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