The clinical course of thrombocytopenic pregnant patients who applied to Obstetric Polyclinic of Dicle University Hospital

Purpose: The main aim of this thesis is to evaluate the etiological distribution and clinical course of pregnant patients who applied to Dicle University Faculty of Medicine Hospital Obstetrics Outpatient Clinic and had a platelet count below 100,000/mm³. Thrombocytopenia during pregnancy is an important haematological finding that can occur due to different reasons and may affect maternal and foetal health. In this study, it is aimed to classify the diagnoses in the patient group presenting with thrombocytopenia during pregnancy, determine the etiological causes, and analyse the effects of these causes on the clinical course. In addition, by comparing the clinical and laboratory findings of the patients at the time of diagnosis with their follow-up during pregnancy, it is aimed to reveal the effects of different aetiologies on maternal and perinatal outcomes. In line with the obtained data, it is aimed to contribute to clinical awareness and appropriate management strategies for patients presenting with thrombocytopenia during pregnancy Methods: This study is retrospective descriptive research conducted within the Department of Obstetrics and Gynaecology at Dicle University Faculty of Medicine. Pregnant women who applied to the Obstetrics Outpatient Clinic of Dicle University Hospital between 01.01.2011 and 31.12.2024 and were found to have a platelet count below 100,000/mm³ were included in the study. Patient data were retrospectively reviewed from the hospital automation system and patient files. Age, gestational week, obstetric history, laboratory findings, platelet level at the time of diagnosis, accompanying systemic diseases, diagnostic criteria, treatment approaches, and clinical course of the individuals included in the study were recorded. The aetiology of thrombocytopenia was classified as pregnancy-related (gestational thrombocytopenia), immune (ITP), preeclampsia/HELLP syndrome-related, and other causes. The findings were compared and analysed according to diagnostic groups. Data analysis was performed using a statistical software package, and in addition to descriptive statistics, appropriate parametric or non-parametric tests were used to evaluate differences between groups. A p-value of <0.05 was considered statistically significant. Results: Our study included a total of 125 pregnant patients diagnosed with thrombocytopenia. When classified according to platelet counts, 4% of the patients had platelet counts of ≤25×10³/ml, 16% had counts ≤50×10³/ml, 26.4% had counts ≤75×10³/ml, and 53.6% had counts above 75×10³/ml. The mean platelet count across the entire patient group was determined as 71.62 ± 23.38 ×10³/ml. Abdominal ultrasonography (USG) was performed in 36.8% of the patients. The mean platelet counts in patients who underwent abdominal USG (60.98 ± 23.39 ×10³/ml) were significantly lower compared to those who did not undergo USG (77.82 ± 21.16 ×10³/ml) (p < 0.001). Furthermore, among patients who underwent abdominal USG, the proportion of patients with platelet counts ≤50×10³/ml (36.9%) was significantly higher than those who did not undergo USG (10.1%) (p < 0.001). Upon evaluation for splenomegaly, 26.4% of the patients were found to have splenomegaly. Patients with splenomegaly had significantly higher mean platelet counts (77.42 ± 16.45 ×10³/ml) compared to patients without splenomegaly (54.67 ± 23.02 ×10³/ml) (p = 0.003). Regarding diagnostic distribution, the most frequent diagnoses were gestational thrombocytopenia (39.2%) and immune thrombocytopenic purpura (38.4%). Other diagnoses included pseudothrombocytopenia (4%), HELLP syndrome (4%), liver cirrhosis (3.2%), and other less frequent conditions. Serological analyses revealed several significant differences regarding hepatitis viruses (HAV, HBV), Toxoplasma, Rubella, and Cytomegalovirus (CMV) infections, as well as ANA antibodies and anticardiolipin IgG/IgM antibodies. Positive ANA antibody results were particularly prevalent in the patient group with platelet counts ≤50×10³/ml (p < 0.05). Additionally, negative HAV IgM and HBc IgM results were significantly more common among patients who underwent abdominal USG and those with splenomegaly (p < 0.05). Conclusion: In this study, the clinical and serological characteristics of patients diagnosed with thrombocytopenia were comprehensively evaluated. The findings revealed that thrombocytopenia encompasses a broad etiological spectrum and that both laboratory investigations and imaging modalities significantly contribute to the diagnostic process. The majority of the study population was diagnosed with gestational thrombocytopenia (39.2%) and immune thrombocytopenic purpura (38.4%), indicating the predominant role of pregnancy-related and autoimmune mechanisms in the pathogenesis of thrombocytopenia. Nevertheless, secondary causes such as liver cirrhosis, HELLP syndrome, sepsis, and hematological malignancies were also identified with notable frequency. Serological test results demonstrated that infectious and autoimmune etiologies could be excluded in a substantial proportion of cases. Notably, a significant association was found between thrombocytopenia severity and the presence of autoantibodies, including ANA, anticardiolipin IgG/IgM, and Rubella IgM (p<0.05), supporting the role of autoimmune mechanisms in the development of thrombocytopenia. However, the high percentage of unperformed tests highlights the need for a more systematic approach to serological assessment in clinical practice. Statistically significant differences in platelet levels based on the presence of splenomegaly and abdominal ultrasonography (USG) findings (p<0.05) underscore the importance of imaging techniques in evaluating hypersplenism and portal hypertension as underlying causes. Interestingly, patients with splenomegaly had higher platelet levels, which may suggest that hypersplenism develops in more advanced stages or that differing pathologies coexist in this subgroup. In conclusion, a multidisciplinary approach is essential in the management of thrombocytopenia. A comprehensive assessment that integrates clinical findings, laboratory parameters, and imaging results facilitates accurate diagnosis and effective treatment planning. These findings also provide a valuable foundation for future prospective studies in the field.