Anyone diagnosed with low platelets?

chikinyellow

I was just diagnosed with a mild version of low platelets, and was told that they have to be monitored up until delivery and if they go much lower, I will not be able to have an epidural.

I am wondering how often you are being monitored and if they are also monitoring you for symptoms of HELLP?

I had low platelets with DS, but it didn't appear until during/after delivery.  I also started swelling and had high BP.  Just worried since I have developed this earlier that I may develop complications before I am full term.

mgarza1231

I have ITP which is low platelets period, not just with pregnancy. Although it can happen in pregnancy and go away right after birth. I was monitored every month with mine. They say it will come down to the day i'm in the hospital whether or not I can get the epidural. It also may mean if you were to have a c-section they would have to put you under general anesthesia instead of a spinal block/epidural. Making it more of an "emergency" situation. If they did not mention that, I would ask about it. Although they usually have to be pretty low for either of those things to happen. My doctor says under 75,000 no epi but other doctors say no under 100,000. I wish you the best of luck, thought I would share my little bit of knowledge.

chikinyellow

Thank you so much for responding!  I don't know what my levels are, but I am going to ask.  I can go without an epidural, but if I to have a c-section, I don't want to be under general anesthesia.

GL with your labor!! 

KensBarbieNJ

I was diagnosed first trimester and had my baby this week. I was referred to a hematologist who checked a ton of things (auto immune diseases, etc) to rule those out. Then I was monitored every month with a blood test until my June appointment, when the OB's CBC test showed that my platelets dropped to 44K. because I was a repeat c-section, they wanted to keep me above 50K for surgery. (vag delivery goal is 25K or above). The doctor prescribed 40mg/1x day of prednizone (orally) for me. That brought my level up to 120k. They dropped it down to 20mg/day the next week and it was 137k. Needless to say, I responded quite well to the meds. I continued on varying low doses of the prednizone until the week before delivery, then it was increased back up to 40mg. The day of surgery, I was at 110k, and it has continued to increase after delivery as well. I wound up having a spinal. :-)

I didn't have ITP with my first child, this was completely new for this pregnancy.  Last pregnancy I had a lot of swelling, this time: almost none. My BP was very good this time as well. Keep a record of the BPs from your appointments, because if you call after hours with a concern, they will ask you about your recent BPs. I didn't show any signs of HELLP at any time, i hope it's the same for you.

I will not lie, it was incredibly stressful. but it turned out quite fine, and I was on the fence with my levels for months. I didn't know until the day of surgery that I would be awake.

When my platelets dropped below 50K, the doctors started monitoring me weekly until the end of the pregnancy. I delivered Monday evening and they are releasing me today, so I was here a little longer. The care has been great though, so I don't mind. ;-) 

I hope this helps. If you have any questions, you can page me on the Babies 0-3 board. I will say, the prednizone gave me a LOT of energy. Perhaps too much energy. Take it as early in the morning as possible so you can sleep at night. Taking it with food helps a lot too (it has a nasty aftertaste). 

I found a discussion board about it, and although there isn't much to say about here, I found it comforting to know other people have gone through it:

https://discuss.pdsa.org/

Best of luck to you and your baby! It is nowhere near as bad or scary as I thought it would be. I was scared due to lack of knowing people with experience with it, being uncommon, etc. It is very manageable, and your doctors knowing about it early is a great thing. I hope the rest of your pregnancy goes smoothly and without any complications!

KensBarbieNJ

ps-I also  had to do a consult with anesthesiology (via phone). I had to send all my blood work from hematologist and OB to her. Based on our hospital's policy, our guidelines are:

below 80K: general

80-100K: assess the risks of doing general vs spinal. for example: my labs have consistently showed that I have large healthy platelets. That gave me a better of shot of being able to get a spinal vs general.

 above 100K: spinal

these vary by hospital and doctor. the other anesthesiologist here would go as low at 75k. all the factors have to be looked at before a final decision is made. I feel very fortunate about how my situation turned out, knock on wood!

chikinyellow

Thank you KensBarbie!

 

Reading everything online has made me scared and this helped!! 

KensBarbieNJ

Glad I could help! :-) I know how scary it was that no one could give me any information or personal experience. It was so frustrating and upsetting.

The hematologist!MFM doctors told me that I should continually remind the hospital to do a platelet count for DS when he was born. ITP is passed on to less than 5% of babies, if that. In our hospital, the pediatrician is the one who orders it, not the OB, etc. I point this out so you know who will need to order it and remind the staff. You can ask your OB if s/he will order it.

AND the ITP will affect the type of meds you can take for pain afterwards. I couldn't take ibuprofran afterwards, so I was given morpheme for 24 hours, then 2 percocets while in the hospital (and now I get 1 every 4 hours at home). The hematologist can evaluate your count and decide later if they want to let you take the ibuprofran. however, if they do agree, you need to stay on top of making sure the hospital gets the order. my order wasn't put in and i never received it.

my platelets were checked mon/tues/wed/fri this week. They skipped yesterday (which was nice, because lab rounds were at 5am and I was able to sleep in). When I left today, they were up to 191 from 110 on Monday. This is also with a decrease in the prednizone. I need to have my levels checked tuesday or wednesday of this week at the office. On the mornings I had the lab work done, they had a difficult time sticking me because I had not eaten or had anything to drink for hours. After discussing it with my nurse on Wednesday, we decided at my 3am medication time, she would bring me a huge drink. this helped a lot with getting a good draw. 

So i think that is EVERYTHING I can say. I will not lie, Monday was the hardest day of my life. I have never cried so much or so hard, I was just so scared because there was a lot I didn't know, and I knew I could possibly need transfusions, etc. It went so well, and I truly wish the same for you. I feel so lucky that things are okay. I questioned everyone in the past several months, and as far anyone in the health field who has experience with this can tell me, people don't die from this, their children don't have huge problems from it, and when the doctors are aware of it from an early time (like with you and I), they are prepared for it. Being prepared is key, from I've been told. You can look at it as now that they know there is a possibility you will have problem, they know exactly what to be prepared for. It's like travel insurance! They said when people show up for birth and then it's discovered their platelets are low that they face the most potential problems. even then, it's not a death or severe experience (in most cases. I've yet to find something that said: she went to deliver but died because her platelets were too low and they didn't know).

I wish I could tell you to relax and not worry, but the more people said that to me, the more I wanted to explode, the more upset I became. however, I can tell you that I have been dealing with this since early spring and as I sit here right now with my new baby, I have never felt happier or more peaceful in my life. Never. :-) I feel like a huge load has been lifted, I'm happier than I've been in months. And it's definitely not the drugs talking, because they all make me loopy. :-D