{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:23:58Z","timestamp":1788276238357,"version":"build-2803163510"},"reference-count":23,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Severe thrombocytopenia (platelet count \u2264 50,000\/\u00b5L) is a diagnostically heterogeneous condition during pregnancy, encompassing obstetric and non-obstetric etiologies that require distinct management approaches. The aims of this study were to determine the etiological distribution of severe thrombocytopenia during pregnancy and to evaluate its management strategies and perinatal outcomes in a tertiary perinatology center. Methods: This retrospective cohort study included 203 pregnant women with severe thrombocytopenia (platelet count \u2264 50,000\/\u00b5L) stratified into three groups: Group A (30,000 &lt; platelet count \u2264 50,000\/\u03bcL, n = 123), Group B (10,000 &lt; platelet count \u2264 30,000\/\u03bcL, n = 54), and Group C (&lt;10,000\/\u00b5L, n = 26). Demographic characteristics, etiological diagnoses, treatment modalities, and perinatal outcomes were evaluated. Results: The etiological distribution varied significantly across severity groups (p = 0.001). HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome was the most common cause overall (36.5%) and predominated in milder thrombocytopenia (Group A: 40.7%; Group B: 42.6%), whereas non-obstetric etiologies, such as immune thrombocytopenia (ITP), were significantly more frequent in Group C (57.7%). Treatment intensity increased with severity, with 79.7% of Group A requiring no intervention compared to only 26.9% of Group C (p = 0.001). Gestational age at delivery (median 37 weeks, p = 0.587) and birth weight (mean 2547 \u00b1 968 g, p = 0.191) were comparable across severity groups. Minimum platelet count showed no significant correlation with delivery timing, birth weight, or hemoglobin decline. Conclusions: Severe thrombocytopenia in pregnancy exhibits distinct etiological patterns that vary according to platelet count severity. Favorable perinatal outcomes are achievable with appropriate diagnosis and management in specialized centers, underscoring the importance of comprehensive diagnostic evaluation rather than relying solely on platelet count thresholds for clinical decision-making.<\/jats:p>","DOI":"10.3390\/jcm14228162","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:55:31Z","timestamp":1763556931000},"page":"8162","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Severe Thrombocytopenia in Pregnancy: Etiology, Management, and Outcomes Across Platelet Count Categories"],"prefix":"10.3390","volume":"14","author":[{"given":"F\u0131rat","family":"Ersan","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Perinatology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34490 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5937-0220","authenticated-orcid":false,"given":"Verda","family":"Alpay","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Perinatology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34490 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3831-3745","authenticated-orcid":false,"given":"Bar\u0131\u015f","family":"Boza","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Perinatology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34490 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakan","family":"Erenel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Perinatology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34490 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"ref_1","first-page":"e59156","article-title":"Feto-Maternal Outcome in Pregnancy With Thrombocytopenia and Abnormal Platelet Indices","volume":"16","author":"Mushahary","year":"2024","journal-title":"Cureus"},{"key":"ref_2","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."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"ACOG (American College of Obstetricians and Gynecologists) (2019). ACOG Practice Bulletin No. 207: Thrombocytopenia in Pregnancy. Obstet. Gynecol., 133, e181\u2013e193.","DOI":"10.1097\/AOG.0000000000003100"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s12288-017-0784-1","article-title":"Moderate to Severe Thrombocytopenia During Pregnancy: A Single Institutional Experience","volume":"33","author":"Kim","year":"2017","journal-title":"Indian J. Hematol. Blood Transfus."},{"key":"ref_5","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."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ejogrb.2005.12.031","article-title":"Moderate to severe thrombocytopenia during pregnancy","volume":"128","author":"Parnas","year":"2006","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_7","first-page":"1563","article-title":"Fetomaternal outcome in pregnancy with severe thrombocytopenia","volume":"16","author":"Dwivedi","year":"2012","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.preghy.2018.02.007","article-title":"Thrombotic microangiopathies of pregnancy: Differential diagnosis","volume":"12","author":"Gupta","year":"2018","journal-title":"Pregnancy Hypertens."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1080\/09537104.2019.1640870","article-title":"Managing ITP and thrombocytopenia in pregnancy","volume":"31","author":"Eslick","year":"2020","journal-title":"Platelets"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1182\/blood-2009-06-225565","article-title":"International consensus report on the investigation and management of primary immune thrombocytopenia","volume":"115","author":"Provan","year":"2010","journal-title":"Blood"},{"key":"ref_11","unstructured":"ACOG (American College of Obstetricians and Gynecologists) (2019). ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet. Gynecol., 133, 1."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/j.1365-2141.2009.07600.x","article-title":"Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology","volume":"145","author":"Levi","year":"2009","journal-title":"Br. J. Haematol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1111\/bjh.13864","article-title":"The haematological features and transfusion management of women who required massive transfusion for major obstetric haemorrhage in the UK: A population based study","volume":"172","author":"Green","year":"2016","journal-title":"Br. J. Haematol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1007\/s10238-019-00575-6","article-title":"Severe thrombocytopenia in pregnancy: A case series from west China","volume":"19","author":"Zhou","year":"2019","journal-title":"Clin. Exp. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e7561","DOI":"10.1097\/MD.0000000000007561","article-title":"Thrombocytopenia in pregnancy with different diagnoses: Differential clinical features, treatments, and outcomes","volume":"96","author":"Wang","year":"2017","journal-title":"Medicine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/MBC.0000000000000955","article-title":"Severe thrombocytopenia in pregnancy: A retrospective study","volume":"31","author":"Ozturk","year":"2020","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1111\/1471-0528.16225","article-title":"Maternal risk factors and adverse birth outcomes associated with HELLP syndrome: A population-based study","volume":"127","author":"Lisonkova","year":"2020","journal-title":"BJOG: Int. J. Obstet. Gynaecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1182\/hematology.2022000375","article-title":"Thrombocytopenia in pregnancy","volume":"2022","author":"Pishko","year":"2022","journal-title":"Hematol. Am. Soc. Hematol. Educ. Program"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Li, B., and Yang, H. (2022). Comparison of clinical features and pregnancy outcomes in early- and late-onset preeclampsia with HELLP syndrome: A 10-year retrospective study from a tertiary hospital and referral center in China. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04466-9"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1182\/hematology.2024000595","article-title":"ITP in pregnancy: Diagnostics and therapeutics in 2024","volume":"2024","author":"Fogerty","year":"2024","journal-title":"Hematol. Am. Soc. Hematol. Educ. Program"},{"key":"ref_21","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":"Reese","year":"2021","journal-title":"Am. J. Hematol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1515\/jpm-2024-0528","article-title":"Severe thrombocytopenia in pregnancy: A cross-sectional analysis of perinatal and neonatal outcomes across different platelet count categories","volume":"53","author":"Ezveci","year":"2025","journal-title":"J. Perinat. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1182\/blood.2019000962","article-title":"How I treat thrombotic thrombocytopenic purpura in pregnancy","volume":"136","author":"Ferrari","year":"2020","journal-title":"Blood"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8162\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T13:24:54Z","timestamp":1763558694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":23,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14228162"],"URL":"https:\/\/doi.org\/10.3390\/jcm14228162","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,18]]}}}