Anesthetic Considerations in Diffuse Bleeding Diathesis of Uncertain Origin

Abstract

This is a report of a case of a diffuse bleeding tendency in a pregnant woman who presented for emergency splenectomy with a tentative diagnosis of thrombotic thrombocytopenic purpura. The influence of multiple organ dysfunction in the selection of appropriate monitors and the anesthetic technic in such cases are complex.

Pregnancy outcomes after recovery from thrombotic thrombocytopenic purpura–hemolytic uremic syndrome

“…Of 328 articles retrieved for review, 44 articles published from 1968 to 2002 described 49 women with 70 pregnancies after recovery from TTP‐HUS. Twenty‐one of the women were described in single‐patient case reports; 9‐32 18 women were described in case series of 2 to 16 patients; 33‐47 10 women were superficially described in four case series of 44 to 108 patients 48‐52 . Risk factors for pregnancy complications were not described in 45 of the 49 women.…”

Thrombotic Thrombocytopenic Purpura in Pregnancy: Successful Treatment with Plasma Exchange

“…Because of the risk to the fetus (pregnancy category D), vincristine should be avoided during pregnancy [72], Twenty-eight pregnancies were terminated either by abortion or delivery. In 8 cases, the authors suggest a temporal relationship be tween remission and termination of pregnan cy: a complete remission was noted in 7 cases and a partial remission in 1 (response rate 25%) [57,85,[92][93][94][95][96]. In one instance, sple nectomy was performed at the time of deliv ery [96].…”