high platelet count during pregnancy

Practice bulletin no. Lin RJ, Afshar-kharghan V, Schafer AI. Other disorders can happen, too: . Your healthcare team will monitor your platelet count and other, Separation of the placenta from your womb, Obesity, Nutrition, and Physical Activity, Thrombotic Thrombocytopenic Purpura (TTP). Of these women, 4568 (46.1%) had sufficient data for our analyses. Ananth CV, Oyelese Y, Yeo L, Pradhan A, Vintzileos AM. FOIA A novel approach to the assessment of variations in the human platelet count. According to a NEJM study, if the platelet count is less than 100,000 per cubic millimeter, then a cause other than pregnancy should be considered. Frederiksen MC, Glassenberg R, Stika CS. In women with platelet counts below 100,000 per cubic millimeter who do not have preeclampsia or a preexisting disorder associated with thrombocytopenia, a cause other than pregnancy or its complications should be considered. In this treatment, you receive donated blood or blood components. Most women experience symptom improvement within two days of giving birth. Among women who had one of the other three disorders, 1.4 to 6.0% had platelet counts below 80,000 per cubic millimeter (Table S4B in the Supplementary Appendix). Data on nonpregnant women 15 to 44 years of age from the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2012 were used for comparisons. The alternative causes for the thrombocytopenia that were identified in the other 7 women were immune thrombocytopenic purpura (2 women), pseudothrombocytopenia due to in vitro platelet clumping (2 women), error in measurement of platelet count (2 women), and hereditary thrombocytopenia (1 woman). ), and the MaternalFetal Medicine Section, Department of Obstetrics and Gynecology, College of Medicine (D.R.D., J.J.M., E.J.K. A total of 45 women (1.0%) had platelet counts below 100,000 per cubic millimeter during pregnancy, at the time of delivery, or both; 12 women had platelet counts below 80,000 per cubic millimeter during pregnancy, at the time of delivery, or both, but only 5 (0.1%) were identified by medical-record review as having no alternative cause for the thrombocytopenia. In some cases, if there are no symptoms, no treatment may be required. Thrombocytosis, or a high platelet count, is diagnosed when platelet levels are greater than 450,000 platelets per microliter of blood. National Library of Medicine Are you at risk for clots? HELLP syndrome is a rare pregnancy complication. 2020;70(698):e622-e628. National Center for Advancing Translational Sciences, Genetic and Rare Diseases Information Center. Managing HELLP syndrome may include taking medications to lower your blood pressure and prevent seizures. Thrombocytopenia is a relatively common occurrence in people with sepsis, occurring in around 5-20% . If you have severe symptoms such as heavy bleeding or seizures, call 911 or go to your nearest emergency department. When to Worry About High Platelet Count. The mean platelet counts of the 4568 women who had uncomplicated pregnancies are shown at each trimester (with the mean time of gestation when they were measured indicated on the x axis), at the time of delivery (designated by D on the x axis), and during the post-partum period (designated by PP on the x axis). Haram K, Svendsen E, Abildgaard U. To search for potential alternative causes of platelet counts less than 80,000 per cubic millimeter in women who had uncomplicated pregnancies, we reviewed the womans entire set of medical records from Oklahoma University Medical Center. Treatment for essential thrombocythemia may include certain medications that slow down the production of platelets. He was a physician in the US Air Force and now practices at MD Anderson Cancer Center, where he is an associate professor. Placental abruption, where the placenta separates prematurely from the uterine wall, is also a possible complication of thrombocytosis, according to the Mayo Clinic. This stratified analysis accounted for any differences in platelet counts on the basis of race or ethnic group or age between the nonpregnant women from NHANES and the pregnant women. A high platelet count, or thrombocytosis, is defined as having more than 450,000 platelets per microliter of blood. 2022;65(4):182-187. doi:10.3345/cep.2021.00864, Kucine N, Chastain KM, Mahler MB, Bussel JB. Before Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. But when that count drops abnormally low, there are several potential causes. A high platelet count is associated with certain kinds of cancer, including: The most common cancers to cause a high platelet count include gastrointestinal cancer, lymphoma, ovarian cancer, lung cancer, and breast cancer. All the analyses were performed with the use of SAS software, version 9.4 (SAS Institute). Pregnancy Loss Pregnancy loss occurs frequently in women with essential thrombocytosis, a case history by lead author Gokhan Anil, MD reports in The Female Patient. Among the women who had one of the other five pregnancy-related complications, 0 to 3.6% had platelet counts of less than 80,000 per cubic millimeter (Table S4A in the Supplementary Appendix). A very high platelet count can cause blood clots that can block blood flow to your baby. When I was pregnant, I also did some readings on pregnancy complications. The small difference between the percentage of women with complicated pregnancies who had a platelet count of less than 150,000 per cubic millimeter and the percentage of women with uncomplicated pregnancies who had a platelet count of less than 150,000 per cubic millimeter may be related to our criteria for pregnancy-related complications. Throughout pregnancy and at the time of delivery, platelet counts of less than 100,000 per cubic millimeter occurred in only 45 of the women (1.0%) who had uncomplicated pregnancies. But it also can develop in the first week after childbirth (postpartum preeclampsia). The difference in the mean platelet count between the women who had no missing platelet counts and the 4232 women who had missing platelet counts during one or more trimesters was not significant (P = 0.79). National Health and Nutrition Examination Survey: sample design, 20072010. These analyses are presented in Table S2 in the Supplementary Appendix. Associated high platelet levels tend to last about three months before they return to normal. Preexisting disorders that were considered to be associated with thrombocytopenia were recorded as immune thrombocytopenic purpura, systemic lupus erythematosus, human immunodeficiency virus infection, and hepatitis B or C. Women who did not have these pregnancy-related complications or preexisting disorders were considered to have had uncomplicated pregnancies even though they could have had other diagnoses that could be considered as complicating a pregnancy, such as a history of treated cancer. and transmitted securely. It is a type of preeclampsia that causes elevated liver enzymes and low platelet count. Be sure to get regular prenatal care. If you have HELLP syndrome, you may need to deliver your baby early. HELLP syndrome was named by Dr. Louis Weinstein in 1982 after its characteristics: It is likely that blood tests or imaging will be done. The National Health and Nutrition Examination Survey: sample design, 19992006. Fetal intrauterine growth retardation (IUGR) complicates approximately four percent of pregnancies in women with essential thrombocytosis, Anil states. Watson J, Jones HE, Banks J, Whiting P, Salisbury C, Hamilton W. Use of multiple inflammatory marker tests in primary care: using clinical practice research datalink to evaluate accuracy. National Heart, Blood, and Lung Institute. J Clin Med Res. Your healthcare provider may recommend that you take a low dose aspirin after the first trimester if you are at high-risk for HELLP syndrome. An official website of the United States government. Br J Gen Pract. The combined mean platelet counts from all studies supported the concept . J Med Case Rep. 2009;3:91. doi:10.1186/1752-1947-3-91. In general, the longer the pregnancy continues, the better the outcome for the newborn. P ublications Committee, Society for Maternal-Fetal Medicine. Segal JB, Moliterno AR. Figs. The HELLP syndrome: clinical issues and management: a review. The mean platelet count in the nonpregnant women was 273,000 per cubic millimeter. Share sensitive information only on official, secure websites. The mean platelet counts of the 2586 women who had pregnancy-related complications were higher than those of the 4568 women who had uncomplicated pregnancies during the first and second trimester (P<0.001) but were not significantly different during the third trimester (P = 0.38) or at the time of delivery (P = 0.09). In secondary thrombocytosis, treating the underlying condition, like an infection, may be all that is needed to decrease high platelet levels. In our primary analyses, we included women who had a singleton pregnancy, whose duration of gestation at the time of delivery was recorded, and who had a platelet count measurement at the time of delivery and at least one additional platelet count measurement during their pregnancy. 2019;53(5):523-536. doi:10.1177/1060028018819450, Mounce LT, Hamilton W, Bailey SE. 102: management of stillbirth. Sejeny SA, RD Eastham, SR Baker. Because the placental circulation is similar to splenic circulation,19 platelets may also accumulate within the intervillous space of the placenta. For the analysis of the NHANES data, we used the sampling weights provided by NHANES to account for the complex survey design, which included oversampling of some populations, and to account for cases in which participants either did not respond to the survey or did not complete all aspects of the survey.12,13 To compare the platelet counts of the pregnant women with those of the nonpregnant women from NHANES, we calculated weighted mean platelet counts for all the nonpregnant women overall and also separately for each subgroup of nonpregnant women defined according to race or ethnic group and age. If you need treatment, your treatment plan will depend on the type of platelet disorder you have and what is causing your condition. The differences in the mean platelet count in the subgroups of women with uncomplicated pregnancies, which were defined according to race or ethnic group and age,14 were preserved throughout pregnancy, which also suggests that the platelet counts of all the women decreased at the same rate. To determine the risk in women of having a platelet count of less than 150,000 per cubic millimeter in a subsequent pregnancy if they had had a platelet count of less than 150,000 per cubic millimeter in a previous pregnancy, we calculated a risk ratio and 95% confidence interval. Read More Created for people with ongoing healthcare needs but benefits everyone. Platelets and pregnancy. Curtin LR, Mohadjer LK, Dohrmann SM, et al. Read our, When a High Platelet Count May Be Concerning. Based on the research I did, they could choose to put you on steroids to increase platelet production or give you a platelet infusion. A total of 59 women with pregnancy-related complications (2.3%) had platelet counts of less than 100,000 per cubic millimeter during pregnancy or at the time of delivery. However, certain serious conditions, such as, If you already have a platelet disorder, pregnancy may make your condition worse. This is called gestational thrombocytopenia. Short and long-term stress is associated with platelet aggregation, which is when they group together near an injury site. At the time of delivery, 11.9% of the women with pregnancy-related complications had platelet counts of less than 150,000 per cubic millimeter, a percentage that was significantly greater than that in the women with uncomplicated pregnancies. Your healthcare provider will order blood tests are ordered to check your blood count, liver function and kidney function. March of Dimes. raised or high platelet count in pregnancy Last reviewed 01/2018 reactive thrombocytosis (RT) may be responsible for more than 85% of cases with thrombocythaemia causes of reactive thrombocythaemia (including inflammation, infection, haemorrhage and iron deficiency) must be excluded before a diagnosis of essential thrombocythaemia (ET) is made The two types of thrombocytosis are primary thrombocytosis and secondary thrombocytosis: A high platelet count may be found during routine blood work and more tests may be done to diagnose any associated conditions. As the spleen increases in size due to increased blood volume during pregnancy, it may destroy more platelets in the filtering process. This is thought to do with the release of epinephrine, or adrenaline. Medications given in pregnancy to prevent pregnancy loss include low-dose aspirin and medications that decrease platelet production. To learn what is known about platelet counts throughout normal pregnancies, we systematically reviewed all publications describing platelet counts during pregnancy. National Heart, Lung, and Blood Institute. Among the 4568 women with uncomplicated pregnancies whom we evaluated, 529 had a subsequent uncomplicated singleton pregnancy during our period of analysis and had a recorded platelet count at the time of delivery. If your platelet disorder is caused only by pregnancy, your platelet count will return to the normal range after your baby is born. Seven longitudinal studies reported a decrease in platelet counts during pregnancy, while four reported no change. These findings were similar to the differences in race or ethnic group and age reported among non-pregnant women in the United States14 (Table 1, and Figs. We analyzed the platelet counts in women 15 to 44 years of age who delivered at Oklahoma University Medical Center between January 1, 2011, and August 19, 2014. Increased platelet volume is indicative of younger platelets, suggesting some increase in platelet turnover in pregnancy. Platelet counts of less than 150,000 per cubic millimeter at the time of delivery were more common among women who had pregnancy-related complications than among women who had uncomplicated pregnancies (11.9% vs. 9.9%, P = 0.01). What level is a high platelet count during pregnancy? However, they can also occur with secondary thrombocytosis. Maymon R, Strauss S, Vaknin Z, Weinraub Z, Herman A, Gayer G. Normal sonographic values of maternal spleen size throughout pregnancy. HELLP syndrome is very rare that occurs in 0.1% to 1% of pregnancies. Of these women, 4568 had uncomplicated pregnancies, 2586 had pregnancy-related complications, and 197 had preexisting disorders associated with thrombocytopenia. This finding is consistent with the finding in our study that the risk of recurrent gestational thrombocytopenia was 14.2 times as high among women who had had previous gestational thrombocytopenia as among women who had not had previous gestational thrombocytopenia. In severe cases, your healthcare provider may use an ultrasound or CT scan to check for an enlarged liver or bleeding in your liver. This results in increased blood volume and causes hemodilution. The interaction between the mean platelet counts in the women with preexisting disorders and the mean platelet counts in the women with uncomplicated pregnancies was not significant (P=0.07), which indicated that the rates of decrease in platelet counts did not differ significantly (Fig. Clin Exp Pediatr. The mean platelet count at the time of delivery was higher in non-Hispanic black women than in non-Hispanic white women and Hispanic women (P<0.001) and was higher in younger women (15 to 19 years of age) than in older women (20 to 44 years of age) (P<0.001). NHANES denotes National Health and Nutrition Examination Survey. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. Pregnancy-related complications, such as pre-eclampsia, may also cause thrombocytopenia.4,810 Therefore, it may be hypothesized that platelet counts in women who have pregnancy-related complications are lower than platelet counts in women who have uncomplicated pregnancies. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://rarediseases.info.nih.gov/diseases/8528/hellp-syndrome), (https://www.preeclampsia.org/hellp-syndrome). The mean platelet counts of the 197 women who had preexisting disorders associated with thrombocytopenia were lower than those of the women who had uncomplicated pregnancies at all trimesters and at the time of delivery (P<0.03 for all comparisons). Delivering the fetus early may also be recommended. Sainio S, Kekomki R, Riikonen S, Teramo K. Maternal thrombocytopenia at term: a population-based study. Aster RH. While some stress is unavoidable during pregnancy, avoiding high-stress situations or learning to manage your stress is a good idea. When we evaluated all 10,296 platelet count values measured during pregnancy and at the time of delivery in women with pregnancy-related complications (Fig. 155 - 409. 146 - 429. Please refer to our Privacy Policy to change your cookie settings. It is common and usually does not cause problems for the mother or baby. Thrombocytopenia in pregnancy. Both conditions usually occur during the later stages of pregnancy, or soon after childbirth. The name HELLP syndrome stands for: . A review and assessment of drug-induced thrombocytosis. Significance of plasma skimming and plasma volume expansion. 165 - 415. Therefore, the risk of a platelet count below 150,000 per cubic millimeter was 14.2 (95% CI, 8.9 to 22.6) times as high among women who had had a count below 150,000 per cubic millimeter in a previous pregnancy as among women who had not. High platelet levels caused by primary thrombocytosis, also known as thrombocythemia, can be dangerous in pregnancy and can result in serious maternal and fetal complications. But uncontrolled . Platelet counts during normal pregnancy. Your provider will keep an eye on your blood pressure and other vital signs to catch problems like HELLP early. Possible causes of preterm delivery include preeclampsia, a complication of pregnancy characterized by maternal high blood pressure, protein in the urine and fluid retention, which affects four percent of women with thrombocytosis. They may have low oxygen and blood sugar levels at birth and may have trouble maintaining their temperatures. 6 A very high platelet count can cause blood clots that can block blood flow to the embryo or fetus, while low platelet counts can cause bleeding. Most women who have essential thrombocythemia have normal, healthy pregnancies. When we evaluated all 13,793 platelet count values measured during pregnancy and at the time of delivery in women with uncomplicated pregnancies (Fig. 2019;69(684):e462-e469. The data from the women who had uncomplicated pregnancies were compared with the data from 8885 nonpregnant women from the NHANES database. Preeclampsia leads to high blood pressure (hypertension) and proteinuria (high levels of protein in the urine). J Clin Med Res. Whether patients are referred to us or already have a Cleveland Clinic ob/gyn, we work closely with them to offer treatment recommendations and follow-up care to help you receive the best outcome. Treating a high platelet count starts with finding the underlying cause. 1, and Table S4B in the Supplementary Appendix). Severe thrombocytopenia with iron deficiency anemia. Dhaliwal G, Cornett PA, Tierney LM. official website and that any information you provide is encrypted Most of the time, your babys platelet count will be within the normal range a few days after birth. A high platelet count may be less worrisome if it is associated with: While these conditions and circumstances tend to result in a high platelet count returning to normal, if these aren't treated, monitored, or managed appropriately, they can lead to more concerning risks. Biomed Res Int. Our objective with respect to women who had preexisting disorders associated with thrombocytopenia was to learn whether their thrombocytopenia becomes more severe during pregnancy. sharing sensitive information, make sure youre on a federal 2010;27(5):413-9. doi:10.3109/08880011003739455, Oida T, Kano H, Mimatsu K, et al. Etiology of thrombocytosis in a general medicine population: analysis of 801 cases with emphasis on infectious causes. Up to 1 in 5 women who have preeclampsia or eclampsia develop HELLP syndrome. Among all 15,385 women who had singleton pregnancies, 338 women had preexisting disorders that were associated with thrombocytopenia. HELLP syndrome is rarely life-threatening. Advertising on our site helps support our mission. P ractice bulletin no. Etiology of thrombocytosis in a general medicine population: analysis of 801 cases with emphasis on infectious causes. Pooling of platelets in the spleen: role in the pathogenesis of hypersplenic thrombocytopenia. When determining whether or not a high platelet count is something to worry about, healthcare providers may look for symptoms like bruising, bleeding, as well as signs of infection or another underlying condition. Here's what you need to know. Previous labor and delivery, with risk increasing for women who have given birth more than once before. Long-term stress is associated with a high platelet count. Belly pain, especially in the upper right side. In healthy, nonpregnant adult women, one third of all circulating platelets are transiently pooled within the low flow-rate circulation of the splenic sinusoids; an increased spleen size results in more pooling of the platelets and a lower platelet count.17 Therefore, the 50% increase in spleen size that occurs during pregnancy18 would also contribute to a lower platelet count. Stillbirth may occur in 5 percent of cases. Less common causes include systemic lupus erythematosus . High platelet levels during pregnancy are dangerous for both the mother and the child and could cause complications. A registered nurse with more than 25 years of experience in oncology, labor/delivery, neonatal intensive care, infertility and ophthalmology, Sharon Perkins has also coauthored and edited numerous health books for the Wiley "Dummies" series. In older children, high platelet counts are usually a result of infection and also resolve once the infection passes. Supported in part by a grant (1K01HL135466-01) from the National Heart, Lung, and Blood Institute. Throughout their pregnancies and deliveries, 59 women (2.3%) with pregnancy-related complications had a platelet count below 100,000 per cubic millimeter, and 31 (1.2%) had a platelet count below 80,000 per cubic millimeter. A high test result means that your platelets are larger than what's considered normal. If still worried, I suggest you repeat the blood test for platelets again in 2 weeks. Your healthcare team will make sure that your diagnostic tests are safe for you and your baby. (Funded by the National Heart, Lung, and Blood Institute.). 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Our objectives with respect to women who had uncomplicated pregnancies were to learn the course of platelet counts throughout pregnancy, the potential severity of gestational thrombocytopenia, and the risk for recurrence of gestational thrombocytopenia with a subsequent pregnancy. Also, your baby may have a low platelet count at birth. Your healthcare team will diagnose a platelet disorder based on your medical history, family history, a physical exam, and test results. Many times, it is linked to a temporary condition or circumstance, such as an infection or recent surgery. Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Multiple physiological changes during pregnancy may contribute to lower platelet counts. Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants. Boehlen F, Hohlfeld P, Extermann P, Perneger TV, de Moerloose P. Platelet count at term pregnancy: a reappraisal of the threshold. S2A in the Supplementary Appendix), we found that platelet counts of less than 150,000 per cubic millimeter occurred in 450 women (9.9%) at the time of delivery (Table 2). 2B). Age, with risk increasing for women over 25. 2020;15(8):e0237016. What Is the Outlook for Those With High Platelet Counts? HELLP stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count. Immunisation Advisory Centre. Of these women, 4568 had an uncomplicated pregnancy, 2586 had a pregnancy-related complication, and 197 had a pre-existing disorder associated with thrombocytopenia (Fig. Less commonly, when the high platelet count has no apparent underlying condition as a cause, the disorder is called primary thrombocythemia or essential thrombocythemia. Annals of Pharmacotherapy. Among all 15,385 women who had singleton pregnancies, 4760 women had pregnancy-related complications. The .gov means its official. the contents by NLM or the National Institutes of Health. Your healthcare team will make sure that your treatment plan is safe for you and your baby. However, high platelet levels can be associated with more serious conditions, such as cancer. Preterm delivery, or delivery before 37 weeks of pregnancy, occurs in eight percent of cases of thrombocytosis in pregnancy, according to Anil.
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