1994 Volume 27 Issue 2 Pages 141-144
It is known that survival in thrombotic thrombocytopenic purpura (TTP), especially TTP associated with pregnancy, is low. Recently, plasma exchange has markedly improved this prognosis. There have, however, been few reports of patients with TTP who delivered an infant. In this paper, we report a patient with TTP who was treated with plasma exchange followed by successful delivery of an infant.
The patient, a 31-year-old house wife, had an attack of TTP in 1986, when she was 25 years old and her first embryo died at 22 weeks. Her illness was improved by artificial abortion, plasma exchange and splenectomy. Subsequently, she was often noted to have thrombocytopenia, necessitating transfusion of fresh frozen plasma (FFP). She became pregnant again in 1992, when she was 30 years old. She visited our hospital, when her embryo was at 6 weeks. She then entered our hospital because of thrombocytopenia, in 1992, when her embryo was at 35 weeks. Platelets were 3.2×104/μl, Hb 10.4g/dl, LDH 2, 330IU/l. Thrombocytopenia was not improved by transfusion of FFP or fresh blood. As anemia also progressed, platelet transfusion and plasma exchange were performed, and her infant was subsequently delivered by cesarean section. Forty units of FFP (3, 200ml) and an anticoagulant, nafamostat mesilate, were used in plasma exchange along with hemodialysis. Plasma exchange was performed for 3 days. As a result, thrombocytopenia improved. The patient and her infant are presently in good health.
