrombocytopaenia cases in pregnancy. This is caused by an acceleration in platelet activation that occurs during placental circulation. This does not usually cause any complications, however, it may require treatment. The exact cause of gestational thrombocytopaenia is unknown, however, physiological changes during pregnancy may be the cause.

Immune thrombocytopaenia purpura: Immune thrombocytopaenia purpura (ITP) is a blood disorder in which the immune system destroys platelets that help the blood clot. Women with pre-existing ITP can develop pregnancy complications like preeclampsia.

Autoimmune diseases: An autoimmune disease like systemic lupus erythematosus (SLE) is common in young women and can lead to thrombocytopaenia. SLE can also flare up during pregnancy.
Nutritional deficiencies: Folic acid and vitamin B12 deficiencies can lead to a low platelet count during pregnancy, although this is rare.

Spleen enlargement: More platelets may be destroyed during pregnancy as the spleen gets enlarged due to an increase in blood volume. This may cause more platelets to be destroyed in the filtration process.

Preeclampsia or HELLP syndrome: HELLP stands for hemolysis, elevated liver enzymes and low platelets. Symptoms include abdominal pain, headache, fatigue, blurred vision, nausea and vomiting. Preeclampsia is a multi-system disorder that affects pregnant women and causes high blood pressure, protein in the urine, headaches, swelling and blurred vision. Preeclampsia usually goes away after childbirth.

Symptoms of Thrombocytopaenia

Most often, thrombocytopaenia is a silent condition that causes very few symptoms. However, there are some symptoms you should definitely watch out for.

Bleeding gums while brushing teeth
Skin bruising easily
Frequent nosebleeds
Vaginal bleeding
Blood in urine or stool
Red-purple spots (petechiae) caused by bleeding below the skin

Diagnosis and Monitoring

If your platelet count is abnormal, it is extremely important for you to get checked regularly. Your doctor will perform routine platelet tests frequently to monitor your platelet levels.

It is important to monitor platelet levels in the third trimester of pregnancy because abnormal platelet levels at the time of birth can cause serious complications for both the mother and the baby.

Having a low platelet count at the time of birth can cause excessive bleeding, during labour and delivery. It can also increase the risk of bleeding around the spinal cord if an epidural or a spinal anaesthetic is used. A low platelet count can also increase the risk of complications like preterm birth, placental separation and loss of pregnancy.

On the other hand, a high platelet count can cause blood clots that block blood flow to the baby.

When To Seek Medical Help

You should seek immediate medical help for thrombocytopaenia if you have symptoms such as:

Bleeding that does not stop or gets controlled by first aid techniques like applying pressure. This includes nosebleeds that continue for 30 minutes or more.
Lightheadedness or dizziness that makes you feel like you might faint
Blood in your urine or stool that is black and looks like tar or has streaks of blood
Bruising or blood spots on your skin

You should also seek medical help if you have a fever or any other signs of an infection. Thrombocytopaenia can be a life-threatening condition especially if you have serious bleeding or bleeding in your brain. Early treatment can help you avoid serious complications.

Treatment for Thrombocytopaenia

Depending on your situation and the severity of the condition, your doctor will suggest treatments. Some common treatments include:

Medications: Medications like corticosteroids, prednisone and dexamethasone can help increase platelet production
Blood transfusions: The doctor may replace lost blood with a transfusion of packed red blood cells and platelets if the platelet count is too low
Immunoglobin therapy: Immunoglobin therapy uses antibodies to fight infections. It also helps in cases of ITP (immune thrombocytopaenia)

What You Can Do To Manage Thrombocytopaenia

Diet and lifestyle changes: Include nutrient-rich food that has folate, vitamin B12, calcium and vitamin K. Foods like eggs, cereal, leafy greens, milk, tofu, almonds, salmon, spinach, broccoli and lettuce should be added to your diet. Additionally, you must ensure that you are getting enough sleep. Create a bedtime routine that reduces stressors for you so you can fall asleep more easily.
Hydration: Drinking more water can help with platelet health in different ways. Drinking water at night can reduce platelet activity in the morning, which is especially beneficial for people with thrombocytopaenia.

Considerations For Delivery

Thrombocytopaenia or low platelet count can affect delivery in many different ways

Risk of bleeding: Thrombocytopaenia can increase the risk of excessive bleeding during delivery, especially if the platelet count is very low
Mode of delivery: Generally when the woman has thrombocytopaenia, a vaginal delivery is preferred, however, the final decision stands with the doctor
Epidural: A low platelet count makes it difficult to administer epidural anaesthesia
Premature delivery: Thrombocytopaenia can lead to premature delivery
Postpartum haemorrhage: Thrombocytopaenia can lead to postpartum haemorrhage, which happens when a woman loses too much blood during delivery

Thrombocytopaenia is a common condition in pregnancy and can be more prevalent in the third trimester, as platelet levels continue to drop. If your doctor finds your platelet counts abnormal, it is important to be regular with your prenatal appointments and maintain open communication with your doctor, especially if you feel your symptoms worsen.

FAQs on How To Manage Thrombocytopaenia in the Third Trimester

Is it normal to have low platelets during pregnancy?
While it is not normal, it is common to have a low platelet count during pregnancy. This happens due to an increase in the production of blood plasma, thereby reducing the number of platelets per volume of blood. This causes a condition called thrombocytopaenia.
Is thrombocytopaenia dangerous?
Yes, thrombocytopaenia can be dangerous during pregnancy, especially since it is hard to diagnose since it rarely shows symptoms. However, if you have symptoms like bleeding gums, excessively bruised skin or a lot of fatigue, consult your doctor immediately.