Myers Linda
Acute Care Renal/Apheresis Unit, University of Virginia Health System, Charlottesville, VA, USA.
Nephrol Nurs J. 2010 Jul-Aug;37(4):399-402.
The occurrence of a hypercoagulable state and decreasing concentration of ADAMTS 13 in late pregnancy and during the postpartum period increases the risk for a woman to develop life-threatening thrombotic thrombocytopenic purpura (TTP). This is also the time of great risk for the more common obstetric complications of preeclampsia; eclampsia; and hemolysis, elevated liver functions tests, low platelets (HELLP) syndrome. These conditions are associated with high maternal and perinatal mortality. Differential diagnosis may be difficult due to the overlapping of clinical and laboratory findings, including thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, and renal insufficiency, making it difficult or impossible to distinguish them from TTP. Management of microangiopathic disorders encountered during pregnancy differ; therefore, an accurate diagnosis is required. Outcomes of TTP without plasma exchange therapy (TPE) are almost uniformly fatal. Early recognition and management of symptoms with prompt and aggressive TPE is essential when TTP is suspected.
在妊娠晚期和产后出现高凝状态以及ADAMTS 13浓度降低,会增加女性发生危及生命的血栓性血小板减少性紫癜(TTP)的风险。这也是发生更常见的产科并发症如先兆子痫、子痫以及溶血、肝酶升高、血小板减少(HELLP)综合征的高风险时期。这些情况与孕产妇和围产期高死亡率相关。由于临床和实验室检查结果存在重叠,包括血小板减少、微血管病性溶血性贫血、神经症状和肾功能不全,鉴别诊断可能很困难,难以或无法将它们与TTP区分开来。孕期遇到的微血管病性疾病的处理方法不同;因此,需要准确诊断。未经血浆置换疗法(TPE)治疗的TTP患者几乎无一幸免。当怀疑TTP时,早期识别症状并及时积极进行TPE治疗至关重要。