1/48. Death due to thrombotic thrombocytopenic purpura in pregnancy: case report with review of thrombotic microangiopathies of pregnancy.maternal death during pregnancy, although uncommon, may result from a broad range of conditions. In this paper, a case of thrombotic thrombocytopenic purpura diagnosed by postmortem examination is presented. Thrombotic thrombocytopenic purpura is one of a subset of diseases that result in the formation of microthrombi within the vasculature, either as a primary or secondary manifestation. Other conditions included in the differential diagnosis during pregnancy are hemolytic uremic syndrome, systemic lupus erythematosus, preeclampsia-eclampsia and the hellp syndrome, acute fatty liver of pregnancy, antiphospholipid antibody syndrome, and disseminated intravascular coagulation. The histologic manifestations of these diseases can be similar and in most cases do not provide adequate information to accurately differentiate these diseases in the postmortem period. This paper addresses the need for clinical history (i.e., symptomatology, trimester of onset) and antemortem laboratory testing in addition to a thorough autopsy to accurately differentiate among the conditions named previously. In the absence of an adequate clinical history and antemortem laboratory testing, the more general diagnosis of "thrombotic microangiopathy of pregnancy" is acceptable.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/48. Mycoplasma-pneumoniae-induced thrombotic thrombocytopenic purpura.Thrombotic thrombocytopenic purpura (TTP) is a fatal disease characterized by widespread platelet aggregation, hemolytic anemia and fever with renal and neurological involvement. Different factors have been associated with the development of TTP, e.g. infections, pregnancy, chemotherapy, drug therapy and bone marrow transplantation. Recent data imply that all these different causes may induce the disease by decreasing the activity of the plasma von willebrand factor-cleaving protease resulting in unusually large von willebrand factor multimers that later on initiate the cascade of TTP. In this communication, we present a unique association between infection with mycoplasma pneumoniae and TTP. We believe that the emergence of antibodies that cross-react with Mycoplasma and the protease might elucidate in this case the pathogenesis of TTP.- - - - - - - - - - ranking = 0.083333333333333keywords = pregnancy (Clic here for more details about this article) |
3/48. Surge of anti-SS-A antibody associated with fulminant thrombotic thrombocytopenic purpura in pregnancy.Thrombotic thrombocytopenic purpura (TTP) is an uncommon clinical syndrome and is rarely associated with systemic lupus erythematosus (SLE). diagnosis of TTP in patients with SLE, especially those who are pregnant, is challenging. We report the case of a pregnant woman with a high level of anti-SS-A antibody (162,143 U/mL) and fulminant TTP. The patient responded to plasma exchange treatment. Recent studies indicate that patients with SLE and another serologic abnormality, such as the presence of antiphospholipid antibody, may be at high risk for TTP. We explore the possible pathogenesis of acute TTP in patients with SLE and summarize the risk factors for acute TTP in patients with SLE and the current treatments for SLE-associated TTP.- - - - - - - - - - ranking = 0.33333333333333keywords = pregnancy (Clic here for more details about this article) |
4/48. Thrombotic thrombocytopenic purpura in early pregnancy. Remission after plasma exchange.A 24-year-old Chinese female developed fever, fluctuating neurological and renal manifestations, microangopathic hemolytic anemia, and thrombocytopenia during the 11th week of her first pregnancy. Therapy for thrombotic thrombocytopenic purpura (TTP), initiated during the 15th week of her pregnancy, including corticosteroids, platelet aggregation inhibitors, hysterotomy, and splenectomy was ineffective. However, dramatic improvement and remission occurred after plasma exchange of 3,560 ml was performed with the Haemonetics Model 30 blood Cell Separator.- - - - - - - - - - ranking = 0.5keywords = pregnancy (Clic here for more details about this article) |
5/48. Thrombotic thrombocytopenic purpura and pregnancy: a case report and a review of the literature.Thrombotic thrombocytopenic purpura (TTP) is a severe disorder affecting the microcirculation of multiple organ systems. Plasma therapy has significantly reduced the mortality rate. Infections, pregnancy, cancers, drugs, and surgery were frequently associated with the initial episodes and relapses. women who are either pregnant or in the postpartum period make up 10-25% of TTP patients, suggesting the interrelationship between TTP and pregnancy. The introduction of aggressive treatment with plasma transfusion or plasmapheresis improved maternal and fetal survival rates. We describe a case of a first successful pregnancy concomitant to a late relapse of TTP, in which the identification of important risk factors for both TTP and pregnancy allowed us easier hematological and obstetrical management. Proposed guidelines for pregnancy-related TTP management and a brief review of current treatment options for this rare condition are also included.- - - - - - - - - - ranking = 0.75keywords = pregnancy (Clic here for more details about this article) |
6/48. Thrombotic thrombocytopenic purpura and human immunodeficiency virus complicating pregnancy.BACKGROUND: Thrombotic thrombocytopenic purpura is a rare but serious medical complication, but is relatively common among patients with human immunodeficiency virus (hiv) infection. It is characterized by the pentad of thrombocytopenia, microangiopathic hemolytic anemia, neurological symptoms, fever, and renal abnormalities. However, the pentad is often incomplete, especially in hiv-positive patients. CASE: An hiv-positive patient complained of easy bruising, hematuria, fever, myalgias, and headache during the second trimester of pregnancy. Laboratory testing revealed hemolytic anemia and severe thrombocytopenia. Bone marrow biopsy was consistent with thrombocytopenic purpura. The patient recovered after plasmapheresis. At 36 weeks' gestation, she was delivered for preeclampsia and fetal growth restriction. CONCLUSION: Absence of the classic pentad seen in thrombocytopenic purpura among pregnant hiv-positive patients may make the diagnosis of thrombocytopenic purpura challenging. Frequent monitoring of patients with thrombotic thrombocytopenic purpura for signs and symptoms of preeclampsia and fetal growth assessment is suggested.- - - - - - - - - - ranking = 0.42474786137799keywords = pregnancy, gestation (Clic here for more details about this article) |
7/48. Thrombotic thrombocytopenic purpura associated with ticlopidine.Thrombotic thrombocytopenic purpura is a syndrome characterized by hemolytic anemia, thrombocytopenia, neurological symptoms, fever and renal dysfunction. Although the syndrome is usually associated with various infections, vasculitis and pregnancy, rarely can it be associated with certain neoplasms and drugs such as ticlopidine. A 63-year-old woman, who had undergone coronary angioplasty and had been started on ticlopidine, was admitted to our clinic with a history of vomiting, fatigue, hematuria and deterioration in her cognitive abilities. Thrombotic thrombocytopenic purpura was diagnosed on the basis of neurological changes, an increase in LDH, urea, creatinine, indirect bilirubin levels, anemia and peripheral smear findings. Treatment was initiated with daily plasmapheresis and complete clinical and laboratory recovery developed. The patient was discharged after 14 days.- - - - - - - - - - ranking = 0.083333333333333keywords = pregnancy (Clic here for more details about this article) |
8/48. Postpartum hemorrhagic shock resulting in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome.thrombotic microangiopathies may be initiated by a number of antecedent events. When presented with postpartum hemorrhage and unexplained thrombocytopenia, it is prudent to consider microangiopathic hemolytic anemia in the differential diagnosis. A 25-year-old woman, gravida 2, para 1, had an uncomplicated repeat Cesarean delivery at 38 weeks' gestation. She subsequently had an exploratory laparotomy for hemoperitoneum resulting from a left uterine artery laceration. On postoperative day 3, she developed thrombotic chrombocytopenic purpura-hemolytic uremic syndrome and was treated with plasma exchange therapy and dialysis. It is critical that clinicians consider this potentially fatal disease in the differential diagnosis when hemorrhagic shock is associated with unexplained thrombocytopenia, so that appropriate and early treatment may lead to a favorable outcome.- - - - - - - - - - ranking = 0.0080811947113186keywords = gestation (Clic here for more details about this article) |
9/48. Early relapse of thrombotic thrombocytopenic purpura during therapeutic plasma exchange associated with acinetobacter anitratus bacteremia.Thrombotic thrombocytopenic purpura (TTP)/hemolytic-uremic syndrome (HUS) is a syndrome characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, renal failure and neurologic manifestation. Almost all cases are idiopathic. However, secondary TTP/HUS associated with viral, bacterial and mycobacterial infections, drugs, connective tissue disease, solid tumors, bone marrow transplantation and pregnancy have been described. Early relapse associated with infection is a rare occurrence. The patient we report had a classic case of postdiarrheal TTP/HUS that responded to plasmapheresis but relapsed during treatment as reflected by the increased schistocytosis, decreased hematocrit, increased lactate dehydrogenase, and decreased platelet counts. This relapse may be attributed to acinetobacter anitratus bacteremia, secondary to central line infection. Administration of antimicrobial treatment resulted initially in a mild improvement. However, this was followed by a fatal relapse. The importance of monitoring the possible bacterial colonization of an indwelling catheter is thus emphasized.- - - - - - - - - - ranking = 0.083333333333333keywords = pregnancy (Clic here for more details about this article) |
10/48. Treatment of postpartum thrombotic microangiopathy with plasma exchange using cryosupernatant as replacement.Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are rare but acknowledged problems of pregnancy and the postpartum period. These diseases together with thrombotic angiopathy are associated with high maternal and fetal mortality and severe long-term morbidity. We describe four women with postpartum HUS/TTP treated with plasma exchange cryosupernatant fraction of plasma (CFP) as replacement fluid. anuria or oliguria at the beginning of treatment and thrombocytopenia [thromb- (29-68) x 109/L] were common features. Two of the patients developed a prolonged and more difficult clinical condition affecting the central nervous system and the liver and their platelet counts remained low despite the plasma exchange. The renal and hepatic function of all of the patients recovered fully. This small analysis lends weight to early plasma exchange with cryosupernatant as part of the treatment of postpartum HUS/TTP and suggests that persistent thrombocytopenia is a signal of more serious disease.- - - - - - - - - - ranking = 0.083333333333333keywords = pregnancy (Clic here for more details about this article) |
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