Management of pregnancies with human immunodeficiency virus, haemolytic anaemia, elevated liver enzymes, low platelets (HELLP) syndrome, and low platelets presents complexities in investigations and treatments, because these conditions and their treatment affect the mother and baby. Low platelets in severe pre-eclampsia, eclampsia and HELLP syndrome are relatively common, and should be detected early once the diagnosis of pre-eclampsia, HELLP syndrome, or both, are made. The mainstay of treatment is lowering of high blood pressure with rapid-acting antihypertensive agents, prevention of convulsions or further seizures with MgSO 4 , use of steroids for fetal lung maturity if necessary, followed by delivery of the baby. The use of high-dose steroids for the rapid recovery of maternal platelet counts is controversial, and should not be used routinely in women with HELLP syndrome. The use of platelet transfusion in women with severe pre-eclampsia, eclampsia and HELLP syndrome is a temporising measure, and should only be justified if the clinical circumstances warrant their use (e.g. before caesarean section when the woman has a low platelet count with evidence of bruising or bleeding from venepuncture sites). Low platelets may be an isolated finding in asymptomatic pregnant women and warrant the offer of a human immunodeficiency virus test, as it may be the first sign of this infection. Isolated low platelets may also indicate gestational thrombocytopaenia or idiothrombocytopaenic purpura. Gestational thrombocytopaenia is a benign condition and a diagnosis of exclusion. All clinicians should be aware that low platelets warrant further investigations because of the above-mentioned issues.
Introduction
Thrombocytopaenia or low platelet count is the most common haematologic disorder in pregnancy other than anaemia, and affects 6–10% of all pregnancies. Although some studies show a decrease in platelet counts of up to 10%, particularly in the third trimester in uncomplicated pregnancies, the absolute platelet count remains within the established normal laboratory-based ranges.
Thrombocytopaenia in pregnancy has many causes ( Table 1 ). These causes range from pregnancy-specific disorders, such as gestational thrombocytopaenia, pre-eclampsia and haemolytic anaemia, elevated liver enzymes, low platelets (HELLP) syndrome to non-pregnancy conditions such as idiopathic thrombocytopaenia (ITP). In countries with high rates of human immunodeficiency virus (HIV), thrombocytopaenia may also be the presenting feature of this viral pandemic in asymptomatic pregnant women. Clinicians are faced with the challenge of making a specific diagnosis of thrombocytopaenia in pregnancy because the time of onset of these conditions and their manifestations often overlap making diagnosis difficult ( Fig. 1 ).
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