Case 45 – update 4

The iron deficiency anaemia has resolved. A ferritin was checked (although not technically necessary) and it was reassuringly well within the normal range indicating adequate iron stores.

Now the issue is she is thrombocytopenic in week 36:

  • Hb 118g/L
  • MCV 86fL
  • PLT 95×10*9/L
  • WCC 10.1×10*9/L (normal white cell differential, except for mild neutrophila)

It is necessary to think about serious causes of thrombocytopenia in pregnancy. Below is a table from

Thrombocytopenia in pregnancy1

Our patient is well with a normal blood pressure, no proteinuria, unremarkable blood film and normal renal and liver function. Her HIV and hepatis B/C testing at booking was negative. Apart from iron she is on no medications. She has had a normal platelet count in the past.

We are happy she does not have pre-eclampsia, HELLP or other serious disorders. The differential lies between ITP and gestational thrombocytopenia. We decide to check her platelet count on a weekly basis until term.


  • How can you tell the difference between ITP and gestational thrombocytopenia?
  • How do you manage delivery – both for baby and mother with a platelet count at this level?

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