Isolated TCP

Gestational TCP

Start in pregnancy, mainly after the middle of the second trimester, counts less than 70 × 10⁹/L are uncommon. No hemorrhagic manifestations. Exclusion diagnosis

Immune TCP

100 × 10⁹/L destruction mediated by production of antibodies against glycoproteins IIa/IIIa

Primary

Exclusion diagnosis. Helps to differentiate from gestational: platelets < 50 × 10⁹/L, pre-pregnancy onset, does not resolve postpartum

Secondary

Triggered by viral, bacterial, drug, or vaccine infections

HIT

Hypercoagulable state (thrombotic manifestations) usually between 5 - 14 days after heparins or earlier without previous exposure.

TCP Associated with Systemic Disorders

Microangiopathy

Hypertensive disorders, Preeclampsia/HELLP

Hypertension (SBP ≥ 140 mmHg DBP ≥ 90 mmHg after 20 weeks of gestation + proteinuria (≥300 mg/day)

In the absence of proteinuria:

Kidney: creatinine > 1.1 mg/dl

Liver: transaminases > 2 times the normal value right upper quadrant or epigastric pain

Neurological compromise: headache, tinnitus, phosphenes

Hematological < 100,000 platelets × 10⁹/L

Uteroplacental dysfunction: intrauterine growth restriction

TTP

ADAMTS13 < 5%, neurological compromise

SHU

ADAMTS13 > 5%, Shiga toxin +

SHUa

ADAMTS13 > 5%, Shiga toxin −

Other Immune Causes

­ Systemic lupus erythematosus < 1%

­ Antiphospholipid syndrome < 1%

­ Drug-induced thrombocytopenia < 1%

Non-immune mediated

­ Fatty liver of pregnancy

­ Hypersplenism

­ Malnutrition (deficiency of folic acid, vitamin B12)

­ Associated with infection: HIV, HCV, EBV

­ Bone marrow disease (leukemia and others)

­ Sepsis and CID