Thrombotic thrombocytopenic purpura during pregnancy and its overlap with the HELLP syndrome, a clinical dilemma: A case report and review of the literature

A COVID-19 pregnant patient with thrombotic thrombocytopenic purpura: a case report

“…Another study treated a pregnant TTP patient who only had HELLP syndrome without COVID-19 infection [ 21 ]. The blood pressure of our case was normal, which ruled out the presence of HELLP syndrome.…”

“…To treat the TTP, our patient took Hydrocortisone 100 mg/IV/stat and then Dexamethasone 4 mg/IV/(every 8 hours) as well as having plasmapheresis daily for 5 days. It should be noted that we applied this treatment due to the severe condition of our patient, as even measuring the ADAMTS13 activities could not be suggested as a reliable diagnostic test at the acute phase [ 21 ].…”

What is causing this pregnant patient's low platelets?

“…TTP is associated with a 90% mortality if untreated, which improves to 10% to 20% with prompt initiation of PLEX 2. PLEX is the mainstay of treatment and should be continued daily until the platelet count has recovered to at least 150,000 cells/mm3 for a minimum of 3 consecutive days and LDH levels have normalized 3. Glucocorticoids can be added to PLEX and rituximab should be considered for patients with relapses or refractory disease 3.…”

“…A sterile speculum examination confirmed PPROM with pooling and ferning. The patient was admitted for induction of labor due to PPROM when routine admission laboratory tests revealed a platelet count of 8,000 cells/mm3 (normal range, 140,000 to 350,000 cells/mm3). On further questioning after the low platelet count was identified, the patient admitted to a recent upper respiratory infection, during which she had mild epistaxis with clots when blowing her nose.…”

“…Confirmatory laboratory testing was ordered to verify and further evaluate the abnormal results identified on initial admission testing. Results included hemoglobin of 9.1 g/dL (normal range, 11.5 to 14.5 g/dL); hematocrit of 27.2% (normal range, 35% to 43%); white blood cell count of 13,400 cells/mm3 (normal range, 4,000 to 10,000 cells/mm3); platelets of 6,000 cells/mm3 ; reticulocytes of 5.41% (normal range, 0.51% to 2.17%); lactate dehydrogenase (LDH) of 719 U/L (normal range, 100 to 250 U/L); haptoglobin of less than 3 mg/dL (normal range, 34 to 200 mg/dL); alkaline phosphatase of 161 U/L (normal range, 35 to 120 U/L); total bilirubin of 2.2 mg/dL (normal range, 0.2 to 1 mg/dL); and aspartate transaminase (AST) of 45 U/L (normal range, less than 41 U/L). Her other results, including alanine transaminase (ALT) and coagulation studies, were within normal limits.…”