But it also can develop in the first week after childbirth (postpartum preeclampsia). Copyright 2023 Leaf Group Ltd., all rights reserved. These findings were similar to the differences in race or ethnic group and age reported among non-pregnant women in the United States14 (Table 1, and Figs. Platelet counts may be even lower in women with pregnancy-related complications. A total of 67 women had uncomplicated twin pregnancies and had at least one recorded platelet count during pregnancy; these women had lower platelet counts in all three trimesters and at the time of delivery than the women who had uncomplicated singleton pregnancies, but the difference at the time of delivery was not significant (P = 0.07) (Table 1, and Fig. Regularly exercising helps maintain platelet function when at rest. Thrombocythemia and thrombocytosis. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Short-term, strenuous exercise can cause an increase in platelet count. This severe form of preeclampsia affects . Other high blood pressure disorders during pregnancy. High platelet levels are either essential, or primary, meaning that an excess of platelets are being made in the bone marrow. Centers for Disease Control and Prevention. An official website of the United States government. 39 Thrombocytopenia defined as a platelet count less than 150 10 9 /L complicates approximately 8-10% of pregnancies. Is it safe to take glucolin or glucose during pregnancy? Platelet Counts: A normal platelet count in humans ranges from 150,000 to 450,000 platelets per microliter of blood tested. Frederiksen MC, Glassenberg R, Stika CS. We included women who had minor complications (e.g., hypertension or diabetes) who would not have been expected to have thrombocytopenia, because our primary aim in the designation of women with uncomplicated pregnancies was to avoid the inclusion of women who had any complications. Orphanet J Rare Dis. High platelets is a condition in which the blood contains more platelets than usual. Dhaliwal G, Cornett PA, Tierney LM. 2B). These analyses are presented in Table S2 in the Supplementary Appendix. Douglas A. Nelson, MD, is double board-certified in medical oncology and hematology. Your provider may give your baby corticosteroids to help their lungs develop. A high platelet count is associated with certain kinds of cancer, including: The most common cancers to cause a high platelet count include gastrointestinal cancer, lymphoma, ovarian cancer, lung cancer, and breast cancer. However, in some cases, it can be linked to more serious conditions. On rare occasions, primary thrombocytosis can turn into certain types of cancer. Your provider will keep an eye on your blood pressure and other vital signs to catch problems like HELLP early. For example, spleen removal surgery, or a splenectomy, is significantly associated with secondary thrombocytosis, impacting up to 90% of individuals who undergo this procedure. Live Chat with us, Monday through Friday, 8:30 a.m. to 5:00 p.m. EST. Your healthcare team will monitor your platelet count and other, Separation of the placenta from your womb, Obesity, Nutrition, and Physical Activity, Thrombotic Thrombocytopenic Purpura (TTP). A total of 59 women with pregnancy-related complications (2.3%) had platelet counts of less than 100,000 per cubic millimeter during pregnancy or at the time of delivery. Platelet counts differ by sex, ethnicity, and age in the United States. A registered nurse with more than 25 years of experience in oncology, labor/delivery, neonatal intensive care, infertility and ophthalmology, Sharon Perkins has also coauthored and edited numerous health books for the Wiley "Dummies" series. An official website of the United States government. Pregnancy-related complications, such as pre-eclampsia, may also cause thrombocytopenia.4,810 Therefore, it may be hypothesized that platelet counts in women who have pregnancy-related complications are lower than platelet counts in women who have uncomplicated pregnancies. HELLP stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count. 1). Besides taking your medical history, examining you physically and running tests, your doctor might ask about factors that could affect your platelets, such as a recent surgery, a blood transfusion or an infection. Here's what you need to know. This can help prevent serious bleeding during delivery. In women who have a platelet count of less than 100,000 per cubic millimeter, a cause other than pregnancy or its complications should be considered. Unless DIC is present, the. Platelets, or thrombocytes, are small blood cell fragments that assist in blood clotting and help stop bleeding. The mean platelet counts of the 336 women with uncomplicated pregnancies who had platelet counts at each trimester and at the time of delivery are also shown in Panel A. This stratified analysis accounted for any differences in platelet counts on the basis of race or ethnic group or age between the nonpregnant women from NHANES and the pregnant women. Platelet disorders during pregnancy. During pregnancy, sometimes platelet levels can become too low or too high. Up to 1 in 5 women who have HELLP syndrome experience it a second time. J Clin Med Res. Pregnancy Trimester Three: 8.2 to 10.4 m3 or 8.2 to 10.4 fl; Results of the Mean Platelet Volume test are a bit confusing as size and number must be taken into consideration. I'm sure they're just erring on the side of caution and want you to get checked out. By Julie Scott, MSN, ANP-BC, AOCNP Many women who have HELLP syndrome need to deliver their baby early. Dilution of platelets by the increased plasma volume that occurs during pregnancy16 is an apparent mechanism. Gestational Thrombocytopenia: What Should You Know About Low Blood Platelets? Women who reported having received a diagnosis of hypertension, diabetes, or cancer were excluded. It is a type of preeclampsia and has similar symptoms. Platelet counts may be even lower in women with pregnancy-related complications. Significance of plasma skimming and plasma volume expansion. Blood clots or bleeding may cause the following complications: Getting routine medical care during your pregnancy can help you avoid or manage these complications. Treatment for essential thrombocythemia may include certain medications that slow down the production of platelets. Short-term stress is associated with changes in platelet function. In some cases this is due to a problem that existed prior to pregnancy; in others, it comes on during pregnancy. HELLP syndrome is a rare pregnancy complication. But it also can develop in the first week after childbirth (postpartum preeclampsia). 2014 Apr;99(4):620-8. doi:10.3324/haematol.2013.092684, Zvizdic Z, Kovacevic A, Milisic E, Jonuzi A, Vranic S. Clinical course and short-term outcome of postsplenectomy reactive thrombocytosis in children without myeloproliferative disorders: A single institutional experience from a developing country. The data from the women who had uncomplicated pregnancies were compared with the data from 8885 nonpregnant women from the NHANES database. Panel B shows the mean platelet counts of the women who had uncomplicated pregnancies, the women who had pregnancy-related complications, and the women who had preexisting disorders that were associated with thrombocytopenia. Sepsis and preeclampsia can both cause high platelet volume with low platelet count. This. Pregnancy-related complications that were recorded as such were hypertension or diabetes before or during pregnancy, preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, preterm birth (defined as birth before 37 weeks of gestation), stillbirth, and placental abnormalities (e.g., placental abruption, placenta previa, or placenta accreta). The interaction between the mean platelet count in the women with uncomplicated pregnancies and the mean platelet count in the women with pregnancy-related complications was significant (P = 0.002), which indicated that the rates of decrease in platelet counts differed. Examples include: Research has found that urinary tract infections, respiratory infections, and gastrointenstinal infections are among the leading causes of a high platelet count. Speaking with your healthcare provider about potential health risks. National Heart, Blood, and Lung Institute. Incidentally detected thrombocytopenia in healthy mothers and their infants. Usually, thrombocytosis isn't serious. 155 - 409. on any woman experiencing symptoms during the third trimester of pregnancy. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://rarediseases.info.nih.gov/diseases/8528/hellp-syndrome), (https://www.preeclampsia.org/hellp-syndrome). However, they can also occur with secondary thrombocytosis. In most cases, this is not something to worry about as it tends to resolve on its own a few weeks after birth. Preeclampsia is one high blood pressure (hypertension) disorder that can occur during pregnancy. Burrows RF, Kelton JG. An abnormally high number of platelets in pregnancy is far less common than low platelet levels. At the time of delivery, 11.9% of the women with pregnancy-related complications had platelet counts of less than 150,000 per cubic millimeter, a percentage that was significantly greater than that in the women with uncomplicated pregnancies. COVID-19; It is a type of preeclampsia. Receive automatic alerts about NHLBI related news and highlights from across the Institute. Blood. Lin RJ, Afshar-kharghan V, Schafer AI. Demographic data, platelet counts, medical-record numbers, and diagnosis codes identified from electronic medical records were combined into a single database. Certain short-term conditions can lead to a high platelet count. Also, your baby may have a low platelet count at birth. Almog B, Shehata F, Aljabri S, Levin I, Shalom-Paz E, Shrim A. Placenta weight percentile curves for singleton and twins deliveries. Preeclampsia leads to high blood pressure (hypertension) and proteinuria (high levels of protein in the urine). Supported in part by a grant (1K01HL135466-01) from the National Heart, Lung, and Blood Institute. Platelet counts were measured with standard electronic equipment maintained in laboratories certified by the Clinical Laboratory Improvement Amendments program and were categorized according to the following time periods: first trimester of pregnancy, 0 to 13 weeks of gestation; second trimester, 14 to 27 weeks; third trimester, 28 to 42 weeks (excluding the time within 48 hours before delivery); delivery; and postpartum period (defined as 4 to 12 weeks after delivery). Thrombocytosis, or a high platelet count, is diagnosed when platelet levels are greater than 450,000 platelets per microliter of blood. Are you at risk for clots? Watson J, Jones HE, Banks J, Whiting P, Salisbury C, Hamilton W. Use of multiple inflammatory marker tests in primary care: using clinical practice research datalink to evaluate accuracy. Platelet counts in all women decrease throughout pregnancy, beginning in the first trimester. Platelets may be destroyed at a higher rate in pregnancy. If you have serious complications, you may have to deliver your baby early. 10.3389/fmed.2023.1111139 Frontiers in Medicine 02 frontiersin.org 1. ACOG practice bulletin no. Fetal intrauterine growth retardation (IUGR) complicates approximately four percent of pregnancies in women with essential thrombocytosis, Anil states. March of Dimes. Hypertension in pregnancy: report of the American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy. It also may occur within 48 hours of delivery, although symptoms may take up to 7 days to be evident. The alternative causes for the thrombocytopenia that were identified in the other 7 women were immune thrombocytopenic purpura (2 women), pseudothrombocytopenia due to in vitro platelet clumping (2 women), error in measurement of platelet count (2 women), and hereditary thrombocytopenia (1 woman). 40, 41 In uncomplicated pregnancy and delivery 1% of women had a platelet count of less than 100 10 9 /L . To learn what is known about platelet counts throughout normal pregnancies, we systematically reviewed all publications describing platelet counts during pregnancy. The mean platelet counts in the nonpregnant women and in the women with uncomplicated pregnancies in the first trimester and at the time of delivery were normally distributed, except for a slight skew toward higher values in all three cases (Fig. When to Worry About High Platelet Count. The mean platelet count in the 8885 nonpregnant women is designated by N on the x axis. The site is secure. As a result, your platelet count per microliter of blood goes down. J Neuroimmune Pharmacol 500512 (2021). This finding is consistent with the finding in our study that the risk of recurrent gestational thrombocytopenia was 14.2 times as high among women who had had previous gestational thrombocytopenia as among women who had not had previous gestational thrombocytopenia. S2C in the Supplementary Appendix), we found that platelet counts of less than 150,000 per cubic millimeter occurred in 39 women (19.8%) at the time of delivery (Table 2); 17 women (8.6%) had platelet counts of less than 80,000 per cubic millimeter (median, 48,000; range, 4000 to 77,000). Segal JB, Moliterno AR. Both conditions usually occur during the later stages of pregnancy, or soon after childbirth. Complications that can be a result of either too high or too low platelet levels include: In most cases, platelet levels can be managed by getting routine medical care during pregnancy. Platelet Counts during Pregnancy and at the Time of Delivery.*. Most commonly, they form in the blood vessels in the arms and legs, or in the brain. Among the 246 women with uncomplicated pregnancies who were assessed during the postpartum period, the mean platelet count was 17% lower at the time of delivery than during the postpartum period (218,000 vs. 264,000 per cubic millimeter). Curtin LR, Mohadjer LK, Dohrmann SM, et al. A novel approach to the assessment of variations in the human platelet count. HELLP syndrome can lead to severe health complications if left untreated. If you have a high platelet count, taking some birth control pills can raise your risk of blood clots. If you have a very low platelet count, you may need treatment to raise it before you deliver your baby. 2014;124(2):184-7. doi:10.1182/blood-2014-03-562538. 2004;69(11):2599-606. High platelet levels during pregnancy are dangerous for both the mother and the child and could cause complications. HELLP syndrome is a rare pregnancy complication. Etiology of thrombocytosis in a general medicine population: analysis of 801 cases with emphasis on infectious causes. HELLP syndrome is a pregnancy complication. Short and long-term stress is associated with platelet aggregation, which is when they group together near an injury site. In healthy, nonpregnant adult women, one third of all circulating platelets are transiently pooled within the low flow-rate circulation of the splenic sinusoids; an increased spleen size results in more pooling of the platelets and a lower platelet count.17 Therefore, the 50% increase in spleen size that occurs during pregnancy18 would also contribute to a lower platelet count. National Heart, Lung, and Blood Institute. Be sure to get regular prenatal care. As elevated platelet counts can be an indicator of an underlying medical condition, it is highly recommended that you further consult and discuss with your doctor to address your concerns, especially if your high platelets condition is persistent. In this treatment, you receive donated blood or blood components. Our objective with respect to women who had preexisting disorders associated with thrombocytopenia was to learn whether their thrombocytopenia becomes more severe during pregnancy. Platelet counts in women with normal pregnancies: a systematic review. Effects of physical (in)activity on platelet function. In women with platelet counts below 100,000 per cubic millimeter who do not have preeclampsia or a preexisting disorder associated with thrombocytopenia, a cause other than pregnancy or its complications should be considered. Read More Created for people with ongoing healthcare needs but benefits everyone. Get useful, helpful and relevant health + wellness information. Oncology Certified Nurse Practitioner and freelance healthcare writer with over a decade of medical oncology and hematology experience. This results in increased blood volume and causes hemodilution. Reese JA, Peck JD, McIntosh JJ, Vesely SK, George JN. We recorded each womans platelet count, race or ethnic group, and age. If you experience signs of HELLP syndrome, get care right away. Secure .gov websites use HTTPS Blood clots or bleeding may cause the following complications: High blood pressure Slow growth of your unborn baby Premature delivery Separation of the placenta from your womb Loss of your pregnancy Placenta previa: a 22-year analysis. Among all 15,723 deliveries that occurred at Oklahoma University Medical Center (OUMC) between January 1, 2011, and August 19, 2014, a total of 7351 women who had a platelet count measurement at the time of delivery and at least one platelet count measurement during their pregnancy were selected for inclusion in our study. Haram K, Svendsen E, Abildgaard U. HELLP syndrome was named by Dr. Louis Weinstein in 1982 after its characteristics: A full-term pregnancy typically lasts for 40 weeks. We do not endorse non-Cleveland Clinic products or services. If you have any symptoms, please contact your provider. When determining whether or not a high platelet count is something to worry about, healthcare providers may look for symptoms like bruising, bleeding, as well as signs of infection or another underlying condition. The characteristics of these women are provided in Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. To determine whether platelet counts changed significantly during gestation, whether they differed significantly among races or ethnic groups or age groups, and whether the rate of decrease during pregnancy differed significantly between women who had uncomplicated pregnancies and women who had pregnancy-related complications or preexisting disorders, we constructed linear mixed models to account for women who had repeated platelet count measurements. Iron pills will replenish the low iron and he. It is common and usually does not cause problems for the mother or baby. Up to 1 in 5 women who have preeclampsia or eclampsia develop HELLP syndrome. 2-4 However, counts < 100 10 9 /L, which is the definition for thrombocytopenia adopted by an International Working Group, 5 are observed in only 1% of pregnant women. This is called gestational thrombocytopenia. 2022;65(4):182-187. doi:10.3345/cep.2021.00864, Kucine N, Chastain KM, Mahler MB, Bussel JB. When we evaluated all 13,793 platelet count values measured during pregnancy and at the time of delivery in women with uncomplicated pregnancies (Fig. It's likely that a routine blood test showing a high platelet count will be your first indication that you have thrombocytosis. Platelet counts below 80,000 per cubic millimeter occurred in 13 of the 24 women (54.2%) who had immune thrombocytopenic purpura. Abruption usually requires immediate delivery or severe maternal and fetal hemorrhage can occur. The 255 women who could not be evaluated and were therefore deemed to be ineligible included 141 women who reported illicit-drug use, 113 women who had received treatment with glucocorticoids for an indication other than a pregnancy-related complication or a pre-existing disorder, and 1 woman who had thrombotic thrombocytopenic purpura. 8600 Rockville Pike During the course of the uncomplicated pregnancies and deliveries, only 45 women (1.0%) had a platelet count below 100,000 per cubic millimeter. Among the 4568 women with uncomplicated pregnancies whom we evaluated, 529 had a subsequent uncomplicated singleton pregnancy during our period of analysis and had a recorded platelet count at the time of delivery. Up to half of women who had HELLP syndrome can have some type of hypertensive disorder in her next pregnancy. Signs of HELLP syndrome include: To diagnose HELLP syndrome, your healthcare provider will ask you about physical changes such as: Often, blood pressure can be elevated and there can be proteinuria but there doesnt have to be. HELLP syndrome is very rare that occurs in 0.1% to 1% of pregnancies. If platelet levels are too high, it may be necessary to take anti-clotting medications until the fetus is safely delivered. A high platelet count is not always a serious concern. A severe lack of folic acid in your blood can cause thrombocytopenia, so it is important to take your prenatal vitamins. Exercise can impact platelet count and function. Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. However, certain serious conditions, such as, If you already have a platelet disorder, pregnancy may make your condition worse. Medications given in pregnancy to prevent pregnancy loss include low-dose aspirin and medications that decrease platelet production. Some platelet-lowering medications, such as anagrelide, busulfan and hydroxyurea, is embryo-toxic and should not be used in pregnancy. However, the exact threshold for determining whether a high WBC count indicates leukaemia during pregnancy can vary depending on the individual case and the specific type of leukaemia. S1A and S1B in the Supplementary Appendix). Platelets and pregnancy. The rate of decrease in platelet counts was similar in the two groups until the third trimester, when the decrease occurred at a greater rate in the women with pregnancy-related complications than in the women with uncomplicated pregnancies (Fig. That means you have the same number of platelet cells in a larger volume of blood. In the pregnant women, the platelet counts decreased significantly throughout pregnancy (P<0.001). If you have a very high platelet count, you may need medicines to lower it during pregnancy and after you give birth to your baby. 6 Effect of pregnancy on the course of immune thrombocytopenia: a retrospective study of 118 pregnancies in 82 women. This can increase the risk of blood clots. If your platelet disorder is caused only by pregnancy, your platelet count will return to the normal range after your baby is born. Aster RH. sharing sensitive information, make sure youre on a federal Mogos MF, Salemi JL, Spooner KK, McFarlin BL, Salihu HH. In our primary analyses, we included women who had a singleton pregnancy, whose duration of gestation at the time of delivery was recorded, and who had a platelet count measurement at the time of delivery and at least one additional platelet count measurement during their pregnancy. 2019;69(684):e462-e469. Your healthcare provider will order blood tests are ordered to check your blood count, liver function and kidney function. The difference in the mean platelet count between the women who had no missing platelet counts and the 4232 women who had missing platelet counts during one or more trimesters was not significant (P = 0.79). Treating a high platelet count starts with finding the underlying cause. One study reported that about 11% of assigned males with high platelets and about 6% of assigned females with high platelets had cancer. Ananth CV, Oyelese Y, Yeo L, Pradhan A, Vintzileos AM. 102: management of stillbirth. Very low platelet counts can cause bleeding. A .gov website belongs to an official government organization in the United States. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Verywell Health's content is for informational and educational purposes only. Previous labor and delivery, with risk increasing for women who have given birth more than once before. The mean platelet counts of the 2586 women who had pregnancy-related complications were higher than those of the 4568 women who had uncomplicated pregnancies during the first and second trimester (P<0.001) but were not significantly different during the third trimester (P = 0.38) or at the time of delivery (P = 0.09). Pregnancy complications. Or you may need to deliver with a cesarean birth (C-section). Your healthcare provider may give you medicine to induce labor. Policy. A person with thrombocytopenia has a platelet count of fewer than 150,000 platelets per L. If still worried, I suggest you repeat the blood test for platelets again in 2 weeks. What are platelets and why are they important? The https:// ensures that you are connecting to the It usually occurs during the third trimester of pregnancy. High platelet levels caused by primary thrombocytosis, also known as thrombocythemia, can be dangerous in pregnancy and can result in serious maternal and fetal complications. FOIA The name HELLP syndrome stands for: . Beginning in 1993, three large studies documented that 5 to 10% of women who had uncomplicated pregnancies had a platelet count of less than 150,000 per cubic millimeter at the time of delivery,13 which was described as gestational thrombocytopenia.4 The normal distribution of platelet counts at the time of delivery and the absence of health problems in the mother and infant suggested that gestational thrombocytopenia was the result of lower platelet counts that occur in all women during pregnancy.2,3,5,6 The current thinking is that platelet counts in all women begin to decrease in the mid-second to third trimester and continue to decrease until the time of delivery.4 However, our recent systematic review of published reports that describe platelet counts throughout uncomplicated pregnancies did not provide support for this concept.7 The number of published reports that we were able to identify was few, and their results were inconsistent. Perkins also has extensive experience working in home health with medically fragile pediatric patients. P ractice bulletin no. Every woman's platelet count falls 15 to 20 percent over the course of pregnancy. To determine the course of platelet counts throughout pregnancy, at the time of delivery, and during the postpartum period, we selected only one platelet count measurement from each time point for each woman: the first platelet count measurement during each trimester and the postpartum period and the platelet count measurement preceding and closest to the time of delivery. If you have thrombotic thrombocytopenic purpura, you may need treatment for your condition during your pregnancy even if you do not have any symptoms. When this stress hormone is released, it impacts several organs, including the spleen, which filters blood and stores platelets. When we analyzed all 970 platelet count values measured during pregnancy, at the time of delivery, or both (Fig. Sejeny SA, RD Eastham, SR Baker. Platelet counts in healthy women and men are genetically determined and exhibit little variation over time.15 Therefore, women whose platelet counts are at the low end of the normal range when they are not pregnant are more likely to have platelet counts that are below the normal range during pregnancy. HELLP syndrome is a separate disorder from preeclampsia as patients may not have high blood pressure or proteinuria. These may include: Be sure to tell your healthcare provider about all medications you are taking. Among the 15,723 deliveries that occurred during the study period, 7351 women had sufficient data for our analyses. Many times, a high platelet count doesnt cause any symptoms or mean something serious is going on. However, the frequencies of the pregnancy-related complications among these women were similar to U.S. population estimates.2229 Therefore, our data may accurately reflect the platelet counts in women with these pregnancy-related complications.