Thrombocytopenia and Anemia - any experiences?

christied954

I saw the hematologist yesterday, thinking I was going to be starting IV iron infusions. He did a preliminary finger prick and thinks I have Thrombocytopenia and Anemia of pregnancy. He then took 10 vials of blood to do extensive lab work and I am to see him again in 2 weeks. The preliminary stick shows my hemoglobin, hematocrit, and platelet levels are in the red. He says he's not convinced it's only due to iron deficiency. I was taken aback and didn't even think to ask what he thinks it could be caused by then. My OB had assumed I would be starting IV iron infusions immediately, so I'm not sure what to think. I've been researching and it appears my preliminary levels are not in the severe range, but I'm reading that they can fall rather quickly in the 3rd trimester. He did say that if my platelets fall below ~80,000 that anesthesiologists get jittery and won't perform epidural/spinal anesthesia, and instead will use general. My platelet levels are currently 110,000. He said delivery is considered safe with levels of 50,000 or above. Obviously I don't want to undergo general anesthesia and miss the birth of my DD.

So, I go back to see him in 2 weeks to discuss my lab results and plan a course of action. In the meantime they're getting insurance pre-authorization to do the IV iron infusions if needed. I'm still taking my massive doses of Rx iron supplements daily. I'll be 33 weeks when I see him again, and I'm delivering at 39 weeks.

Does anyone have experience with either of these conditions? I never had any of these issues with my pregnancy with DS1 and I'm a little concerned. Any advice would be more than welcome!

golfingdarwinfish

Sorry about the pending dx. I have professional experience with thrombocytopenia, but not personal experience.  

My advice would be that your hem & anesthesiologist know best and will be able to formulate a plan for delivery of your daughter that is safe for both of you.  Going under anesthesia may not be ideal, but if it's the safest option, it's likely the right option.  There may be professional disagreements between specialists, but at the end of the day all physician's on your case must be comfortable with the course of action.  

You can request your ob (or MFM if you're now moved to a MFM) begin searching for an anesthesiologist that is comfortable performing a spinal/epidural w/platelet between 50k-80k if that's your ob's comfort range, but at the same time I would likely request a consult with a MFM if you are just seeing a run of the mill ob and obtain his/her professional opinion about delivering with low platelet levels.  

GreenIceSk8r

Christie - thanks for writing this post.  I don't have any experience to offer, only that I was told my platelets are low as well and will be going to my first hematologist appointment on Tuesday.  Now I know a little better of what to expect. I was told the same thing about delivering with low platelets, so I guess we'll both have to wait and see how it turns out.   

christied954

I actually am being followed by my regular OB and a perinatologist. I happen to have an appointment with the peri tomorrow morning, which was planned long before this dx. I need to stay away from google, because I'm actually starting to get concerned about HELLP syndrome. It appears that I have 2 out of the 3 criteria, although I'm obviously no expert.

ashleym373

I had the opposite platelet problem in my first pregnancy and it is appearing they are rising again. I was put on a baby aspirin a day around 34 weeks until 6 weeks post partum. I had a bunch of blood work the first time around and the hematologist ruled out various blood diseases/lukemia. They concluded it was the way my body reacts to pregnancy. The hematologist is following me again to decide if / when I will go back on a baby aspirin a day.

noellemari

I do know that most anesthesiologists won't do an epi once they go under 70. There's too much risk of bleeding in the spine. At 110, you're fine. I will keep my fingers crossed that it stays stable for you.

I'm guessing you're a repeat section? Since you mentioned general anesthesia and delivery at 39 weeks. Maybe, you can schedule it around an anesthesiologist that is comfortable with performing an epidural at lower plt numbers, but usually you just get whoever is on that day, so that's a discussion to have with your OB as they will know who will do it and how low they will go.

And stop googling. . GL!

irisheyes317

I also have thrombocytopenia (no experience with the anemia side, sorry!). Mine was preexisting but has been getting worse as the pregnancy progresses (below 80 now).  I'm now seeing an MFM and a hematologist in addition to my regular OB/midwife practice, and I have been getting the same information you have.  My hematologist and OB group have both said that the cutoff platelet level for an epidural or spinal will depend on the particular anesthesiologist, but generally is between 80 and 100.  I found out that at my hospital, the anesthesiologists generally won't do an epidural below 100, so I'm already too low for it to be an option.  My hematologist is comfortable with delivery (without epidural) as long as my levels are above 50.  If they dip lower than that as it gets closer to my due date, they plan to start me on a course of oral prednisone, which would temporarily raise the levels long enough to get through labor.  My hematologist also said that if my levels drop below 30 at any time, they'd like me start treatment.  If I'm still below 100 and a c-section is necessary, general anesthesia would be required. 

Personally, my plan is to have a vaginal delivery unless there are other medical complications, and to do so without the epidural or spinal.  I've been planning on natural birth techniques and hired a doula to help with the delivery process.  If you're having a scheduled C-section at 39 weeks (I think that's what you mean above?), and your levels start falling as it gets closer, it might be worth exploring with your doctors whether they would recommend you start a course of prednisone prior to the scheduled date to see if it would raise your levels enough to get the epidural.  

Also, it might be worth asking your hematologist if he has any recommendations for the baby.  This may be because my thrombocytopenia is caused by an auto-immune condition called ITP, but my hematologist also recommended that I make sure to speak with the baby's pediatrician about my ITP, because the same antibodies that are destroying my own platelets can cross the placenta and result in temporary thrombocytopenia for the baby.  She wanted me to be sure that the pedi checks's the baby's platelets both right after birth and a few days later, because the baby's levels can drop quickly after a few days even if they're normal right at birth. 

Good luck! I hope your doctor can provide some comforting information at your next appointment, and remember that no matter how the actual delivery goes (even if you have to do general), it will be worth it so long as you have a healthy mom and baby at the end. 

Laurenldlw9

Now I'm even more concerned....my platelets were 103 at 28weeks and my dr just said she was going to keep an eye on them. I go tomorrow and I'll be 32weeks but I'm definitely going to ask her to recheck them. She never mentioned me going to see a hematologist. Pregnancy is so stressful!