What are the safe ways to maintain platelets in pregnancy?

Question

Hello doctor,

I am a 35-year-old woman diagnosed with chronic immune thrombocytopenia two years ago. My platelet count usually stays around 40,000 to 60,000, but recently I have had more bruises and heavy menstrual bleeding that lasts almost nine to 10 days. I am not on any current medication, but my hematologist had earlier prescribed steroids, which caused weight gain and mood swings.

I am now planning for pregnancy and worried about the risks of bleeding during conception, pregnancy, or delivery.

Can I go for IVF with a low platelet count, or do I need to stabilize it first?
Are there any safe treatments during pregnancy to keep platelets up without harming the baby?
Should I avoid birth control pills or hormonal IUDs due to bleeding risk?

I feel anxious every cycle, wondering if it's normal or dangerous.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

I am deeply concerned about your worries. For the management of chronic immune thrombocytopenia, I suggest the following for you:

You should consult a consultant hematologist for further management of thrombocytopenia.
Start tablet Prednisolone 20 mg and increase it up to 60 mg if it does not control. Then, start the second choice IVIG (intravenous immunoglobulin). If you did not control the thrombocytopenia, then you should plan to have a splenectomy, which can be done as a laparoscopy or an open splenectomy.

If you become symptomatic, you must get a platelet transfusion. After increasing the platelet level to more than 100,000, you can plan a pregnancy.

Discuss with a consultant for preconception and start taking Folic acid 5 mg once at night for three months before preconception. The target level of platelets for normal delivery is 50,000 platelets per microliter, and for C/S (cesarean section), epidural anaesthesia is 80,000 platelets per microliter.

If you need a long-term birth control for up to five years, then the best option is Mirena. It is a Progesterone form of IUD (intrauterine device), and it has three different types. It does not cause heavy menstrual bleeding, while the other IUD, like copper, does.

I hope this information is helpful to you.

Thank you.