Department of Obstetrics and Gynecology of Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil.
J Obstet Gynaecol Res. 2021 May;47(5):1898-1902. doi: 10.1111/jog.14717. Epub 2021 Mar 14.
Thrombotic thrombocytopenic purpura (TTP) is a medical emergency that demands prompt diagnosis to allow lifesaving treatment: plasmapheresis. TTP during pregnancy is rare, with estimated prevalence of 1/200 000, and even rarer in association with acquired immunodeficiency syndrome, with only two cases reported. Differential diagnosis includes HELLP syndrome (hemolysis elevated liver enzymes and low platelets), sepsis, intravascular-disseminated coagulation, and acquired autoimmune diseases, each one with its unique treatment and prognosis. A case of a pregnant woman at 26th week with sudden onset of left hand paresthesia and purpura is reported. PLASMIC score showed high risk for ADAMTS-13 deficiency and diagnosis of TTP was made. Human immunodeficiency virus screening test was positive on admission. Plasmapheresis and antiretroviral therapy were initiated and the delivery of a healthy newborn at full-term gestation was achieved, unlike other cases in literature. No obstetric complications were observed and the follow-up shows no signs of disease recurrence.
血栓性血小板减少性紫癜（TTP）是一种医学急症，需要及时诊断以进行救生治疗：血浆置换。妊娠期间 TTP 罕见，估计患病率为 1/200000，与获得性免疫缺陷综合征相关的 TTP 更为罕见，仅有两例报告。鉴别诊断包括 HELLP 综合征（溶血、肝酶升高和血小板减少）、脓毒症、血管内弥散性凝血和获得性自身免疫性疾病，每种疾病都有其独特的治疗和预后。报告了一例 26 周孕妇突发左手麻木和紫癜的病例。PLASMIC 评分显示 ADAMTS-13 缺乏的高风险，诊断为 TTP。入院时人类免疫缺陷病毒筛查试验呈阳性。开始进行血浆置换和抗逆转录病毒治疗，并足月分娩了一名健康的新生儿，与文献中的其他病例不同。未观察到产科并发症，随访未发现疾病复发迹象。
