Does Gestational Thrombocytopenia and Immune Thrombocytopenic Purpura Warrant Hospital Admission?

Objective: To determine the severity of thrombocytopenia in pregnancy and manage gestational thrombocytopenia patients in the outpatient department in order to reduce the economic burden on hospitals. Study Design: Cross-sectional study. Place and Duration of Study: Department of Haematology, Pakistan Railway Hospital, Rawalpindi, in collaboration with the Departments of Obstetrics and Gynaecology of Combined Military Hospital and Fauji Foundation Hospital, Rawalpindi, Pakistan from Oct 2018 to Oct 2019. Methodology: The sample population included ninety pregnant females with platelet count <150x109/l. Blood samples were analyzed for complete blood count, peripheral blood smear, manual count by improved Neubauer chamber, serum uric acid, urinary proteins, liver function tests (bilirubin and aspartate aminotransferase), lactate dehydrogenase, coagulation profile and viral serology (hepatitis B & C). Results: Out of 90 thrombocytopenic pregnant females, gestational thrombocytopenia was most common, (86, 95.5%), while immune thrombocytopenic purpura was detected in 4(4.5%) patients. Mild thrombocytopenia was frequently observed in patients of gestational thrombocytopenia (59, 68.6%), and severe thrombocytopenia was mostly detected in patients of immune thrombocytopenic purpura (3, 75.0%). About 58(64.4%) of these patients were hospitalized, irrespective of the cause of thrombocytopenia. Conclusion: Mild thrombocytopenia was commonly observed in gestational thrombocytopenia, and severe thrombocytopenia was usually diagnosed in patients with immune thrombocytopenic purpura. Gestational thrombocytopenia is frequent in pregnancy and does not require hospitalization. In contrast, patients with immune thrombocytopenic purpura require rational hospitalization for appropriate and judicious management for the safety of the mother and fetus.