The early diagnosis and management of thrombotic thrombocytopenic purpura complicating pregnancy

Objective To investigate the early diagnosis and management of thrombotic thrombocytopenic purpura (TTP)complicating pregnancy.Methods During the June 2006 to Sep.2009,the medical records of 5 cases with TTP complicating pregnancy were reviewed retrospectively. Results Five cases were all primipara.Two cases occurred in second trimester,the other 3 cases in the third trimester,while diagnosis were made as HELLP(hemolytic elevated liver enzymes,low platelets )syndrome at admission.The clinical feature was all anemia,fever associated with coma in 3 cases.The laboratory findings showed hemoglobin ranged from(36.0～73.0g/L),platelets count ranged from(6～42)×109/L.Four cases had abnormal fragmented red cells on peripheral blood smear. Three cases had ADAMTS13 activity5% of normal,in which one with gene mutation that occurred in the 9 exon,the another one inhibitor detected. The ADAMTS13 activity were normal value in 2 case.Cesearen section was performed in 2 cases,one case received forceps per vagina,among them 2 neonatal were alive,one stillbirth. Two cases received,plasma exchange One patient died without plasma exchange. Conclusion With increasing awareness,extra-attention must be pay to primipara,or especially patients with HELLP syndrome associated with thrombotic microangiopathy(TMA)No matter ADAMTS13 is positive or negative,while prompt progressive management include early termination of pregnancy and plasma exchange.