#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Thrombotic microangiopathy in pregnancy complicated by acute hemorrhagic-necrotic pancreatitis during early puerperium


Authors: S. Redechová 1;  L. Féderová 1;  Ľ. Hammerová 1;  A. Filkászová 1;  D. Horváthová 2;  M. Redecha 1
Authors‘ workplace: I. gynekologicko-pôrodnícka klinika LF UK a UN, Bratislava, prednosta prof. MUDr. M. Borovský, CSc. 1;  Klinika hematológie a transfuziológie LF UK, SZU a UN, Bratislava, prednosta doc. MUDr. M. Mistrík, PhD. 2
Published in: Ceska Gynekol 2014; 79(3): 190-192

Overview

Objective:
Authors in the article describe a case of a patient with thrombotic thrombocytopenic purpurain 37 weeks gestation complicated by acute severe hemorrhagic-necrotic pancreatitis during the early puerperium. Design: Case report. Setting: Ist Department of gynaecology and obstetrics of the Comenius University Bratislava. Case-report: 33-years-old patient in the 37 weeks gestation was admitted to our department with the signs of HELLP syndrome (hemolysis, elevated liver enzymes, low platelets). Due to the worsening clinical status, we have performed caesarean section. After the transient stabilization of the patient´s clinical status, the hemolysis with severe thrombocytopenia reappeared. Based on the clinical signs of abdominal pain and computer tomography, the diagnosis of acute hemorrhagic-necrotic pancreatitis was set. The primary diagnosis was thrombotic thrombocytopenic purpura. Therefore, therapeutic plasma exchange was performed with consequent improvement of the patient’s clinical state. Normalization of the platelet count was achieved after 4.plasma exchanges. Consequently 5 plasma exchanges were performed. However, one month later, the disease relapsed. Therapeutic plasma exchanges were needed again (4x), with anti CD 20 administration. This therapy had good clinical outcome, without the need for further plasma exchanges. Conclusion: Thrombotic thrombocytopenic purpura is highly lethal disease. Early diagnosis, treatment, and multidisciplinary approach are essential.. Keywords: HELLP syndrome, thrombotic thrombocytopenic purpura, acute pancreatitis


Sources

1. Ab Rahman, WS., Abdullah, WZ. Mustaffa, R., et al. Thrombotic thrombocytopenic purpura: three peripartum cases and diagnostic challenges. Clin Med Incsight Case Rep, 2013, 6, p. 141–146.

2. Arimoto, M., Komiyama, Y., Okamae, F., et al. A case of thrombotic thrombocytopenic purpura induced by acute pancreatitis. Int J Gen Med, 2012, 5, p. 307–311.

3. Gumulec, J., Šimetka, O., Procházka, M. Diferenciální diagnostika trombocytopenie v těhotenství. Vnitř Lék, 2010, 56(1), p. 91–97.

4. Scully, M., Hunt, BJ., Benjamin, S., et al. Guidelines on diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol, 2012, 158(3), p. 323–335.

5. Scully, M. Rituximab in the treatment of TTP. Hematology, 2012, 17(1), p. 22–24.

6. Scully, M., Starke, R., Lee, R., et al. Successful managment of pregnancy in women with a history of thrombotic thrombocytopenic purpura. Blood Coagul Fibrinolysis, 2008, 17(6), p. 459–463.

7. Swisher, KK. Terrell, DR. Kremer Hovinga, JA., et al. Clinical outcomes after platelet transfusions in patients with thrombotic thrombocytopenic purpura. Transfusion, 2009, 49(5), p. 873–887.

8. Škultéty, J., Nováčková, M., Hadačová, I., et al. Trombotická trombocytopenická purpura v těhotenství. Kazuistika. Čes Gynek, 2010, 75(4), s. 306–308.

9. Tsai, HM. Pathophysiology of thrombotic thrombocytopenic purpura. Int J Hematol, 2010, 91(1), p. 1–19.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 3

2014 Issue 3

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#