Thrombotic Thrombocytopenic Purpura in Pregnancy: Successful Treatment with Plasma Exchange

Mokrzycki, Michele H.; Rickles, Frederick R.; Kaplan, André A.; Köhn, O.

doi:10.1159/000170210

Cited by 26 publications

(14 citation statements)

References 42 publications

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“…There are multiple reports of prolonged courses of plasma exchange, beginning as early as 6 weeks' gestation, which maintained remission of TTP-HUS and allowed delivery of a healthy, full-term infant [36±38]. If plasma exchange fails to induce a prompt remission, termination of the pregnancy may be considered, although the response of TTP-HUS to termination of pregnancy is uncertain [38].…”

Section: Management: Indications For Intervention With Plasma Exchangementioning

confidence: 99%

Evaluation of women with clinically suspected thrombotic thrombocytopenic purpura‐hemolytic uremic syndrome during pregnancy

McMinn

George

2001

J of Clinical Apheresis

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Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) is more common in women, and commonly occurs during pregnancy and the immediate postpartum period. An important clinical issue is the distinction of TTP-HUS from the more common obstetric complications, preeclampsia and HELLP syndrome (hemolysis, elevated liver function tests, low platelets). Clinical suspicion of TTP-HUS requires urgent intervention with plasma exchange treatment, a procedure with substantial risk, while preeclampsia and HELLP syndrome typically resolve spontaneously following delivery. Since clinical features of these syndromes can be similar, especially if preeclampsia becomes severe or if seizures (defining eclampsia) occur, the differential diagnosis may be arbitrary. This review addresses the evaluation and management of these syndromes and describes a clinical approach for determining when plasma exchange is appropriate.

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Section: Management: Indications For Intervention With Plasma Exchangementioning

confidence: 99%

Evaluation of women with clinically suspected thrombotic thrombocytopenic purpura‐hemolytic uremic syndrome during pregnancy

McMinn

George

2001

J of Clinical Apheresis

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“…TTP can also occur during pregnancy but almost all cases have either been reported in second or third trimester of pregnancy [3,4]. The earliest reported case was at 6 weeks of gestation [5]. We report a case of young lady with a 5-week pregnancy, who developed TTP and succumbed to her illness.…”

Section: Introductionmentioning

confidence: 92%

Thrombotic thrombocytopenic purpura in a patient with very early pregnancy: clinical presentation and autopsy findings

Sharma¹,

Radotra

Wanchu³

et al. 2008

Blood Coagulation &Amp; Fibrinolysis

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Thrombotic thrombocytopenic purpura is a thrombotic microangiopathy leading to microvascular occlusion resulting in ischemic dysfunction of various organs. Pregnancy has been thought to precipitate it during second and third trimester, but its reports in first trimester are extremely rare. We report the clinical protocol of a young lady with 5-week period of gestation, who presented with fever, seizures and altered sensorium, and succumbed to her illness during an episode of seizure. Complete autopsy findings are also presented in detail.

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“…The significance of exact antenatal diagnosis is derived from the fact that two divergent management plans are needed. The optimal treatment for TTP is plasmapheresis, and this should be instituted as soon as the diagnosis is entertained [4], while, termination of pregnancy does not ameliorate the condition [5]. On the other hand, delivery remains the definitive treatment in HELLP syndrome [6], whereas, plasmapheresis is not a part of the usual antenatal management plan.…”

Section: Introductionmentioning

confidence: 99%

HELLP Syndrome, Thrombotic Thrombocytopenic Purpura or Both: Appraising the Complex Association and Proposing a Stepwise Practical Plan for Differential Diagnosis

et al. 2018

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Both thrombocytopenia and microangiopathic hemolytic anemia (TMA) are seen in thrombotic thrombocytopenic purpura (TTP) and HELLP syndrome among other disorders during pregnancy. Although both share backgrounds of endothelial injury and microvascular thrombi and some clinical features, yet, they have different etiologies and courses. In late pregnancy, differentiating between these two pathologies can be extremely difficult due to the immense overlap in clinical and laboratory manifestations and this becomes only possible with the use of specific markers as ADAMTS-13, when available. Hereby, we describe three cases that may exemplify the complex association between PE/HELLP syndrome and TTP. The first case presented with PE/HELLP syndrome and deteriorated postpartum to improve on plasmapheresis. The second case was a known TTP patient who developed superimposed PE/HELLP at 27 weeks gestation which necessitated emergent delivery. The third was a case of preeclampsia that progressed to HELLP syndrome on day 2 postpartum but 3 days later was complicated by TTP. HELLP syndrome and TTP can co-exist, but can also complicate one another. In the absence of instantaneous results of ADAMTS-13 and when diagnosis with clinical judgement alone cannot be done with certainty, a short trial-plasmapheresis could be attempted with close observation of the immediate response. This stepwise approach might prove to be a valuable tool when integrated in the usual workup of clinical and laboratory evaluation both before and after delivery.

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Thrombotic Thrombocytopenic Purpura in Pregnancy: Successful Treatment with Plasma Exchange

Cited by 26 publications

References 42 publications

Evaluation of women with clinically suspected thrombotic thrombocytopenic purpura‐hemolytic uremic syndrome during pregnancy

Evaluation of women with clinically suspected thrombotic thrombocytopenic purpura‐hemolytic uremic syndrome during pregnancy

Thrombotic thrombocytopenic purpura in a patient with very early pregnancy: clinical presentation and autopsy findings

HELLP Syndrome, Thrombotic Thrombocytopenic Purpura or Both: Appraising the Complex Association and Proposing a Stepwise Practical Plan for Differential Diagnosis

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