Division of Hematology/Oncology, Department of Medicine, Mass General Cancer Center, Massachusetts General Hospital, Boston, Massachusetts.
Semin Thromb Hemost. 2020 Apr;46(3):256-263. doi: 10.1055/s-0040-1708842. Epub 2020 Apr 7.
The impact of thrombocytopenia varies widely depending on the underlying pathophysiology driving it. The biggest challenge in managing thrombocytopenia in pregnancy is accurately identifying the responsible pathophysiology-a task made difficult given the tremendous overlap in clinical and laboratory abnormalities associated with different thrombocytopenia processes. The most common etiologies of thrombocytopenia in pregnancy range from physiology deemed benign to those that are life-threatening to the mother and fetus. Even in cases in which the responsible etiology is deemed benign, such as gestational thrombocytopenia, there are still implications for the management of labor and delivery, a time where hemostatic challenges may prove life-threatening. In most institutions, a minimum platelet count will be mandated for epidural anesthesia to be deemed a safe option. The causes of thrombocytopenia can also include diagnoses that are pregnancy-specific (such as preeclampsia or gestational thrombocytopenia), potentially triggered by pregnancy (such as thrombotic thrombocytopenic purpura), or unrelated to or predating the pregnancy (such as liver disease, infections, or immune thrombocytopenia purpura). It is imperative that the source of thrombocytopenia is identified accurately and expeditiously, as intervention can range from observation alone to urgent fetal delivery. In this review, the approach to diagnosis and the pathophysiological mechanisms of the most common etiologies of thrombocytopenia in pregnancy and associated management issues are presented.
血小板减少症的影响因导致其发生的潜在病理生理学而异。在妊娠期间管理血小板减少症的最大挑战是准确识别其发病机制——鉴于与不同血小板减少症过程相关的临床和实验室异常有很大的重叠，这项任务非常困难。妊娠期间血小板减少症最常见的病因范围从被认为良性的生理状况到对母亲和胎儿有生命威胁的情况。即使在被认为良性的病因的情况下，如妊娠性血小板减少症，仍然存在分娩管理的问题，因为在分娩期间止血方面的挑战可能会危及生命。在大多数机构中，为了认为硬膜外麻醉是安全的选择，将会规定最低血小板计数。血小板减少症的原因还可能包括妊娠特异性的诊断（如子痫前期或妊娠性血小板减少症），可能由妊娠触发（如血栓性血小板减少性紫癜），或者与妊娠无关或先于妊娠（如肝病、感染或免疫性血小板减少性紫癜）。至关重要的是要准确、迅速地确定血小板减少症的来源，因为干预措施可以从单纯观察到紧急分娩不等。在这篇综述中，介绍了妊娠期间最常见的血小板减少症病因的诊断方法和病理生理学机制，以及相关的管理问题。
