Thrombocytopenia & Massively Enlarged Spleen - Pregnant & Undiagnosed

[BrittanyFR]

Hi All,

I was hoping that someone here would be able to shed some light on what is happening before I lose my mind reading endlessly about all of the horrible things that could be wrong with me.

I'm 28 years old and 20 weeks pregnant with a 5 year old boy and one miscarriage 7 months ago.  Through a routine blood test at 13 weeks it was discovered that I had low blood platelets.  They were at 96,000 at that point, so I took another test at 17 weeks and they had dropped to 86,000.  I was referred to a hemotologist and my results at 19 weeks showed they were then at 84,000 (smear test).  The hemotologist says she wants me to do another test when I go back in 3 weeks and mentioned the possibility of bone marrow testing if she could not diagnose me without it.

At 19 weeks I also did an ultrasound of the baby (everything is fine) and my spleen at the same time.  It turns out my spleen is 22cm, so double the normal size.  I assume that all my platelets are going there...  The doctor also mentioned that my liver is misshapen and not in the normal place, but they think it might be due to me having a paralyzed right diaghragm.  They told me there is no sign of disease.

Since my pregnancy from 2 until 12 weeks I had spotting everyday - mostly brown/pink blood.  I've been told I have a small cyst on my cervix that could possibly have caused the bleeding.  After that I only bled one other time, red blood, for two days but it stopped on its own.


Before pregnancy I was never more than 10lbs overweight, and fairly athletic; playing volleyball 3 nights a week and working a physical job.

Symptoms include:
fatigue (always blamed that on being a working mother)
shortness of breath more than usual; maybe due to the enlarged spleen?
one petechiae mark on my abdomen
sometimes one slightly rosy cheek that reminds me a bit of the blush malar rash - possibly on my nose but I have many freckles so it's hard to tell.  It burns when in the sun too long; maybe just a sunburn though??
anemia symptoms my whole life; pale skin & craving ice (pica) on and off - I don't eat a lot of meats or beans; blood tests say no anemia.
sometimes insane headaches after playing a hard game of volleyball; not from dehydration - usually they would come in spurts one month on and 3-4 months off.  This just started in the past few years.
have always sweat easily in heat or with exercise
have always had a very red face while exercising hard

I had also injured my right shoulder playing volleyball and had taken 6 months off to heal before becoming pregnant.  Since pregnancy, the pain is back with a vengeance and only occurs when lying down.  I never had my shoulder checked out so do not know the initial cause of pain.  I assume it could be the rotator cuff from playing so many overhead sports throughout my life.


Does any of this give an idea of what could be wrong?  Or do you have any suggestions for specific tests to request from my doctor & hemotologist?

All I keep reading about is cancer, lymphoma, leukemia, etc. and I'm just so scared.  I feel like I'm too young and "healthy" for this to be happening to me  :(

Thank you

[Dr. Kokil Mathur]

Hi!
Pregnancy itself can cause mild thrombocytopenia. However, since spleen is enlarged, this could be contributing to the dropping levels of platelets. Other causes could be tumors of spleen, chronic malaria, tuberculosis or polycythemia vera (which is a blood disorder with high red cell count, so ruled out in your case probably). Untreated or uncontrolled rheumatoid arthritis is also a major cause for hyperspleenism. Toxoplasmosis can also be a cause and hence a VDRL test should be done. A comprehensive investigation is required keeping all the points in mind. Do discuss this with your doctor and get yourself examined. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.

[BrittanyFR]

I forgot to mention...

My first pregnancy was normal with blood platelets normal (191,000) at 4 months.  I had major heart burn every night at the same time, no matter what I ate, for the last month of my pregnancy.  At 35 weeks I became unbearably itchy and my gynocologist said it was normal - I now suspect I had developed cholestasis of pregnancy.  I delivered my son at 36 weeks and he was normal size 7lbs 6oz, 21" with no complications.

During delivery I was cut and ripped, hemorrhaged, and was given a catheter for 2 days with some sort of IV.

I've since changed gynocologists.


I don't know if any of that is related to now?  I've been looking at all kind of different problems like HELLP and am just trying to piece it together.  All of the symptoms just seem to overlap each other and I don't know where to start  :(