A case of thrombotic thrombocytopenic purpura developed during pregnancy

Abstract

We report on a case of thrombotic thrombocytopenic purpura (TTP) that developed during pregnancy. A 37-year-old woman at 23 weeks of gestation was admitted to our hospital with disturbance of consciousness, severe anemia, and thrombocytopenia. A disintegrin-like and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS13) activity was less than 3% and specific antibodies to ADAMTS13 were detected, and therefore plasma exchange was performed six times. Steroid pulse and antiplatelet therapy were also started. The platelet count immediately increased after the start of these therapies, and the ADAMTS13 activity recovered and the antibodies could no longer be detected. The ADAMTS13 activities were measured periodically and they were stable with no findings indicating recurrence. Periodic measurements of ADAMTS13 activity were useful for management of TTP and to decide on the indication of plasma exchange.