title: Thrombotic thrombocytopenic purpura during pregnancy versus imitator of preeclampsia.
abstract: BACKGROUND
  Thrombotic thrombocytopenic purpura (TTP) is a severe disorder affecting the microcirculation of multiple organs due to a systemic endothelial cell injury secondary to a deficiency in ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13) activity. TTP is a rare complication of pregnancy with a poor prognosis and high fetal mortality, especially when it occurs during the first trimester. Recent data have supported that effective treatment of TTP is plasma therapy. Unfortunately a major problem remains in the delay in diagnosis due to confounding factors between other "imitators of preeclampsia." Rapid and readily available laboratory testing to quickly diagnose TTP is desperately needed to improve care and to save mother and future child life.
  
  
  METHODS
  We describe a rare case of successful pregnancy after TTP manifestations occurring in the first trimester; most importantly, our experience represents the first case of atypical manifestation due to neurologic and kidney manifestations preceding laboratory assay alterations.
  
  
  RESULTS
  We treated a patient with plasma replacement of 30 mL/kg/day and daily plasmapheresis in combination with continuous infusion of fresh-frozen plasma 10 mL/kg/day. The response of clinical manifestation immediately improved. At 30 weeks, the patient had multiple episodes of high blood pressure and concomitant decrease of hemoglobin and platelet count, so a cesarean section was immediately performed. She delivered a healthy female baby.
  
  
  CONCLUSIONS
  Early diagnosis by ADAMTS13 activity, occasionally occurring before clinical manifestations, aided us in promptly administering commended and life-saving treatments.
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Gasparri
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Bellati
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Brunelli
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Perrone
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pecorini
authors.affiliation: Department of Gynecology and Obstetrics, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Papadia
authors.affiliation: Cellular Biotechnologies and Hematology Unit, , "Sapienza" University of Rome, Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Meloni
authors.affiliation: Cellular Biotechnologies and Hematology Unit, , "Sapienza" University of Rome, Rome, Italy.
authors.forename: Silvia Maria
authors.initials: SM
authors.lastname: Trisolini
authors.affiliation: Unit of Immunohematology and Transfusional Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Gozzer
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Domenici
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lecce
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Benedetti Panici
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010951:Plasma Exchange; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood / Q000175:diagnosis / Q000628:therapy