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AJP Rep 2013; 03(01): 045-050
DOI: 10.1055/s-0032-1331380
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Pregnancy-Associated Thrombotic Thrombocytopenia Purpura

Ashley Fyfe-Brown
1   Division of Maternal-Fetal Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
,
Gwen Clarke
2   Division of Hematology, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
,
Kara Nerenberg
3   Division of General Internal Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
,
Sujata Chandra
1   Division of Maternal-Fetal Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
,
Venu Jain
1   Division of Maternal-Fetal Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
› Author Affiliations
Further Information

Publication History

12 August 2012

14 August 2012

Publication Date:
19 December 2012 (online)

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Abstract

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.

Keywords

fresh frozen plasma - cryosupernatant plasma - platelet transfusion - preeclampsia - HELLP syndrome - TTP
 

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