Successful prevention of thrombotic thrombocytopenic purpura (TTP) relapse using monthly prophylactic plasma exchanges throughout pregnancy in a patient with systemic lupus erythematosus and a prior history of refractory TTP and recurrent fetal loss
Section snippets
Case report
We report on the case of a successful pregnancy outcome with the use of antepartum steroids and monthly prophylactic plasma exchange in a woman with a history of systemic lupus erythematosus (SLE) 18 months after an episode of severe refractory thrombotic thrombocytopenic purpura (TTP) unrelated to pregnancy.
A 36-year-old female (gravida 5, term 1, preterm 0, abortions 3, living 1) was diagnosed with SLE 1 year before presenting with an episode of TTP outside of pregnancy. Investigations for the
Discussion
In TTP, PLEX has become the standard of care [1]. Unfortunately, relapses occur in 30–60% of TTP survivors [2]. TTP occurring during pregnancy is associated with relapses in subsequent pregnancies. Furthermore, pregnancy may trigger a relapse in women with a previous history of TTP outside of pregnancy [3], [4]. More than 75% of cases will occur in the third trimester or the postpartum period [5]. This can be attributed in part to the hypercoagulable state of pregnancy and to the occurrence of
Conflict of interest statement
The authors declare that they have no conflicts of interest relevant to this publication.
Acknowledgments
Informed consent was obtained from the patient for publication of this case report. K.A., J.K., A.G. and D.A. were involved in the conception and writing of the manuscript. All authors read and approved the final manuscript. DA is an adjunct scientist at the Canadian Blood Services. There are no significant sources of financial support for this research.
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