Is it common to experience a low platelet count during the eighth month of pregnancy?

Question

Hi doctor,

My wife is on a routine ANC investigation and got to know she has thrombocytopenia, with 38 thousand platelets. She is eight months pregnant. Then, on the physician's advice, the MP and dengue test were done.

MP test negative.
Dengue antigen negative.
IgM negative.
IgG positive.

When the CBC was repeated, the platelet count was reduced to 25,000. As I was worried about the child, we went through 8 units of platelet transfusion under the guidance of a doctor. After an 8-unit transfusion, platelets rose to 43 thousand. Today, platelets are 45 thousand.

Now, she is discharged, and a carica papaya syrup is prescribed. The doctor asked us to wait and watch. We will repeat the complete blood count after three days. My wife is normal throughout the day. There are no signs and symptoms of bleeding, rashes, or fever, except for a cough from last night due to the air conditioner. I want your help.

Should I wait or go for a second opinion?
I fear it is due to dengue, pathology, or physiology (pregnancy), immunological thrombocytopenia (ITP), or isolated thrombocytopenia. What should I do?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Let me give you my opinion regarding your wife's condition.

She is now stable, and no further management is needed if no active bleeding is present. Just take the prescribed syrup and drink lots of water. It is a case of dengue infection.

In gestational thrombocytopenia, platelet count usually does not decrease to less than 60000. In immune thrombocytopenic purpura (ITP), the platelet count is usually low for many months, at least six months, and the previous count is also abnormal in such cases. ITP is suspected if no other causes of secondary thrombocytopenia are present.

So here, dengue can be the most common possibility, and in dengue, at the middle stage of the disease, platelets decrease to a low level, fluid is given in such cases, and symptomatic management is done. If active bleeding is present, then a platelet transfusion is needed. Repeat CBC after three days. Until then, take the prescribed syrup and rest.

If the cough increases, then auscultation should be done.

I hope this will help you.

Thank you.