Successful Treatment of Thrombotic Thrombocytopenic Purpura in Pregnancy: A Case Report

Document Type : Case Report

Authors

1 Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Resident, Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Obstetrics, School of Nursing and Obstetrics, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Thrombotic thrombocytopenic purpura (TTP) is severe form of thrombotic microangiopathies. Mechanism of this disease has been linked to a disintegrin and metalloprotease with thrombospondin type 1 motif member 13 (ADAMTS13) activity. This protease cleaves von Willebrand factor (VWF). This disease manifest with severe deficiency in ADAMTS13 and increase concentration of ultralarge multimers of VWF that leads to extensive microvascular platelet deposition thereupon thrombocytopenia and small-vessel occlusion, followed by hemolytic anemia. Incidence of disease during pregnancy is 1 in 25,000. VWF levels increase in third trimester and ADAMTS13 levels reduce. Before start of specific treatments such as plasmapheresis, maternal mortality was about 85% and fetal mortality approached 80%. Our purpose is review of the newest method of investigation and management the disease of TTP in the third trimester of pregnancy.Case Report: Patient is 30 years old woman with term pregnancy with complaint of nausea, vomiting, weight gain and high blood pressure. In primary lab data has hemolysis, elevated liver enzyme and low platelet. She admitted with suspicion of hemolysis elevated liver enzyme low platelet count (HELLP) syndrome. Because of ongoing decrease of platelet count and hemolysis she underwent emergency caesarian section. After caesarian section as regards hemolytic microangiopathic anemia and diagnosis of TTP plasmapheresis started. The patient finally improved and was discharged.Conclusion: TTP is correlated with pregnancy. Regarding the definite and effective therapeutic impress of plasmapheresis in TTP, it is advised to start plasmapheresis in patients whose laboratory and clinical data are suspicious to TTP.

Keywords

References

  1. Falter T, Kremer Hovinga JA, Lackner K, Fullemann HG, Lammle B, Scharrer I. Late onset and pregnancy-induced congenital thrombotic thrombocytopenic purpura. Hamostaseologie 2014; 34(3): 244-8.
  2. Delmas Y, Helou S, Chabanier P, Ryman A, Pelluard F, Carles D, et al. Incidence of obstetrical thrombotic thrombocytopenic purpura in a retrospective study within thrombocytopenic pregnant women. A difficult diagnosis and a treatable disease. BMC Pregnancy Childbirth 2015; 15: 137.
  3. Gasparri ML, Bellati F, Brunelli R, Perrone G, Pecorini F, Papadia A, et al. Thrombotic thrombocytopenic purpura during pregnancy versus imitator of preeclampsia. Transfusion 2015; 55(10): 2516-8.
  4. Scully M, Thomas M, Underwood M, Watson H, Langley K, Camilleri RS, et al. Thrombotic thrombocytopenic purpura and pregnancy: presentation, management, and subsequent pregnancy outcomes. Blood 2014; 124(2): 211-9.
  5. Ferrari B, Maino A, Lotta LA, Artoni A, Pontiggia S, Trisolini SM, et al. Pregnancy complications in acquired thrombotic thrombocytopenic purpura: a case-control study. Orphanet J Rare Dis 2014; 9: 193.
  6. Ugur BA, Karaselek MA, Camli K. Successful management of thrombotic thrombocytopenic purpura associated with pregnancy. Transfus Apher Sci 2014; 50(3): 433-7.
  7. Vafaeemanesh J, Parham M. A case report of successful treatment of hellp syndrome and thrombotic thrombocytopenic purpura by plasmapheresis. Qom Univ Med Sci J 2012; 6(4): 117-25. [In Persian].
  8. Corton MM, Leveno K, Bloom S, Spong CY, Dashe J. Williams Obstetrics. 24th ed. New York, NY: McGraw-Hill; 2014. p. 742, 1116.
  9. Mwita JC, Vento S, Benti T. Thrombotic Thrombocytopenic purpura-haemolytic uremic syndrome and pregnancy. Pan Afr Med J 2014; 17: 255.
  10. Pitton MA, Petolillo M, Papi S, Grismondi GL, Masin GP, Forcellini F. Hemolytic uremic syndrome in twin pregnancy at 32 weeks gestation with HELLP syndrome. Case report. Minerva Ginecol 2001; 53(4): 279-81. [In Italian].
  11. Rehberg JF, Briery CM, Hudson WT, Bofill JA, Martin JN, Jr. Thrombotic thrombocytopenic purpura masquerading as hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome in late pregnancy. Obstet Gynecol 2006; 108(3 Pt 2): 817-20.
  12. Burns ER, Lou Y, Pathak A. Morphologic diagnosis of thrombotic thrombocytopenic purpura. Am J Hematol 2004; 75(1): 18-21.
Journal of Isfahan Medical School
Volume 34, Issue 388 - Serial Number 388
May and June 2016
Pages 751-755

Files

History

  • Receive Date: 12 December 2015
  • Revise Date: 27 May 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics