Most women, especially first time mothers, have deficient knowledge about the normal physiological changes in pregnancy. In the third trimester, mothers are concerned about the changes in body weight, appearance and her complete blood count. It is not surprising if the mother is worried about blood disorders such as anemia.
All these can be attributed to the cardiovascular system changes in a pregnant woman which includes an increase of the blood volume for at least 30% (and possibly for as much as 50%.) An increase of the blood volume is needed by the mother to provide for adequate exchange of nutrients in the placenta and to provide for adequate blood to compensate for blood loss at birth.
In consequence, the increase of blood volume dilutes the blood components including the red blood cells, white blood cells and platelets. In response, these blood components also increase slightly. Iron intake is increased to address pseudoanemia and the needs of the fetus. What about the platelets? Platelets or thrombocytes are tiny cell fragments responsible for clotting.
Unlike red blood cells and white blood cells, platelets do not increase in number in pregnancy causing it to be inadequate for the needs of the pregnant mother. The average adult has a platelet count of 150 to 450 thousand per milliliter of blood. This normal value can vary from person to person but more or less it doesn’t deviate from the standard value.
If the platelet count goes below 50,000, this condition called thrombocytopenia can be life threatening not only for the pregnant mother but also for the baby. Serious blood loss and anemia can happen. Pregnancy can cause dilutional thrombocytopenia, a normal occurrence, but a low platelet count can also result from serious anomalies such as AIDS, thrombocytopenic purpura and cancer which causes a compromised immune system.
Pre-eclampsia, a triad of conditions where the woman’s urine has protein, presence of edema and the mother’s blood pressure increases in pregnancy, can lead to a very serious condition called HELLP syndrome. HELLP syndrome includes H or hemolysis (destruction of RBCs), EL or elevated liver enzymes and LP or low platelet count. The physician or midwife may issue a blood work and a 24 hour urine collection. In HELLP syndrome, anemia can result from hemolysis and can cause the liver to over work.
Elevation of liver enzymes indicates liver damage. Signs and symptoms include nausea with or without vomiting, upper abdominal pain, high level of liver enzymes and thrombocytopenia. Bruising, bleeding and slow or no blood clotting because of thrombocytopenia are other presenting symptoms. In order to prevent further lowering of platelet count, mothers must follow a healthy and balanced diet with plenty of fluids, proteins, vitamins, fruits and vegetables with a lot of Vitamin B12 and folate.
Mothers must be faithful to their prenatal check-ups and must go their physician if she is feeling unusual or any of the symptoms above. Any cramping or pain when bleeding must be reported to the physician as soon as possible. Implantation syndrome experienced in the first trimester includes slight bleeding as the fertilized ovum implants itself in the uterine wall. Mothers diagnosed with HELLP syndrome must only deliver their baby to be cured.
Childbirth dramatically reduces plasma volume thereby returning to pre-pregnant levels. Blood components also slowly returns to normal values. Thrombocytopenia caused by other conditions aside from pregnancy can also be treated through blood transfusions. Whole blood can cause dilutional thrombocytopenia and increases other blood components, so it whole blood is usually discouraged. Blood components such as platelet transfusions are more preferred than whole blood. Platelet transfusions are more expensive though.
