Additional Investigations

The topic was presented very clearly, but I would still like to add some comments. On thrombocytopenia—such as gestational thrombocytopenia, for example—a thrombocyte function test should be undertaken, in order to rule out a possibly comorbid thrombopathy—especially in frequent epistaxis or hematoma. The test of choice would be either the Multiplate, Chrono-log, or VerifyNow test. In confirmed thrombocytopenia and increased peripartum hemorrhage, 1 ampoule of desmopressin per 10 kg body weight should be given intravenously (IV) as a brief infusion, followed by 1 g tranexamix acid IV. As an emergency measure in persistent hemorrhages, 1000 international units (IU) von Willebrand factor should be given IV, for example. Although measuring antiplatelet antibodies is not recommended as a routine examination, in idiopathic thrombocytopenia, it is important to try to detect antiplatelet antibodies of the IgG type and, if required, to determine their titers. These can enter into the fetal circulation and cause thrombocytopenia in the infant Furthermore, the human platelet antigen (HPA) status should be determined in women who take acetylsalicylic acid (ASS) (2). In mothers who are HPA-1a or HPA-5b negative, the partner’s HPA status should be ascertained. If this is positive for one of the two characteristics, then HPA antibodies will need to be detected from the 16^th week of gestation at monthly intervals (3). If such antibodies are confirmed, neonatal alloimmune thrombocytopenia may affect the newborn. For this reason, the peripartum and postpartum measures should be undertaken as in autoimmune thrombocytopenia (4). A further helpful differentiation between HELLP syndrome and thrombotic-thrombocytopenic purpura (TTP) can be achieved by using von Willebrand activity. Where activities > 150% of the normal maximum value occur without acute phase reaction with hyperfibrinogenemia, Factor VIII, CRP and D-Dimer increase, leukocytosis or thrombocytosis, then this would indicate TTP.