28 Weeks Pregnant - my diagnosis of gestational thrombocytopaenia and iron deficiency
Weekly pregnancy updates from a childbirth educator, doula and mum to 2 little girls. Come and join me on my journey as I share how I’m feeling, how baby is developing, what I’m doing to prepare, and some favourite resources!
If you’re asking “Thrombo...umm, what even is that??”, that’s a perfectly valid question! It’s a fancy name for “low platelets”, and no, I wasn’t familiar with the term before either! It’s a relatively common condition in pregnancy, although the diagnosis is quite subjective. In Australia, the accepted “healthy minimum” level of platelets shows up as 150 on your blood test results, so anything below that is diagnosed as thrombocytopaenia. In Italy, where I had my first baby, they calculate the minimum as 130, so the level of 145 on my latest blood test results wouldn’t have even raised an eyebrow there.
When my midwife got my blood test results at the beginning of this week and contacted me about them, she mentioned an episode of The Great Birth Rebellion dealing with this topic. I had a listen to that, and it turns out the choice of 150 as a lower reference point seems to be perfectly arbitrary and not based on research! The research would indicate that even levels of 80-100 are generally quite adequate to provide good blood clotting for birth, though obviously generalisations shouldn’t be taken as being for everyone! Women with levels below 80 are unlikely to be able to access an epidural, because of the risk of internal bleeding. The lower the platelet count, the less Caesarean sections are advisable (except in life-or-death situations of course), because of the anticipated greater blood loss during a C-section compared to a vaginal birth.
Iron deficiency
Another low level noted on the test results was ferritin, which had dropped down to 10. The lower reference point is 30, and anything below 15 is deemed to indicate an iron deficiency. Haemoglobin levels are in the norm, and I’m certainly not feeling any symptoms of iron deficiency or anaemia. Actually, these results came as quite a shock to me, partly since I’ve never had low levels on blood tests in any pregnancy, but this is also the pregnancy I've been feeling most energetic!
The point of being alerted to these numbers isn’t that the numbers are actually “bad” or “dangerous” in themselves. The point is more the trajectory. I’ve had a drop of platelets from 210 to 145 and ferritin from 71 to 10 in the space of 3-4 months. If the levels were to stay as they are now, there would be no cause for concern, but the risk is they might keep dropping if we don’t do anything about it, and I might find myself with symptoms of anaemia or other issues.
Possible cause
Reflecting on this situation, the thing that came to mind was the fact that I was off meat for so long this pregnancy. If you’ve been following along, you might remember that around 7 weeks pregnant I really just couldn’t stomach red meat anymore and dropped it. I kept up the poultry a little bit longer, but not for long, and from then on ate very little meat up until nearly 22 weeks. That’s 3-4 months with next to no red meat, which I normally eat regularly, and which is high in iron. Probably not a coincidence!
My thinking is that it’s possible the levels may have even dropped a little lower, and were already starting to climb again by the time I got my blood tests done last week. But we have no way of knowing that. It is also really common for these levels to drop during pregnancy, due to the extra demands on our body’s resources, so there’s a good chance that levels have continued dropping since I added meat back in, though hopefully more slowly.
My plan of action
The current plan of action is to increase my meat intake, and other dietary iron sources, and I’ve also started taking Spatone, which is a food-based iron supplement (a mineral water naturally rich in iron). I’ll get more blood tests done more regularly, starting next week, and see how things are going. We don’t actually realistically expect to see improvement by next week, since food-based iron is going to build up over time rather than show results super quickly. The main reason for doing the blood tests so soon is to check there isn’t anything else underlying the thrombocytopaenia diagnosis. Apparently around 75% of women who get gestational thrombocytopaenia have just that, without any pathologies. But for the other 25% it can be connected to pre-eclampsia or HELLP syndrome. I don’t have any symptoms of either of these, but we’d rather test and rule them out than not know for sure! Provided all is clear, I’ll continue the focus on building up my iron stores using diet and natural supplements for a number of weeks, with the goal of seeing levels stabilise or even increase.
What symptoms am I feeling?
It’s just been a normal week for me! No symptoms to speak of, which as I said was one reason I was a little surprised at the blood test results! But this is half the point of doing regular blood tests - so we can get onto deficiencies or downwards trends before we are actually feeling negative effects!
How has baby been developing this week?
At around 38cm long and weighing 1.2-1.4kg (as always, these are approximate measurements just to give a rough idea!), baby is now practicing sucking and swallowing the amniotic fluid!
What am I doing to prepare?
Added to my regular daily prep this week, of course I spent time researching iron deficiencies, low platelets, and listening to a couple of relevant episodes of The Great Birth Rebellion (linked below).
I also pulled out my antenatal records from my previous pregnancies, just out of curiosity. With my oldest back in Italy, there was no record of ferritin levels, but haemoglobin was always within range, and we did test platelets at 14 weeks (179), 33 weeks (149) and 38 weeks (131). But as noted above, thrombocytopaenia isn’t considered until below 130 in Italy, so I didn’t get that diagnosis.
Next pregnancy here in Australia I don’t have any record of platelets. Haemoglobin was always within range, and the midwife did write my ferritin levels in my note at 27 weeks (47) and 35 weeks (26). So regardless of the lack of complete records to compare properly, it’s pretty clear that I’ve had a much bigger drop this time in both ferritin and platelets, and I’m pretty confident that reason is that I was off meat for so long, whereas it had been no more than a few weeks in the previous pregnancies.
Resources:
The Great Birth Rebellion Podcast Episode 27 - Low Platelets in pregnancy (Gestational Thrombocytopaenia)
The Great Birth Rebellion Podcast Episode 142 - Iron deficiency in pregnancy
And that’s it for this week! 🌿💛
[Image credit: Photo by Parnis Azimi on Unsplash]