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Chapter 53 - Thrombotic Thrombocytopenic Purpura in Pregnancy

from Section 9 - Hematologic Conditions in Pregnancy

Published online by Cambridge University Press:  23 February 2023

By
Paula D. James  and
Laura M. Gaudet
Edited by
Amira El-Messidi  and
Alan D. Cameron
Amira El-Messidi
Affiliation:
McGill University, Montréal
Alan D. Cameron
Affiliation:
University of Glasgow
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Summary

During your call duty, a healthy 32-year-old primigravida at 22+3 weeks’ gestation, confirmed by first-trimester sonography, presents to the obstetrics emergency assessment unit of your hospital center with new-onset, asymptomatic port-wine-colored urine with chills and an oral temperature of 39.1°C at home; she also notes a two-day history of headache, now accompanied by visual changes. Your obstetric trainee informs you that clinical history is not suggestive of an infectious etiology, although comprehensive investigations are pending. She has no obstetric complaints, and fetal viability was ascertained upon presentation. Routine prenatal laboratory investigations, aneuploidy screening, and fetal morphology survey were unremarkable. The laboratory urgently notifies you that the platelet concentration is 12 × 109/L, confirmed on manual count; other requested laboratory tests are in progress.

Keywords

Thrombotic microangiopathy, thrombotic thrombocytopenic purpura (TTP), acquired and congenital TTP, pregnancyDiagnosis, criteria, pentadPathophysiologyMicroangiopathic hemolytic anemia (MAHA)Perinatal risks, complications, maternal-fetal morbidity, adverse outcomeAntepartum, intrapartum, postpartum managementPlasma exchangePreconception counselingPreeclampsia, HELLP syndrome
Type
Chapter
Information
OSCEs in Obstetrics and Maternal-Fetal Medicine
An Evidence-Based Approach
 , pp. 680 - 689
Publisher: Cambridge University Press
Print publication year: 2023

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References

Suggested Readings

Battinelli, EM. TTP and pregnancy. Blood. 2014;123(11):1624–1625.CrossRefGoogle ScholarPubMed
Fyfe-Brown, A, Clarke, G, Nerenberg, K, et al. Management of pregnancy-associated thrombotic thrombocytopenia purpura. AJP Rep. 2013;3(1):45–50.CrossRefGoogle ScholarPubMed
Jiang, Y, McIntosh, JJ, Reese, JA, et al. Pregnancy outcomes following recovery from acquired thrombotic thrombocytopenic purpura. Blood. 2014;123(11):1674–1680.CrossRefGoogle ScholarPubMed
Keiser, SD, Boyd, KW, Rehberg, JF, et al. A high LDH to AST ratio helps to differentiate pregnancy-associated thrombotic thrombocytopenic purpura (TTP) from HELLP syndrome. J Matern Fetal Neonatal Med. 2012;25(7):1059–1063.CrossRefGoogle ScholarPubMed
Pourrat, O, Coudroy, R, Pierre, F. Differentiation between severe HELLP syndrome and thrombotic microangiopathy, thrombotic thrombocytopenic purpura and other imitators. Eur J Obstet Gynecol Reprod Biol. 2015;189:68–72.CrossRefGoogle ScholarPubMed
Savignano, C, Rinaldi, C, De Angelis, V. Pregnancy associated thrombotic thrombocytopenic purpura: Practical issues for patient management. Transfus Apher Sci. 2015;53(3):262–268.CrossRefGoogle ScholarPubMed
Scully, M, Thomas, M, Underwood, M, et al. Thrombotic thrombocytopenic purpura and pregnancy: presentation, management, and subsequent pregnancy outcomes. Blood. 2014;124(2):211–219.CrossRefGoogle ScholarPubMed
Vesely, SK. Life after acquired thrombotic thrombocytopenic purpura: morbidity, mortality, and risks during pregnancy. J Thromb Haemost. 2015;13(Suppl 1):S216–S222.CrossRefGoogle ScholarPubMed
von Auer, C, von Krogh, AS, Kremer Hovinga, JA, et al. Current insights into thrombotic microangiopathies: thrombotic thrombocytopenic purpura and pregnancy. Thromb Res. 2015;135(Suppl 1):S30–S33.CrossRefGoogle ScholarPubMed
Zheng, XL, Vesely, SK, Cataland, SR, et al. ISTH guidelines for treatment of thrombotic thrombocytopenic purpura. J Thromb Haemost. 2020;18(10):2496–2502.CrossRefGoogle ScholarPubMed

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