Management of Thrombotic Thrombocytopenic Purpura with Autoantibodies to ADAMTS-13 and Concurrent Preeclampsia in Pregnancy: Multidisciplinary Team Approach

Abstract

Background Thrombotic thrombocytopenic purpura (TTP) can present with many laboratory features of preeclampsia, which can make an accurate diagnosis difficult in late pregnancy. Because the treatments of TTP and preeclampsia are different and the clinical sequelae of delayed therapy potentially lethal, a rapid and accurate diagnosis is important.

Case Report We present a case of an acute episode of TTP secondary to acquired autoantibodies complicated by severe preeclampsia with headache and treated with corticosteroids, plasma exchange therapy, magnesium sulfate, and delivery. The postpartum course was complicated and resulted in a prolonged hospital stay. A multidisciplinary team was recruited as consultants.

Conclusion Concurrent TTP and severe preeclampsia can result in life-threatening complications. To ensure the best possible clinical outcome, an awareness of the medical systems' resources is required.

Keywords

TTP - severe preeclampsia - multidisciplinary team - autoantibodies

• References

• 1 Martin Jr JN, Bailey AP, Rehberg JF, Owens MT, Keiser SD, May WL. Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955–2006. Am J Obstet Gynecol 2008; 199: 98-104
• 2 Crowther MA, George JN. Thrombotic thrombocytopenic purpura: 2008 update. Cleve Clin J Med 2008; 75: 369-375
• 3 Dashe JS, Ramin SM, Cunningham FG. The long-term consequences of thrombotic microangiopathy (thrombotic thrombocytopenic purpura and hemolytic uremic syndrome) in pregnancy. Obstet Gynecol 1998; 91 (5 Pt 1) 662-668
• 4 Cunningham FG, Lindheimer MD. Hypertension in pregnancy. N Engl J Med 1992; 326: 927-932
• 5 Natelson EA, White D. Recurrent thrombotic thrombocytopenic purpura in early pregnancy: effect of uterine evacuation. Obstet Gynecol 1985; 66 (3) (, Suppl) 54S-56S
• 6 George JN. Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med 2006; 354: 1927-1935