Case 21 – update 2

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?

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

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This entry was posted in Anaemia, Platelet disorders, Related to other specialities, Transfusion. Bookmark the permalink.

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