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Thrombotic thrombocytopenic purpura and pregnancy: presentation, management, and subsequent pregnancy outcomes.

Abstract：

:Pregnancy can precipitate thrombotic thrombocytopenic purpura (TTP). We present a prospective study of TTP cases from the United Kingdom Thrombotic Thrombocytopenic Purpura (UK TTP) Registry with clinical and laboratory data from the largest cohort of pregnancy-associated TTP and describe management through pregnancy, averting fetal loss and maternal complications. Thirty-five women presented with a first TTP episode during pregnancy: 23/47 with their first congenital TTP (cTTP) episode and 12/47 with acute acquired TTP in pregnancy. TTP presented primarily in the third trimester/postpartum, but fetal loss was highest in the second trimester. Fetal loss occurred in 16/38 pregnancies before cTTP was diagnosed, but in none of the 15 subsequent managed pregnancies. Seventeen of 23 congenital cases had a missense mutation, C3178T, within exon 24 (R1060W). There were 8 novel mutations. In acquired TTP presentations, fetal loss occurred in 5/18 pregnancies and 2 terminations because of disease. We also present data on 12 women with a history of nonpregnancy-associated TTP: 18 subsequent pregnancies have been successfully managed, guided by ADAMTS13 levels. cTTP presents more frequently than acquired TTP during pregnancy and must be differentiated by ADAMTS13 analysis. Careful diagnosis, monitoring, and treatment in congenital and acquired TTP have assisted in excellent pregnancy outcomes.

journal_name

Blood

journal_title

Blood

authors

Scully M,Thomas M,Underwood M,Watson H,Langley K,Camilleri RS,Clark A,Creagh D,Rayment R,Mcdonald V,Roy A,Evans G,McGuckin S,Ni Ainle F,Maclean R,Lester W,Nash M,Scott R,O Brien P,collaborators of the UK TTP Registr

doi

10.1182/blood-2014-02-553131

subject

Has Abstract

pub_date

2014-07-10 00:00:00

pages

211-9

issue

2

eissn

0006-4971

issn

1528-0020

pii

blood-2014-02-553131

journal_volume

124

pub_type

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