ITP in Pregnancy

See also ITP main page or Immune thrombocytopenic purpura (peds) for pediatric patients.


  • Marked diff between maternal and fetal platelet counts
  • No antenatal measures predict fetal status
  • Maternal response to medicine does not guarantee a favorable outcome for baby
  • Only previous neonatal outcomes provide predictor of neonatal platelet counts.

Clinical Features

Petechiae in a patient with ITP.
Petechiae on the tongue in a patient with ITP.
Petechiae on the lower leg in a patient with ITP.
Unprovoked gingival bleeding as a presenting symptom in ITP.

Differential Diagnosis


Decreased production

Increased platelet destruction or use

Drug Induced

Comparison by Etiology

↓ PLT Yes Yes Yes Yes Yes
↑PT/INR No No No +/- Yes
MAHA No Yes Yes No Yes
↓ Fibrinogen No No No No Yes
Ok to give PLT Yes No No No Yes


  • Usually mild thrombocytopenia (>70k)
    • Platelet count normalizes after delivery


  • Balance risk of thrombocytopenia (for mother and fetus/baby) vs potential teratogenesis from therapy
  • Treatment indicated if[1]:
    • Platelets <10,000
    • Platelets <30,000 and bleeding or in 2nd or 3rd trimester
  • Risk of prednisone or IVIG outweighed by benefits in above situations[2]
  • Infant has slightly increased risk of ICH with v low risk of ICH- but higher of normal baby
    • role of cesarean in preventing ICH controversial
  • If baby has platelets <30k; IVIG and or prednisone
  • No contraindication to breastfeeding.

See Also


  1. Stavrou E, Mccrae KR. Immune thrombocytopenia in pregnancy. Hematol Oncol Clin North Am. 2009;23(6):1299-316.