Her physical exam is unremarkable with the exception of an 8-cm bruise over her right anterior tibia. She has a normal blood pressure (BP), normal reflexes, and no peripheral edema.
You obtain the following lab tests:
CBC, which demonstrates white blood cell (WBC) 9000/mm3, hemoglobin (Hb) 11.8 g/dL, and platelet count 95,000/mm3; negative urinalysis, normal liver enzymes.
What is your next step?
A) Recommend immediate delivery by cesarean section as the infant likely has thrombocytopenia as well and is at high risk for intracranial hemorrhage.
B) Recommend immediate delivery by cesarean section as this disorder will likely progress to
eclampsia.
C) Recommend close observation, and reassure the patient that this is typically a self-limited condition.
D) Start prednisone, 1 mg/kg daily, and taper slowly over the next 6 weeks.
E) Recommend splenectomy as soon as possible after delivery.
Answer And Discussion:
The correct answer is “C.” Recommend close observation, and reassure the patient that this is typically a self-limited condition
This patient likely has gestational thrombocytopenia, a condition that occurs in up to 5% of pregnant women. It is characterized by mild thrombocytopenia occurring in late gestation; the platelet count is usually>70,000/mm3 (two-thirds are between 130,000/mm3 and 150,000/mm3). The condition resolves after delivery and is not associated with severe neonatal thrombocytopenia. No specific
change in routine obstetrical care is warranted, although the anesthesiologist placing an epidural may want a follow-up platelet count closer to the time of delivery.
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