Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955-2006.
A review of pregnancy-associated thrombotic thrombocytopenic purpura (TTP) in 166 pregnancies was undertaken using 92 English-language publications from 1955 to 2006. Initial and recurrent TTP presents most often in the second trimester (55.5%) after 1-2 days of signs/symptoms; postpartum TTP usually occurs following term delivery. TTP with preeclampsia (n = 28) exhibits 2-4 times higher aspartate aminotransferase (AST) values and lower total lactate dehydrogenase (LDH) to AST ratios (LDH to AST ratio = 13:1), compared with TTP without preeclampsia (LDH to AST ratio = 29:1). Maternal mortality is higher with initial TTP (26% vs 10.7%), especially with concurrent preeclampsia (44.4% vs 21.8%, P < .02). Although maternal mortality with TTP has substantially declined when plasma therapy is utilized, delay of diagnosis and therapy for initial TTP confounded by preeclampsia/hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome remains a significant maternal-perinatal threat. Rapid and readily available laboratory testing to quickly diagnose TTP and HELLP syndrome/preeclampsia is desperately needed to improve care.
Martin
James N
JN
Department of Obstetrics and Gynecology, Divisions of Maternal-Fetal Medicine and Women's Health, University of Mississippi Medical Center, Jackson, MS, USA.
Bailey
Amelia P
AP
Rehberg
Jonathan F
JF
Owens
Michelle T
MT
Keiser
Sharon Dixon
SD
May
Warren L
WL
D051722:ADAM Proteins / Q000097:blood; D000071120:ADAMTS13 Protein; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008428:Maternal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*
D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human