Universidade de Coimbra, Coimbra, Portugal.
Rev Bras Ginecol Obstet. 2020 Dec;42(12):834-840. doi: 10.1055/s-0040-1721350. Epub 2020 Dec 21.
Thrombocytopenia, defined as platelet count < 150,000 mm, is frequently diagnosed by obstetricians since this parameter is included in routine surveillance during pregnancy, with an incidence of between 7 and 12%. Therefore, decisions regarding subsequent examination and management are primordial. While most of the cases are due to physiological changes, as gestational thrombocytopenia, other causes can be related to severe conditions that can lead to fetal or maternal death. Differentiating these conditions might be challenging: they can be pregnancy-specific (pre-eclampsia/HELLP syndrome [hemolysis, elevated liver enzymes, low platelets]), or not (immune thrombocytopenia purpura, thrombotic thrombocytopenic purpura or hemolytic uremic syndrome). Understanding the mechanisms and recognition of symptoms and signs is essential to decide an adequate line of investigation. The severity of thrombocytopenia, its etiology and gestational age dictates different treatment regimens.
血小板减少症定义为血小板计数<150,000/mm,由于该参数包含在妊娠期间的常规监测中,因此经常由产科医生诊断,发生率在 7%至 12%之间。因此,后续检查和管理的决策至关重要。虽然大多数病例是由于生理变化引起的,如妊娠性血小板减少症,但其他原因可能与严重情况有关,这些情况可能导致胎儿或母亲死亡。区分这些情况可能具有挑战性:它们可能是妊娠特异性的(子痫前期/HELLP 综合征[溶血、肝酶升高、血小板减少]),也可能不是(免疫性血小板减少性紫癜、血栓性血小板减少性紫癜或溶血尿毒综合征)。了解这些情况的机制以及症状和体征的识别对于决定适当的检查方法至关重要。血小板减少症的严重程度、病因和胎龄决定了不同的治疗方案。