Aust NZ J Obstet Gynaecol 1992; 32: 3: 278
Thrombotic Thrombocytopenic Purpura in Pregnancy Michael Permezel’, MD, BS, MRCP, MRCOG, FRACOG, Newton Lee:z4 MMed, BS, FRACP, FRCPA and June Corry:x4 MBBS University of Melbourne Department of Obstetrics and Gynaecology, Royal Women’s Hospital‘ and Department of Haemutolog3 St. Vincent’s Hospital4, Melbourne The coexistence of thrombocytopenia and haemolysis in pregnancy creates a major diagnostic dilemma with potentially serious consequences of misdiagnosis. We report a case of thrombotic thrombocytopenic purpura (TTP) in pregnancy and discuss the difficulty in differentiation from the variant of preeclampsia known as the ‘HELLP’ syndrome (Hypertension, Elevated Liver Enzymes, Low Platelets).
Case report Mrs MS, a 26-year-old secundigravida, presented to her family doctor at approximately 26 weeks’ gestation with a 3-week history of increasing malaise, nausea and occasional headaches. Her previous pregnancy had ended in a Caesarean section because of a ‘failed induction’ for postmaturity. There were no unusual findings on clinical examination but a full blood examination revealed the patient to be anaemic (haemoglobin value 7.6 g/dl) and thrombocytopenic (platelet count 23 x 109/l). She was transferred to to the Royal Women’s Hospital where a blood film showed fragmented red cells and features of acute haemolysis. Coagulation studies (prothrombin time, partial thromboplastin time and fibrin degradation products) provided values all within the normal range. Over the next 3 days she failed to respond to prednisolone 60 mg daily with the platelet count falling to less than 10 x 109/1and the haemoglobin value falling to 5.6 g/dl despite transfusion with 6 units of blood. The plasma bilirubin value rose from 20 to 63 mmol/l. The plasma alkaline phosphatase value remained within the normal range but the aspartate transaminase rose from 30 mmol/l to 42 mmol/l (normal range
Thrombotic Thrombocytopenic Purpura in Pregnancy Michael Permezel’, MD, BS, MRCP, MRCOG, FRACOG, Newton Lee:z4 MMed, BS, FRACP, FRCPA and June Corry:x4 MBBS University of Melbourne Department of Obstetrics and Gynaecology, Royal Women’s Hospital‘ and Department of Haemutolog3 St. Vincent’s Hospital4, Melbourne The coexistence of thrombocytopenia and haemolysis in pregnancy creates a major diagnostic dilemma with potentially serious consequences of misdiagnosis. We report a case of thrombotic thrombocytopenic purpura (TTP) in pregnancy and discuss the difficulty in differentiation from the variant of preeclampsia known as the ‘HELLP’ syndrome (Hypertension, Elevated Liver Enzymes, Low Platelets).
Case report Mrs MS, a 26-year-old secundigravida, presented to her family doctor at approximately 26 weeks’ gestation with a 3-week history of increasing malaise, nausea and occasional headaches. Her previous pregnancy had ended in a Caesarean section because of a ‘failed induction’ for postmaturity. There were no unusual findings on clinical examination but a full blood examination revealed the patient to be anaemic (haemoglobin value 7.6 g/dl) and thrombocytopenic (platelet count 23 x 109/l). She was transferred to to the Royal Women’s Hospital where a blood film showed fragmented red cells and features of acute haemolysis. Coagulation studies (prothrombin time, partial thromboplastin time and fibrin degradation products) provided values all within the normal range. Over the next 3 days she failed to respond to prednisolone 60 mg daily with the platelet count falling to less than 10 x 109/1and the haemoglobin value falling to 5.6 g/dl despite transfusion with 6 units of blood. The plasma bilirubin value rose from 20 to 63 mmol/l. The plasma alkaline phosphatase value remained within the normal range but the aspartate transaminase rose from 30 mmol/l to 42 mmol/l (normal range
