Thrombotic thrombocytopenic purpura: medical and biological monitoring of six pregnancies.
BACKGROUND
Thrombotic thrombocytopenic purpura (TTP) is a rare cause of severe thrombocytopenia in pregnancy.


METHODS
Six pregnancies in five patients with TTP were followed prospectively over 5 years. Ultralarge von Willebrand factor (ULvWF) multimers and cleaving protease (cp) levels were measured.


RESULTS
TTP relapsed, complicating four of the six pregnancies. Of three patients who relapsed, two had complete or partial vWF-cleaving protease (vWF-cp) deficiency, and one had a normal vWF-cleaving protease level. In all three we found abnormal UL multimers. The two women who did not relapse had normal vWF-cleaving protease level and an absence or loss of UL multimers.


CONCLUSIONS
Pregnant patients with a history of TTP must be followed in a tertiary obstetric unit with plasmapheresis available. Influence of vWF-cleaving protease and vWF multimeric abnormalities on TTP relapsing during pregnancy has to be evaluated in a further multicentre study.
Département d'anesthésie réanimation I, CHRU Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France. asducloy@chru-lille.fr
Anne-Sophie
AS
Ducloy-Bouthors
Claudine
C
Caron
Damien
D
Subtil
François
F
Provot
Antoine
A
Tournoys
Bénédicte
B
Wibau
Renée
R
Krivosic-Horber
D000328:Adult; D016362:Analgesia, Obstetrical; D005260:Female; D005865:Gestational Age; D006801:Humans; D010956:Plasmapheresis; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011446:Prospective Studies; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D012008:Recurrence; D014841:von Willebrand Factor / Q000032:analysis / Q000737:chemistry
D014841:von Willebrand Factor