Thrombocytopenia in pregnancy

Borders Ref Help Toolkit
NHS Borders

Services are based at the Haematology/Obstetric Clinic RIE

Please see Primary Care Management for investigations prior to referral to facilitate an informative consultation – whether in primary care or obstetric settings. These are not required for URGENT REFERRALS to avoid delay.

Who to refer, who not to refer, how to refer

Who to refer:

Urgent Referrals

  1. Abnormal blood film (except platelet clumping)
  2. Plt < 50 x 109/L
  3. Deranged coagulation screen with thrombocytopenia
  4. Symptomatic***
  5. Suspicion of TTP *
  6. Delivery imminent & plt < 100 x 109/L (< 4 weeks)
  7. History or suspicion of Antiphospholipid Syndrome (APS) **

Routine Referrals

  1. Plt 50 – 99 x 109/L
  2. Known history of thrombocytopenia (ITP/congenital)
  3. Known history of gestational thrombocytopenia

Who not to refer:

  • Platelet clumping on blood film
  • Untreated B12 or folate deficiency (may take 3-4 weeks to see clinical response to treatment) – please see below on management of thrombocytopenia with low B12.

Notes:

* Microangiopathic haemolytic anaemia (MAHA); renal impairment; neurological signs/symptoms; fever

** Previous thrombosis (arterial or venous); recurrent miscarriage; late foetal loss

*** Increased bruising; epistaxis lasting > 10 mins; blood blisters in mouth

Management of thrombocytopenia with low B12 (and no other indications for referral):

  • B12 < 125 ng/L – B12 loading and maintenance treatment as per RefHelp B12 guidance
  • B12 125-150 ng/L: 1x 1mg IM B12 dose during pregnancy and GP to recheck B12 levels 3 months post-partum
  • B12 >150 ng/L: no action as not likely to be clinically significant.

NB Platelets 100 – 149 x 109/L; midwife to monitor FBC at each antenatal visit and refer if meets any of criteria above.

How to refer:

GPs should refer via SCI Gateway to haematology, copying to obstetric consultant.

Primary care management

Initial investigations apply to both primary care and obstetric settings.

Please arrange for these investigations to be completed before haematology referral to facilitate an informative consultation. This is NOT required for urgent referrals.

  • FBC, Routine Blood film; Reticulocytes
  • LFTs
  • U&E
  • LDH
  • TFTs
  • Coagulation Screen
  • Vitamin B12 and folate; ferritin
  • Urinalysis
  • BP
  • (HIV, if not done at booking).

Resources and links

Gernsheimer T, James AH, Stasi R, How I treat thrombocytopenia in pregnancy. Blood. 2013;121(1):38-47.

Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia.

Editorial Information

Last reviewed: 19/02/2025

Next review date: 19/02/2027

Author(s): Charlotte Robertson.