TITLE:
Thrombotic Thrombocytopenic Purpura in Pregnancy Presented with Stroke at 29 Weeks: A Case Report
AUTHORS:
Shamsa Kassam, Jodie Lam, Gabrielle Baptiste
KEYWORDS:
Thrombotic Thrombocytopenic Purpura, Pregnancy, Ischemic Stroke, Caesarean Section
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.14 No.3,
March
13,
2024
ABSTRACT: Thrombotic thrombocytopenic purpura (TTP) is a rare
but acute, life-threatening condition which may be precipitated by pregnancy.
This disorder that presents with thrombocytopenia, haemolytic anemia, and
clinical consequences of microvascular thrombosis such as stroke. The exact
cause is not known but it is associated with a deficiency of ADAMTS13 enzymes. Immune mediated TTP is more common and can present in pregnancy. The aim of
this case is to bring awareness as many clinicians are unaware of this
condition in pregnancy, its diagnosis may be missed or delayed, leading to
fetal loss or serious maternal implications. In this case the patient presented
at 29 weeks with stroke in Emergency department, referred to delivery suit for
Obstetric review, with suspicion of Pre-eclampsia/HELLP. The diagnosis of TTP
was achieved by a multidisciplinary team who worked tirelessly together. The
patient was transferred to a Specialist Tertiary Care Centre for further
management. The pregnancy continued until 33 weeks and 5 days. She underwent an
emergency caesarean section for fetal distress. Steroids and Rituximab were
continued postnatally. The outcome was favourable due to fast and efficient
multidisciplinary care. Awareness of this rare but important condition can lead
to recognition of clinical presentation, prompt diagnosis and appropriate
management.