title: Thrombotic thrombocytopenic purpura masquerading as hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome in late pregnancy.
abstract: BACKGROUND
  Thrombotic thrombocytopenic purpura rarely presents during late pregnancy or immediately postpartum. This report describes the clinical course of a patient considered to have hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome but later determined to have thrombotic thrombocytopenic purpura.
  
  
  METHODS
  At 37 weeks of gestation, a multiparous woman was diagnosed with HELLP syndrome. She received high-dose dexamethasone, magnesium, antihypertensives, and platelets before delivery. Over the next 36 hours, renal function acutely worsened and death ensued. One week after death a plasma ADAMTS13 activity of 4% was reported.
  
  
  CONCLUSIONS
  Thrombotic thrombocytopenic purpura can mimic HELLP syndrome late in gestation. Lack of response to dexamethasone within 12-24 hours and atypical relationships among laboratory values are two clues that thrombotic thrombocytopenic purpura may be the underlying pathology and that plasma exchange is emergently needed.
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA.
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Rehberg
authors.forename: Christian M
authors.initials: CM
authors.lastname: Briery
authors.forename: William T
authors.initials: WT
authors.lastname: Hudson
authors.forename: James A
authors.initials: JA
authors.lastname: Bofill
authors.forename: James N
authors.initials: JN
authors.lastname: Martin
mesh_terms: D051722:ADAM Proteins / Q000097:blood; D000071120:ADAMTS13 Protein; D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage; D017604:Cesarean Section, Repeat; D003907:Dexamethasone / Q000008:administration & dosage; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D005865:Gestational Age; D017359:HELLP Syndrome; D006801:Humans; D008274:Magnesium / Q000008:administration & dosage; D017713:Platelet Transfusion; D011247:Pregnancy; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis*; D051437:Renal Insufficiency
chemical_list: D000959:Antihypertensive Agents; D003907:Dexamethasone; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human; D008274:Magnesium