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 http://asheducationbook.hematologylibrary.org/content/2010/1/397.full.pdf

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.

Questions:

• 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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