title: [Thrombotic microangiopathy in pregnancy complicated by acute hemorrhagic-necrotic pancreatitis during early puerperium].
abstract: OBJECTIVE
  Authors in the article describe a case of a patient with thrombotic thrombocytopenic purpurain 37 weeks gestation complicated by acute severe hemorrhagic-necrotic pancreatitis during the early puerperium.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Ist Department of gynaecology and obstetrics of the Comenius University Bratislava.
  
  
  METHODS
  33-years-old patient in the 37 weeks gestation was admitted to our department with the signs of HELLP syndrome (hemolysis, elevated liver enzymes, low platelets). Due to the worsening clinical status, we have performed caesarean section. After the transient stabilization of the patient's clinical status, the hemolysis with severe thrombocytopenia reappeared. Based on the clinical signs of abdominal pain and computer tomography, the diagnosis of acute hemorrhagic-necrotic pancreatitis was set. The primary diagnosis was thrombotic thrombocytopenic purpura. Therefore, therapeutic plasma exchange was performed with consequent improvement of the patients clinical state. Normalization of the platelet count was achieved after 4.plasma exchanges. Consequently 5 plasma exchanges were performed. However, one month later, the disease relapsed. Therapeutic plasma exchanges were needed again (4x), with anti CD 20 administration. This therapy had good clinical outcome, without the need for further plasma exchanges.
  
  
  CONCLUSIONS
  Thrombotic thrombocytopenic purpura is highly lethal disease. Early diagnosis, treatment, and multidisciplinary approach are essential.
authors: S
authors: S
authors: Redechová
authors: L
authors: L
authors: Féderová
authors: L
authors: L
authors: Hammerová
authors: A
authors: A
authors: Filkászová
authors: D
authors: D
authors: Horváthová
authors: M
authors: M
authors: Redecha
mesh_terms: D000328:Adult; D042241:Early Diagnosis; D005260:Female; D005865:Gestational Age; D006801:Humans; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010951:Plasma Exchange / Q000379:methods*; D049590:Postpartum Period; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed