Pregnancy-associated thrombotic thrombocytopenic purpura.
Thrombocytopenia during pregnancy is a common diagnostic and management problem. Several differential diagnosis must be considered including manifestations of thrombotic thrombocytopenic purpura (TTP). We report here on a case of a 21-year-old pregnant woman who presented initially severe thrombocytopenia (8 Gpt/l) in the 20(th)+1 week of gestation. The patient had an antibody against ADAMTS13, and enzyme activity was <5%. Immediate plasmapheresis treatment was initiated, followed by plasma infusions, and again plasmapheresis. A male neonate was delivered by caesarean section in the 32(nd )week of gestation. The child had an uncomplicated postnatal development. After delivery, the mother's platelet count and ADAMTS13 activity increased to normal values. This case shows interesting aspects of TTP in pregnancy and a close cooperation between obstetricians, nephrologists and pediatricians is necessary for a successful outcome of the pregnancy.
Gerth
Jens
J
Department of Internal Medicine III, University Hospital Jena, Erlanger Allee 101, D-07740 Jena, Germany.
Schleussner
Ekkehard
E
Kentouche
Karim
K
Busch
Martin
M
Seifert
Mandy
M
Wolf
Gunter
G
D051722:ADAM Proteins / Q000276:immunology; D000071120:ADAMTS13 Protein; D001323:Autoantibodies / Q000097:blood; D016913:Blood Component Transfusion; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth; D008297:Male; D010348:Patient Care Team; D010956:Plasmapheresis; D010976:Platelet Count; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal / Q000379:methods; D055815:Young Adult; D014841:von Willebrand Factor / Q000378:metabolism
D001323:Autoantibodies; D014841:von Willebrand Factor; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human