Kidney Week

Abstract: TH-PO629

Thrombotic Thrombocytopenic Purpura in Early Second Trimester Pregnancy Successfully Treated with Membrane Therapeutic Plasma Exchange

Session Information

• Fellows/Residents Case Reports: Genetic Diseases, Pregnancy, Monoclonal Gammopathy
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Nephrology Education

• 1302 Fellows and Residents Case Reports

Authors

• Carag, Charissa Marie R., Rush University Medical Center, Chicago, Illinois, United States

Charissa Marie R. Carag,

• Gashti, Casey N., Rush University Medical Center, Chicago, Illinois, United States

Casey N. Gashti,

• Whittier, William Luke, Rush University Medical Center, Chicago, Illinois, United States

William Luke Whittier,

Background

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathy which presents with hemolytic anemia, thrombocytopenia, and an ADAMTS13 activity <10%. Although rare, it can flare in pregnancy, and should be considered in the differential diagnosis of thrombocytopenia in pregnancy. In the general population, acquired TTP is more common, although recently, more studies have demonstrated that hereditary TTP makes up a greater number of pregnancy-associated TTP. We report a case of acquired TTP in pregnancy successfully managed by membrane-based therapeutic plasma exchange (mTPE) leading to delivery of a healthy child 13 weeks after diagnosis.

Methods

The patient was a 34-year-old G4P2012 woman with severe thrombocytopenia (platelets 8 K/uL) and anemia (Hgb 4.9 g/dl) in the 21^st week of gestation. Her ADAMTS13 activity was <10% on two occasions with the presence of an inhibitor. She was started on daily mTPE and high-dose steroids, followed by thrice-weekly mTPE to maintain a platelet count of at least 150 K/uL. The patient received 43 mTPE sessions during pregnancy without any complications. She delivered a healthy child at 34 weeks of gestation. After delivery, her platelets normalized without mTPE or steroids. An ADAMTS13 activity after delivery was 69%. (Fig 1)

Conclusion

TPE should be initiated immediately in cases of TTP, and can be performed safely in pregnancy. This case highlights the unique pathophysiology of TTP in pregnancy, as the mother did not require TPE once the placenta was delivered and her ADAMTS13 activity normalized. It has been theorized that certain proteins in the placental circulation induce antigen-triggering antibody production against ADAMTS13. Our case is the first report of using mTPE in pregnancy and demonstrates its efficacy and safety with 43 sessions over 13 weeks.