Thrombotic thrombocytopenic purpura and pregnancy and the outcomes of the next pregnancy: a case report

Thrombotic Thrombocytopenic purpura (TTP) is a life-threatening disease with high prevalence of 5% in pregnancy which causes Thrombocytopenia. Since pregnancy is a known trigger of TTP attacks¡ pregnant women are at risk of recurrence. Prompt diagnosis and treatment before 20 weeks gestation is important and is associated with positive outcomes. In this study¡ a pregnant woman with TTP in her second and third pregnancies is introduced. This study was performed with aim to introduce the patient and review the most recent management and treatment of TTP in pregnancy and prenatal counseling in patients who have a history of TTP.
The patient is a 28-years-old woman (g3p1d1ab1). Her first pregnancy was ended with spontaneous abortion at 6 weeks and in second pregnancy¡ she had a cesarean section at 28 weeks gestation due to HELLP syndrome and eclampsia. After the surgery with diagnosis of TTP¡ plasmapheresis was performed. In current pregnancy at 36 weeks gestation¡ cesarean section was performed with primary diagnosis of HELLP syndrome; due to a drop in platelet count after surgery and observation of schistocytosis in peripheral blood smear¡ with diagnosis of TTP¡ daily plasmapheresis was done until the platelet count achieved above 100000 and the patient was discharged with good general condition.
Since pregnancy is a known trigger of TTP episodes¡ follow-up of patients with TTP in next pregnancy and control of 13 factor and differentiating of congenital and acquired disease is essential; thus the risk of recurrence of maternal and fetal complications are greatly reduced.