The team are considering the differential diagnosis of thrombocytopenia in pregnancy/post partum. As the patient is not bleeding heavily and platelets may worsen the condition the team have decided to hold on platelet transfusion for now.
Differential diagnosis so far
- Disseminated intravascular coagulation due to sepsis
- Heparin-induced thrombocytopenia
- Thrombotic thrombocytopenic purpura
- HELLP (haemolysis, elevated liver enzymes, low platelets)
- Acute fatty liver of pregnancy
- Pre-eclampsia
- Malignant hypertension
- Dilutional
- Immune/idiopathic/autoimmune thrombocytopenic purpura
- Gestational thrombocytopenia
The team have decided that that baby is not at risk as the platelet count was normal (350×10*9/L) on the day of delivery.
The patient says she feels tired and wonders whether she needs another blood transfusion. The obstetric team gave her a unit of blood prior to discharge because of Hb 75g/L and as she wouldn’t take her iron tablets.
Questions:
- Which of the differential diagnoses can we exclude with the results given in this and previous entries?
- Can you calculate the risk of HIT using the 4T score. is HIT common in this setting? (FYI – no recent heparin expose except for 7 days post partum and no reported rashes, thrombosis or reactions)
- Should she have had a blood transfusion and could this be relevant?
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