title: The diagnostic dilemma of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in the obstetric triage and emergency department: lessons from 4 tertiary hospitals.
abstract: OBJECTIVE
  We report a series of occurrences of thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS) in pregnancy that emphasizes early diagnosis.
  
  
  METHODS
  Fourteen pregnancies with TTP (n = 12) or HUS (n = 2) were studied. Analysis focused on clinical and laboratory findings on examination, initial diagnosis, and treatment.
  
  
  RESULTS
  There were 14 pregnancies in 12 patients; 2 cases of TTP were diagnosed as recurrent. Five women were admitted to the emergency department (ED), and 7 patients were admitted to an obstetrics triage. Patients who were evaluated by an obstetrician were treated initially for hemolysis, elevated liver enzymes and low platelets syndrome/preeclampsia, whereas patients who were seen in the ED had a diagnosis that is commonplace in the ED (panic attack, domestic violence, gastroenteritis). Latency from the onset of symptoms to diagnosis ranged from 1-7 days. Plasmapheresis treatments in early gestation resulted in favorable maternal-neonatal outcome. Maternal and perinatal mortality rates were 25% each.
  
  
  CONCLUSIONS
  TTP/HUS is a challenging diagnosis in obstetric triage and ED areas. We propose a management scheme that suggests how to triage patients for early diagnosis in pregnancy.
authors.affiliation: University of Cincinnati College of Medicine, Department of Obstetrics & Gynecology, Cincinnati, OH, USA.
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Stella
authors.forename: John
authors.initials: J
authors.lastname: Dacus
authors.forename: Edwin
authors.initials: E
authors.lastname: Guzman
authors.forename: Pushpinder
authors.initials: P
authors.lastname: Dhillon
authors.forename: Kristin
authors.initials: K
authors.lastname: Coppage
authors.forename: Helen
authors.initials: H
authors.lastname: How
authors.forename: Baha
authors.initials: B
authors.lastname: Sibai
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis*; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis*; D012189:Retrospective Studies; D014218:Triage; D055815:Young Adult