Management of pregnancy-associated thrombotic thrombocytopenia purpura.
Thrombotic thrombocytopenia purpura (TTP) is an infrequent but serious disease. Pregnancy is a known risk factor for presentation or relapse of TTP. Difficulties in differentiating TTP from preeclampsia/HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome, and current treatment recommendations are discussed in this case report. A woman with previously treated and stable TTP had a relapse at 36 weeks' gestation. Careful surveillance led to an early diagnosis. Severe disease in the peripartum period was treated successfully with cryosupernatant plasma-based plasmapheresis and platelet transfusion, with good maternal and neonatal outcomes. Cryosupernatant plasma is a viable alternative to fresh frozen plasma for plasmapheresis for TTP and may offer some therapeutic and logistical advantages. Platelet transfusion can be undertaken safely if needed to prevent or treat significant hemorrhage.
Division of Maternal-Fetal Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada.
Ashley
A
Fyfe-Brown
Gwen
G
Clarke
Kara
K
Nerenberg
Sujata
S
Chandra
Venu
V
Jain
HELLP syndrome; TTP; cryosupernatant plasma; fresh frozen plasma; platelet transfusion; preeclampsia