We have now narrowed the differentials:

• Disseminated intravascular coagulation due to sepsis (unlikely as normal coag)
• Heparin-induced thrombocytopenia (possibility, but rare in obstetric patients)
• Thrombotic thrombocytopenic purpura (unlikely – no red cell fragments on film and more common earlier on in pregnancy)
• HELLP (haemolysis, elevated liver enzymes, low platelets) (unlikely as no elevation in LFTs)
• Acute fatty liver of pregnancy (unlikely as LFTs and coag normal)
• Pre-eclampsia (not as BP normal and no proteinuria)
• Malignant hypertension (BP normal)
• Dilutional (unlikely as tests repeated and confirmed on film)
• Immune/idiopathic/autoimmune thrombocytopenic purpura (possibility but ITP is diagnosis of exclusion and usually occurs antenatally)
• Gestational thrombocytopenia (occurs antenatally)

The HIT risk score is ‘low’ – based on the 4Ts probability score:

There is one other factor at play – she had a blood transfusion.

Questions:

• How does the blood transfusion relate to her current thrombocytopenia?
• Would you have transfused the patient?

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.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion