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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