Testing recommendations in suspected thrombocytopenia in pregnancy
| Tests . | Notes . |
|---|---|
| Recommended for all patients | |
| CBC and peripheral blood smear review | Macrothrombocytopenia |
| Check for other inherited thrombocytopenias | |
| Depending on family history and smear, consider genetic testing, platelet function testing, testing for type 2b von Willebrand disease and platelet-type von Willebrand disease | |
| Schistocytes may suggest microangiopathy in hemolysis and hypertensive disorders | |
| Reticulocyte count | Elevated in cases of hemolysis and hypertensive disorders |
| Coagulation screening | PTT may be prolonged in patients with a history of thrombosis or pregnancy loss. Consider testing for APLAs, anti-cardiolipin antibodies, and lupus anticoagulant. |
| PT/PTT, fibrinogen | |
| Liver function | Possibly viral infection, if abnormal |
| Check for hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). | |
| Thyroid function | |
| Viral serologies (HIV, HCV) | |
| Renal function | HUS/TTP may manifest for the first time in pregnancy. Consider testing for ADAMTS-13, alternative complement pathway. |
| Consider atypical HUS due to autoantibodies against complement components | |
| To be considered | |
| Anti-nuclear antibody | |
| H pylori testing | H pylori stool or antigen test should be performed in patients with history of thrombocytopenia prior to pregnancy |
| Ig levels | Quantitative Ig test should be performed in patients with a history of thrombosis or pregnancy loss |
| Not recommended | |
| Platelet autoantibody testing | Not predictive of neonatal platelet count |
| Bone marrow examination, peripheral blood flow cytometry | |
| Fetal blood sampling | |
| TPO level | May be of value in the future |
| Tests . | Notes . |
|---|---|
| Recommended for all patients | |
| CBC and peripheral blood smear review | Macrothrombocytopenia |
| Check for other inherited thrombocytopenias | |
| Depending on family history and smear, consider genetic testing, platelet function testing, testing for type 2b von Willebrand disease and platelet-type von Willebrand disease | |
| Schistocytes may suggest microangiopathy in hemolysis and hypertensive disorders | |
| Reticulocyte count | Elevated in cases of hemolysis and hypertensive disorders |
| Coagulation screening | PTT may be prolonged in patients with a history of thrombosis or pregnancy loss. Consider testing for APLAs, anti-cardiolipin antibodies, and lupus anticoagulant. |
| PT/PTT, fibrinogen | |
| Liver function | Possibly viral infection, if abnormal |
| Check for hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). | |
| Thyroid function | |
| Viral serologies (HIV, HCV) | |
| Renal function | HUS/TTP may manifest for the first time in pregnancy. Consider testing for ADAMTS-13, alternative complement pathway. |
| Consider atypical HUS due to autoantibodies against complement components | |
| To be considered | |
| Anti-nuclear antibody | |
| H pylori testing | H pylori stool or antigen test should be performed in patients with history of thrombocytopenia prior to pregnancy |
| Ig levels | Quantitative Ig test should be performed in patients with a history of thrombosis or pregnancy loss |
| Not recommended | |
| Platelet autoantibody testing | Not predictive of neonatal platelet count |
| Bone marrow examination, peripheral blood flow cytometry | |
| Fetal blood sampling | |
| TPO level | May be of value in the future |
HUS, hemolytic-uremic syndrome; PT, prothrombin time; TTP, thrombotic thrombocytopenic purpura.