{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T22:57:58Z","timestamp":1789340278775,"version":"build-2803163510"},"reference-count":40,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,12,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Hematologists are often consulted for thrombocytopenia in pregnancy, especially when there is a concern for a non-pregnancy-specific etiology or an insufficient platelet count for the hemostatic challenges of delivery. The severity of thrombocytopenia and trimester of onset can help guide the differential diagnosis. Hematologists need to be aware of the typical signs of preeclampsia with severe features and other hypertensive disorders of pregnancy to help distinguish these conditions, which typically resolve with delivery, from other thrombotic microangiopathies (TMAs) (eg, thrombotic thrombocytopenic purpura or complement-mediated TMA). Patients with chronic thrombocytopenic conditions, such as immune thrombocytopenia, should receive counseling on the safety and efficacy of various medications during pregnancy. The management of pregnant patients with chronic immune thrombocytopenia who are refractory to first-line treatments is an area that warrants further research. This review uses a case-based approach to discuss recent updates in diagnosing and managing thrombocytopenia in pregnancy.<\/jats:p>","DOI":"10.1182\/hematology.2022000375","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T16:10:09Z","timestamp":1670602209000},"page":"303-311","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":25,"title":["Thrombocytopenia in pregnancy"],"prefix":"10.1182","volume":"2022","author":[{"given":"Allyson M.","family":"Pishko","sequence":"first","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariela L.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","published-online":{"date-parts":[[2022,12,9]]},"reference":[{"issue":"1","key":"2022121313293144700_hem2022000375C1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1056\/NEJMoa1802897","article-title":"Platelet counts during pregnancy","volume":"379","author":"Reese","year":"2018","journal-title":"N Engl J Med"},{"issue":"1","key":"2022121313293144700_hem2022000375C2","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1182\/blood-2012-08-448944","article-title":"How I treat thrombocytopenia in pregnancy","volume":"121","author":"Gernsheimer","year":"2013","journal-title":"Blood"},{"issue":"21","key":"2022121313293144700_hem2022000375C3","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1182\/blood-2017-05-781971","article-title":"Thrombocytopenia in pregnancy","volume":"130","author":"Cines","year":"2017","journal-title":"Blood"},{"issue":"5","key":"2022121313293144700_hem2022000375C4","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1111\/j.1365-2141.2011.09012.x","article-title":"UK guidelines on the management of iron deficiency in pregnancy","volume":"156","author":"Pavord","year":"2012","journal-title":"Br J Haematol"},{"issue":"2","key":"2022121313293144700_hem2022000375C5","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/bjh.13853","article-title":"Guidelines for the diagnosis and management of adult aplastic anaemia","volume":"172","author":"Killick","year":"2016","journal-title":"Br J Haematol"},{"key":"2022121313293144700_hem2022000375C6","doi-asserted-by":"crossref","first-page":"100638","DOI":"10.1016\/j.blre.2019.100638","article-title":"Thrombocytopenia in pregnancy: diagnosis and approach to management","volume":"40","author":"Pishko","year":"2020","journal-title":"Blood Rev"},{"issue":"2","key":"2022121313293144700_hem2022000375C7","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1055\/s-0041-1723799","article-title":"Type 2B von Willebrand disease in pregnancy: a systematic literature review","volume":"47","author":"Makhamreh","year":"2021","journal-title":"Semin Thromb Hemost"},{"issue":"6","key":"2022121313293144700_hem2022000375C8","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1097\/AOG.0000000000003892","article-title":"ACOG Practice Bulletin Summary, Number 222","volume":"135","author":"Gestational hypertension and preeclampsia","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"19","key":"2022121313293144700_hem2022000375C9","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.1182\/blood.2020005221","article-title":"Management of thrombotic microangiopathy in pregnancy and postpartum: report from an international working group","volume":"136","author":"Fakhouri","year":"2020","journal-title":"Blood"},{"issue":"1","key":"2022121313293144700_hem2022000375C10","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1182\/hematology.2021000290","article-title":"How to evaluate and treat the spectrum of TMA syndromes in pregnancy","volume":"2021","author":"Scully","year":"2021","journal-title":"Hematology Am Soc Hematol Educ Program"},{"issue":"17","key":"2022121313293144700_hem2022000375C11","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1182\/blood-2016-03-705434","article-title":"Maternal extracellular vesicles and platelets promote preeclampsia via inflammasome activation in trophoblasts","volume":"128","author":"Kohli","year":"2016","journal-title":"Blood"},{"issue":"1","key":"2022121313293144700_hem2022000375C12","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa1414838","article-title":"Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia","volume":"374","author":"Zeisler","year":"2016","journal-title":"N Engl J Med"},{"issue":"suppl 1","key":"2022121313293144700_hem2022000375C13","doi-asserted-by":"crossref","first-page":"S56","DOI":"10.1016\/S0049-3848(17)30069-5","article-title":"Disseminated intravascular coagulation in pregnancy\u2014clinical phenotypes and diagnostic scores","volume":"151","author":"Erez","year":"2017","journal-title":"Thromb Res"},{"issue":"4","key":"2022121313293144700_hem2022000375C14","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.ajog.2015.03.054","article-title":"Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management","volume":"213","author":"Erez","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"24","key":"2022121313293144700_hem2022000375C15","doi-asserted-by":"crossref","first-page":"5888","DOI":"10.1182\/blood-2012-02-408914","article-title":"Unexpected frequency of Upshaw-Schulman syndrome in pregnancy-onset thrombotic thrombocytopenic purpura","volume":"119","author":"Moatti-Cohen","year":"2012","journal-title":"Blood"},{"issue":"12","key":"2022121313293144700_hem2022000375C16","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1002\/ajh.26328","article-title":"Severe thrombocytopenia and microangiopathic hemolytic anemia in pregnancy: a guide for the consulting hematologist","volume":"96","author":"Perez Botero","year":"2021","journal-title":"Am J Hematol"},{"issue":"1","key":"2022121313293144700_hem2022000375C17","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1182\/asheducation-2018.1.530","article-title":"Clinical and laboratory diagnosis of TTP: an integrated approach","volume":"2018","author":"Chiasakul","year":"2018","journal-title":"Hematology Am Soc Hematol Educ Program"},{"issue":"8","key":"2022121313293144700_hem2022000375C18","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1038\/s41581-021-00424-4","article-title":"Thrombotic microangiopathy in aHUS and beyond: clinical clues from complement genetics","volume":"17","author":"Fakhouri","year":"2021","journal-title":"Nat Rev Nephrol"},{"issue":"12","key":"2022121313293144700_hem2022000375C19","doi-asserted-by":"crossref","first-page":"3085","DOI":"10.1681\/ASN.2014100954","article-title":"Characteristics and outcomes of AKI treated with dialysis during pregnancy and the postpartum period","volume":"26","author":"Hildebrand","year":"2015","journal-title":"J Am Soc Nephrol"},{"issue":"10","key":"2022121313293144700_hem2022000375C20","doi-asserted-by":"crossref","first-page":"2775","DOI":"10.1111\/jth.15030","article-title":"TTP in the setting of pregnancy: the story still has to be written","volume":"18","author":"Coppo","year":"2020","journal-title":"J Thromb Haemost"},{"issue":"10","key":"2022121313293144700_hem2022000375C21","doi-asserted-by":"crossref","first-page":"2496","DOI":"10.1111\/jth.15010","article-title":"ISTH guidelines for treatment of thrombotic thrombocytopenic purpura","volume":"18","author":"Zheng","year":"2020","journal-title":"J Thromb Haemost"},{"issue":"5","key":"2022121313293144700_hem2022000375C22","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1007\/s40620-021-01025-x","article-title":"Pregnancy-triggered atypical hemolytic uremic syndrome (aHUS): a Global aHUS Registry analysis","volume":"34","author":"Fakhouri","year":"2021","journal-title":"J Nephrol"},{"issue":"26","key":"2022121313293144700_hem2022000375C23","doi-asserted-by":"crossref","first-page":"6511","DOI":"10.1182\/blood-2009-01-129155","article-title":"The ITP syndrome: pathogenic and clinical diversity","volume":"113","author":"Cines","year":"2009","journal-title":"Blood"},{"issue":"13","key":"2022121313293144700_hem2022000375C24","doi-asserted-by":"crossref","first-page":"4306","DOI":"10.1182\/blood-2002-10-3317","article-title":"A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura","volume":"102","author":"Webert","year":"2003","journal-title":"Blood"},{"issue":"11","key":"2022121313293144700_hem2022000375C25","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1182\/blood-2017-09-742353","article-title":"Splenectomy for immune thrombocytopenia: down but not out","volume":"131","author":"Chaturvedi","year":"2018","journal-title":"Blood"},{"issue":"18","key":"2022121313293144700_hem2022000375C26","doi-asserted-by":"crossref","first-page":"2436","DOI":"10.1080\/14767058.2017.1344636","article-title":"Improved pregnancy outcome following earlier splenectomy in women with immune thrombocytopenia: a 5-year observational study","volume":"31","author":"Rezk","year":"2018","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"10","key":"2022121313293144700_hem2022000375C27","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1182\/blood-2016-04-710285","article-title":"Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy","volume":"128","author":"Sun","year":"2016","journal-title":"Blood"},{"issue":"23","key":"2022121313293144700_hem2022000375C28","doi-asserted-by":"crossref","first-page":"3829","DOI":"10.1182\/bloodadvances.2019000966","article-title":"American Society of Hematology 2019 guidelines for immune thrombocytopenia","volume":"3","author":"Neunert","year":"2019","journal-title":"Blood Adv"},{"issue":"22","key":"2022121313293144700_hem2022000375C29","doi-asserted-by":"crossref","first-page":"3780","DOI":"10.1182\/bloodadvances.2019000812","article-title":"Updated international consensus report on the investigation and management of primary immune thrombocytopenia","volume":"3","author":"Provan","year":"2019","journal-title":"Blood Adv"},{"key":"2022121313293144700_hem2022000375C30","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2013-201778","article-title":"Splenectomy during pregnancy: treatment of refractory immune thrombocytopenic purpura","volume":"2013","author":"Mahey","year":"2013","journal-title":"BMJ Case Rep"},{"issue":"14","key":"2022121313293144700_hem2022000375C31","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1080\/14767058.2016.1222365","article-title":"Safety of splenectomy during pregnancy","volume":"30","author":"Bleau","year":"2017","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"5","key":"2022121313293144700_hem2022000375C32","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1182\/blood-2010-07-295444","article-title":"Pregnancy outcomes after maternal exposure to rituximab","volume":"117","author":"Chakravarty","year":"2011","journal-title":"Blood"},{"key":"2022121313293144700_hem2022000375C33","doi-asserted-by":"crossref","first-page":"20406207211001139","DOI":"10.1177\/20406207211001139","article-title":"Thrombopoietin receptor agonist for treatment of immune thrombocytopenia in pregnancy: a narrative review","volume":"12","author":"Agarwal","year":"2021","journal-title":"Ther Adv Hematol"},{"issue":"9","key":"2022121313293144700_hem2022000375C34","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1182\/blood-2017-01-761262","article-title":"A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy","volume":"130","author":"Kong","year":"2017","journal-title":"Blood"},{"issue":"26","key":"2022121313293144700_hem2022000375C35","doi-asserted-by":"crossref","first-page":"3056","DOI":"10.1182\/blood.2020007594","article-title":"Use of thrombopoietin receptor agonists for immune thrombocytopenia in pregnancy: results from a multicenter study","volume":"136","author":"Michel","year":"2020","journal-title":"Blood"},{"key":"2022121313293144700_hem2022000375C36","unstructured":"U.S. Food and Drug Administration. Tavalisse\u2122 (fostamatinib disodium hexahydrate) [package insert]. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2018\/209299lbl.pdf. Accessed 26September2022."},{"issue":"6","key":"2022121313293144700_hem2022000375C37","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1213\/ANE.0000000000005355","article-title":"The Society for Obstetric Anesthesia and Perinatology interdisciplinary consensus statement on neuraxial procedures in obstetric patients with thrombocytopenia","volume":"132","author":"Bauer","year":"2021","journal-title":"Anesth Analg"},{"issue":"10084","key":"2022121313293144700_hem2022000375C38","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1016\/S0140-6736(17)30638-4","article-title":"Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial","volume":"389","author":"Shakur","year":"2017","journal-title":"Lancet"},{"issue":"4","key":"2022121313293144700_hem2022000375C39","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1007\/BF02982137","article-title":"Nationwide study of idiopathic thrombocytopenic purpura in pregnant women and the clinical influence on neonates","volume":"75","author":"Fujimura","year":"2002","journal-title":"Int J Hematol"},{"issue":"2","key":"2022121313293144700_hem2022000375C40","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.ajog.2021.04.211","article-title":"New developments in fetal and neonatal alloimmune thrombocytopenia","volume":"225","author":"Bussel","year":"2021","journal-title":"Am J Obstet Gynecol"}],"container-title":["Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ashpublications.org\/hematology\/article-pdf\/2022\/1\/303\/2023106\/303pishko.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/ashpublications.org\/hematology\/article-pdf\/2022\/1\/303\/2023106\/303pishko.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T13:33:14Z","timestamp":1670938394000},"score":1,"resource":{"primary":{"URL":"https:\/\/ashpublications.org\/hematology\/article\/2022\/1\/303\/493504\/Thrombocytopenia-in-pregnancy"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,9]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12,9]]},"published-print":{"date-parts":[[2022,12,9]]}},"URL":"https:\/\/doi.org\/10.1182\/hematology.2022000375","relation":{},"ISSN":["1520-4391","1520-4383"],"issn-type":[{"value":"1520-4391","type":"print"},{"value":"1520-4383","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,12,9]]},"published":{"date-parts":[[2022,12,9]]}}}