Thrombocytopenia is a platelet count below 150,000 platelets per microliter (ppm) of blood. A normal platelet count is between 150,000 ppm and 400,000 ppm. A low platelet count is not symptomatic for most people until it falls below 50,000 ppm and some people are asymptomatic (experience no apparent problems) with platelet counts below 10,000 ppm.

There are many causes of thrombocytopenia, some unique to pregnancy such as pregnancy-induced hypertension (preeclampsia). Immune thrombocytopenic purpura (ITP), an autoimmune disease, is another cause of thrombocytopenia.

Thrombocytopenia has been observed in 7% to 10% of all pregnancies. In uncomplicated pregnancies, the platelet count will often drop about 10%. For most women this drop in platelets does not result in thrombocytopenia. But if a woman is at the low end of the normal range, say 160,000 ppm, and her platelets drop 10% to 144,000 ppm; she would become thrombocytopenic.

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In most cases of DHF/DSS IV fluids / plasma expanders are adequate. However blood transfusion is indicated when haematocrit falls due to severe bleeding ( refractory shock) and not due to fluid therapy. Fresh whole blood is preferable and volume administered should be just adequate to raise the RBC concentration to normal. Fresh frozen plasma and / or concentrated platelets may be indicated in a few cases when disseminated intravascular coagulation (DIC) causes massive bleeding.

Yes, there is no medical reason that gestational thrombocytopenia or ITP should prevent a vaginal, natural delivery. A number of reports describe natural deliveries where the mother’s platelet count is below 20,000 ppm with no difficulties or problems for mother or child. These reports are reassuring, but as a precaution most physicians strive for a platelet count above 50,000 ppm at delivery in case a C-section is needed for obstetrical reasons.

Lovenox is associated with a lower risk of immune sensitization and thrombocytopenia than heparin. However, it is possible for Lovenox to produce a positive in-vitro test for heparin induced thrombocytopenia (HIT) in patients with a history of HIT. Thrombocytopenia may occur in these patients. Warkentin et. al. conducted a large randomized clinical trial comparing the occurrence rate of thrombocytopenia between unfractionated heparin and Lovenox. His group found that HIT occurred in 2.

Since the heparin in the CBAS coating is covalently bound, leaching of heparin is insignificant. Vast numbers of patients have been exposed to or implanted with CBAS-coated devices with no reports of confirmed complications related to HIT. In a study of cardiac support, comparing the use of CBAS-coated and uncoated EXCOR? VADs in a patient population at elevated risk of HIT, no increase in HIT-related incidents could be detected in the coated device group1.