نوع مقاله : گزارش مورد
1 استادیار، گروه زنان و مامایی، دانشکدهی پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران
2 دستیار، گروه زنان و مامایی، دانشکدهی پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران
3 گروه مامایی، دانشکدهی پرستاری مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران
عنوان مقاله [English]
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.