Low platelets and Swollen Gland

I am 25 years old and am 14 weeks pregnant with my second child. When I went to my gyno last time, they did blood work, and it came back that I have a low platelet count. (At the time, I wasn't smart enough about this to remember the actual count.) So I went home and did some research, read about ITP and TTP, and thought maybe it was just due to being pregnant that they were low. No biggie for the time being, right? WRONG. All day yesterday, I had a pain under my arm, which I thought was my underwire from my bra cutting into my skin. Upon further investigation, I realized it's not from that, it is a swollen lymph node. I haven't had a swollen node under my arm since I was about 12 yrs old. Now, I am not the smartest person in the world, but I AM smart enough to know that these two together are NOT a good sign. So NOW I am freaking out. BAD! What could this be??? Any advice or help would be greatly appreciated.

[Dr. Kokil Mathur]

Hi

How are you now?

You were not wrong to think that pregnancy too can lower the platelets. Since you do not know what the count was it is difficult to comment, since pregnancy only marginally lowers the count.

A swelling in your armpit may be due to so many reasons and not all are very serious.
“Lumps may be produced by lymph nodes enlarged due to bacterial infections, viral infections, vaccinations, and malignancy. A self-examination of breast should always include the armpit because breast cancer can enlarge the armpit lymph nodes even when the breast itself seems perfectly normal.” Other causes could be Lipoma (collection of fat), cyst, abscess etc. It is difficult to give a diagnosis without examining the swelling. Ref: http://www.*************.com/ency/408/003099.html

I would suggest you consult your physician about this and get yourself examined. Do a self examination of your breast for any lump. You may be required to do a FNAC (where the cells from the lump are pulled into the syringe with a very fine needle and examined under microscope) for the lump. The swelling and low platelets may or may not be related.

The various causes of low platelets are as you know ITP, TTP, Dengue fever, rheumatoid arthritis, etc. Refer: http://www.mayoclinic.com/health/thrombocytopenia/DS00691/DSECTION=causes
http://www.netdoctor.co.uk/diseases/facts/thrombocytopenia.htm

Dangerously low platelets will cause bruising of skin and bleeding. Refer: http://www.mayoclinic.com/health/thrombocytopenia/DS00691/DSECTION=symptoms

Please keep me posted about the results and other development. If you need more help, please feel free to contact. I’ll be happy to answer your queries.

[Bhupinder Kaur, MD]

Hello,

It is normal for platelets to decrease in count in pregnancy slightly.But as you don’t remember your counts and probably having a swollen lymph node,it can’t be considered normal.

An abnormally low platelet count(<150000) in pregnancy is usually associated with a pre-existing condition, such as lupus,lymphomas,leukemias,HIV or with certain medications, such as heparin. Or it could be a sign of an underlying problem with your pregnancy, such as HELLP syndrome, which is a rare complication of pre-eclampsia. In this case you would have other symptoms, such as headaches, nausea and pain in your upper abdomen.HELLP means (H) hemolyis, (EL) elevated liver enzymes and (LP) low platelets.Ref: http://www.babycentre.co.uk/pregnancy/complications/lowplateletsexpert/

I feel that you need further injvestigations like complete blood count, peripheral blood sample, prothrombin time,activated partial thromboplastin time,ANA antibody titres,liver enzymes and ELISA for HIV.If ITP(idiopathic throbocytopenic purpura) is found to be the cause of low platelets then an ultrasound-guided "cordocentesis" may be recommended to foresee the risk to the baby.Moreover your BP has to be monitored regularly to foresee any pregnancy induced hypertension(PIH).

Mostly,gestational thrombocytopenia requires no treatment other than a sharp eye on the development of labout and amount of blood loss in labour.But if ITP is found out to be the cause,then platelet transfusion may be required.

My advise is to consult your gynecologist and get yourself evaluated for ITP and HELLP.
Hope it helps.Take care and pls do keep me posted on how you are doing.