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AJP Rep 2012; 02(01): 037-038
DOI: 10.1055/s-0032-1305799
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Thrombotic Thrombocytopenic Purpura with Autoantibodies to ADAMTS-13 and Concurrent Preeclampsia in Pregnancy: Multidisciplinary Team Approach

Tiffany Patrick
1   Department of Obstetrics and Gynecology, Winnie Palmer Hospital, Orlando Regional Healthcare, Orlando, Florida
,
Steve J. Carlan
1   Department of Obstetrics and Gynecology, Winnie Palmer Hospital, Orlando Regional Healthcare, Orlando, Florida
,
Jose Eugenio Najera
2   Department of Hematology/Oncology, MD Anderson Cancer Center Orlando, Orlando, Florida
,
Julie Eastwood
1   Department of Obstetrics and Gynecology, Winnie Palmer Hospital, Orlando Regional Healthcare, Orlando, Florida
› Author Affiliations
Further Information

Publication History

17 October 2011

01 December 2011

Publication Date:
22 February 2012 (online)

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Abstract

Background Thrombotic thrombocytopenic purpura (TTP) can present with many laboratory features of preeclampsia, which can make an accurate diagnosis difficult in late pregnancy. Because the treatments of TTP and preeclampsia are different and the clinical sequelae of delayed therapy potentially lethal, a rapid and accurate diagnosis is important.

Case Report We present a case of an acute episode of TTP secondary to acquired autoantibodies complicated by severe preeclampsia with headache and treated with corticosteroids, plasma exchange therapy, magnesium sulfate, and delivery. The postpartum course was complicated and resulted in a prolonged hospital stay. A multidisciplinary team was recruited as consultants.

Conclusion Concurrent TTP and severe preeclampsia can result in life-threatening complications. To ensure the best possible clinical outcome, an awareness of the medical systems' resources is required.

Keywords

TTP - severe preeclampsia - multidisciplinary team - autoantibodies
 

  • References

  • 1 Martin Jr JN, Bailey AP, Rehberg JF, Owens MT, Keiser SD, May WL. Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955–2006. Am J Obstet Gynecol 2008; 199: 98-104
    CrossrefPubMedGoogle Scholar
  • 2 Crowther MA, George JN. Thrombotic thrombocytopenic purpura: 2008 update. Cleve Clin J Med 2008; 75: 369-375
    CrossrefPubMedGoogle Scholar
  • 3 Dashe JS, Ramin SM, Cunningham FG. The long-term consequences of thrombotic microangiopathy (thrombotic thrombocytopenic purpura and hemolytic uremic syndrome) in pregnancy. Obstet Gynecol 1998; 91 (5 Pt 1) 662-668
    CrossrefPubMedGoogle Scholar
  • 4 Cunningham FG, Lindheimer MD. Hypertension in pregnancy. N Engl J Med 1992; 326: 927-932
    CrossrefPubMedGoogle Scholar
  • 5 Natelson EA, White D. Recurrent thrombotic thrombocytopenic purpura in early pregnancy: effect of uterine evacuation. Obstet Gynecol 1985; 66 (3) (, Suppl) 54S-56S
    PubMedGoogle Scholar
  • 6 George JN. Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med 2006; 354: 1927-1935
    CrossrefPubMedGoogle Scholar