American Journal of Obstetrics & Gynecology
Volume 199, Issue 2 , Pages 98-104, August 2008

Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955-2006

Presented at the 74th Annual Meeting of the Central Association of Obstetricians and Gynecologists, Chicago, IL, Oct. 17-20, 2007.

  • James N. Martin Jr, MD

      Affiliations

    • Department of Obstetrics and Gynecology (Divisions of Maternal-Fetal Medicine and Women's Health), University of Mississippi Medical Center, Jackson, MS
  • ,
  • Amelia P. Bailey, MD

      Affiliations

    • Department of Obstetrics and Gynecology (Divisions of Maternal-Fetal Medicine and Women's Health), University of Mississippi Medical Center, Jackson, MS
  • ,
  • Jonathan F. Rehberg, MD

      Affiliations

    • Department of Obstetrics and Gynecology (Divisions of Maternal-Fetal Medicine and Women's Health), University of Mississippi Medical Center, Jackson, MS
  • ,
  • Michelle T. Owens, MD

      Affiliations

    • Department of Obstetrics and Gynecology (Divisions of Maternal-Fetal Medicine and Women's Health), University of Mississippi Medical Center, Jackson, MS
  • ,
  • Sharon Dixon Keiser, MD

      Affiliations

    • Department of Obstetrics and Gynecology (Divisions of Maternal-Fetal Medicine and Women's Health), University of Mississippi Medical Center, Jackson, MS
  • ,
  • Warren L. May, PhD

      Affiliations

    • Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS.

Received 1 October 2007; received in revised form 28 February 2008; accepted 5 March 2008. published online 06 May 2008.

A review of pregnancy-associated thrombotic thrombocytopenic purpura (TTP) in 166 pregnancies was undertaken using 92 English-language publications from 1955 to 2006. Initial and recurrent TTP presents most often in the second trimester (55.5%) after 1-2 days of signs/symptoms; postpartum TTP usually occurs following term delivery. TTP with preeclampsia (n = 28) exhibits 2-4 times higher aspartate aminotransferase (AST) values and lower total lactate dehydrogenase (LDH) to AST ratios (LDH to AST ratio = 13:1), compared with TTP without preeclampsia (LDH to AST ratio = 29:1). Maternal mortality is higher with initial TTP (26% vs 10.7%), especially with concurrent preeclampsia (44.4% vs 21.8%, P < .02). Although maternal mortality with TTP has substantially declined when plasma therapy is utilized, delay of diagnosis and therapy for initial TTP confounded by preeclampsia/hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome remains a significant maternal-perinatal threat. Rapid and readily available laboratory testing to quickly diagnose TTP and HELLP syndrome/preeclampsia is desperately needed to improve care.

Key words: hemolysis, elevated liver enzymes, and low platelets syndrome, lactate dehydrogenase to aspartate aminotransferase ratio, preeclampsia, thrombotic thrombocytopenic purpura

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 Reprints not available from the authors.

PII: S0002-9378(08)00272-X

doi:10.1016/j.ajog.2008.03.011

American Journal of Obstetrics & Gynecology
Volume 199, Issue 2 , Pages 98-104, August 2008