Two successful pregnancies in a woman with chronic thrombotic thrombocytopenic purpura treated by plasma infusion

American Journal of Hematology
E C LianD R Harkness

Abstract

A 21-year-old primigravida in her 20th week of pregnancy developed TTP. She was managed with weekly or semiweekly plasma infusions and delivered a healthy 1.6 kg baby 2 weeks prior to the expected date of delivery. After delivery she continued to have active TTP with thrombocytopenia which responded repeatedly to plasma infusion though their frequency gradually decreased to about one unit every 3-4 weeks. Three years after the birth of the first child she conceived again and was easily managed with repeated plasma infusions although the frequency and amount of plasma required to prevent thrombocytopenia were increased. She delivered a normal 3.4 kg term baby after which she again had a decreased plasma requirement. This is the first report of a woman with 5 years of active TTP managed with plasma alone. She experienced two pregnancies in which both mother and infant survived. We believe that the use of plasma in the management of TTP during pregnancy will improve the survival rate of both mother and infant. At the time of second birth, the platelet count was low in the mother but normal in the baby. This suggests that the platelet depressing factor of this patient does not cross the placental barrier.

References

Jan 1, 1979·Seminars in Thrombosis and Hemostasis·J J Byrnes, E C Lian
Nov 1, 1978·Annals of Internal Medicine·J AnsellL Pechet
Oct 15, 1976·American Journal of Obstetrics and Gynecology·H V MayW N Thornton
Nov 1, 1982·American Journal of Hematology·C S Kitchens
Jun 1, 1982·British Journal of Obstetrics and Gynaecology·M AtlasP Lieberman

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Citations

Jan 1, 1992·Journal of Clinical Apheresis·E G Taft, B B Carver
May 1, 1995·Obstetrics and Gynecology·H W HsuK J Moise
Apr 2, 2010·Annales Françaises D'anesthèsie Et De Rèanimation·B MoulinUNKNOWN Société française de anesthésie et de réanimation
Jun 16, 2010·Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis·Karim Abou-NassarDavid Allan
Feb 17, 2009·Thrombosis Research·Armando D'AngeloLuciano Crippa
Feb 18, 2003·British Journal of Haematology·Sarah L AllfordUNKNOWN Haemostasis and Thrombosis Task Force, British Committee for Standards in Haematology
May 27, 2014·Blood·Marie ScullyUNKNOWN collaborators of the UK TTP Registry
May 6, 2008·American Journal of Obstetrics and Gynecology·James N MartinWarren L May
Aug 1, 1989·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Y EzraA Eldor
Jul 25, 2008·Nature·Ruslan Medzhitov
Aug 17, 2020·Blood·Barbara Ferrari, Flora Peyvandi
Feb 24, 2021·American Journal of Obstetrics and Gynecology·Shayna MiodownikAnat Rabinovich

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