Maternal and fetal outcomes of pregnancy occurring after a diagnosis of immune-mediated thrombotic thrombocytopenic purpura

Brown, Jenna; Potugari, Bindu; Mazepa, Marshall A.; Kohli, Ruhail; Moliterno, Alison R.; Vaught, Jason; Burwick, Richard M.; Chaturvedi, Shruti

doi:10.1007/s00277-022-04936-2

Cited by 5 publications

(2 citation statements)

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“…Another observational study identified TTP presentations more commonly occurring in the second trimester and early postpartum [ 5 ]. Preeclampsia, typically diagnosed after 20 weeks gestation, is a common feature of pregnancies complicated by TTP, so proteinuria and a clinical overlap may be seen [ 5 , 6 , 18 ]. This supports the use of low-dose aspirin for preeclampsia prevention in pregnant patients with known TTP.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who are diagnosed with thrombotic thrombocytopenic purpura (TTP) during pregnancy are at increased risk of fetal and maternal complications. There is a high rate of preterm birth, preeclampsia, late fetal demise including stillbirth, and maternal complications such as neurological, renal, or arterial sequelae, and rarely maternal death [ 1 , 2 , 3 , 4 , 5 , 6 ]. Thrombotic thrombocytopenic purpura may occur for the first time in pregnancy or the postpartum period and may be acquired (autoimmune) or congenital [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Hypercoagulability and Inflammatory Markers in a Case of Congenital Thrombotic Thrombocytopenic Purpura Complicated by Fetal Demise

Skeith

Hurd

Chaturvedi

et al. 2022

JCM

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Background: Congenital thrombotic thrombocytopenic purpura (cTTP) is a rare disorder caused by an inherited genetic deficiency of ADAMTS13 and affects less than one per million individuals. Patients who are diagnosed with TTP during pregnancy are at increased risk of maternal and fetal complications including fetal demise. We present a case of a 32-year-old G3P0 (gravida 3, para 0) who presented at 20 weeks gestation with a new diagnosis of congenital TTP (cTTP) and fetal demise. Methods: We describe the pathophysiology of pregnancy complications in a patient with cTTP using platelet procoagulant membrane dynamics analysis and quantitative proteomic studies, compared to four pregnant patients with gestational hypertension, four pregnant patients with preeclampsia, and four healthy pregnant controls. Results: The cTTP patient had increased P-selectin, tissue factor expression, annexin-V binding on platelets and neutrophils, and localized thrombin generation, suggestive of hypercoagulability. Among 15 proteins that were upregulated, S100A8 and S100A9 were distinctly overexpressed. Conclusions: There is platelet-neutrophil activation and interaction, platelet hypercoagulability, and proinflammation in our case of cTTP with fetal demise.

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