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Postpartum Thrombotic Thrombocytopenic Purpura (TTP) Complicating Pregnancy-Associated Immune Thrombocytopenic Purpura (ITP)
- Martee Olenich, MD; and
- Elaine Schattner, MD
- From The New York Hospital-Cornell Medical Center, New York, New York. Requests for Reprints: Elaine Schattner, MD, Division of Hematology-Oncology, Room C-606, The New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, NY 10021.
Although immune thrombocytopenic purpura in pregnancy is common, thrombotic thrombocytopenic purpura is rare and requires aggressive therapy. We report the case of a young pregnant woman with refractory immune thrombocytopenic purpura who developed postpartum thrombotic thrombocytopenic purpura and was successfully treated with plasmapheresis. The case emphasizes the importance of reviewing peripheral blood smears for evaluation of thrombocytopenia even when the diagnosis is felt to be clear. The coexistence of these two disorders has not been previously reported in the English-language literature.
Case Report
A 15-year-old girl, gravida 1, para 0, presented at 11 weeks of pregnancy with hyperemesis gravidarum. A manual platelet count was 56 × 109/L. The patient had had no previous blood counts and no history of bleeding or bruising. She was normotensive and had no petechiae, bruises, or organomegaly. The hemoglobin was 107 g/L; hematocrit, 0.33; mean corpuscular volume, 83 fL; and leukocyte count, 11.5 × 109/L. The peripheral blood smear showed normal red cell structure, with some platelet clumping and an overall decreased platelet count. The prothrombin time was 12.1 s (normal range, 9 to 13 s), and the activated partial thromboplastin time was 31.8 s (normal range, 23 to 38 s). Circulating antiplatelet antibody assays were negative, and renal …
