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妊娠期血栓性血小板减少性紫癜病例报告并文献复习。

Case report of thrombotic thrombocytopenic purpura during pregnancy with a review of the relevant research.

机构信息

Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.

Department of Obstetrics and Gynecology, Xi'an People's Hospital, Xi'an, China.

出版信息

Medicine (Baltimore). 2024 May 17;103(20):e38112. doi: 10.1097/MD.0000000000038112.

Abstract

RATIONALE

Thrombotic thrombocytopenic purpura (TTP) is a syndrome characterized by widespread blood vessel clotting and bleeding. It can affect individuals of any age but is more commonly observed in females, particularly during pregnancy. Pregnancy combined with TTP is a critical and rapidly progressing condition that is often misdiagnosed as an obstetric disorder like severe preeclampsia or HELLP syndrome. To deepen the understanding of TTP during pregnancy with the help of a clinical case.

PATIENT CONCERNS

A 20-year-old patient, is pregnancy 1 birth 0, 32 weeks dated by her last menstrual period, presented chest tightness, and shortness of breath after physical activity for 3 days.

DIAGNOSES

TTP.

INTERVENTIONS

At present, there are no preventive measures. Timely diagnosis and treatment are useful. Plasma exchange and treat to the patient hinder autoantibodies, such as gamma globulin, methylprednisolone, rituximab, and cyclosporine were effective.

OUTCOMES

The patient exhibited stable vital signs, normal examination results, and experienced no complications. We continued to monitor her progress after she was discharged.

LESSONS SUBSECTIONS

The acute onset of TTP is often associated with pregnancy, as it is a triggering factor. Timely identification, accurate diagnosis, and a comprehensive treatment approach involving plasma exchange, immunosuppressants, and the termination of pregnancy can lead to remission and a favorable outlook for the majority of patients.

摘要

背景

血栓性血小板减少性紫癜(TTP)是一种以广泛血管内血栓形成和出血为特征的综合征。它可影响任何年龄段的个体,但更常见于女性,特别是在怀孕期间。妊娠合并 TTP 是一种严重且迅速进展的疾病,常被误诊为产科疾病,如严重子痫前期或 HELLP 综合征。通过临床病例加深对妊娠 TTP 的认识。

患者关注

一位 20 岁患者,孕 1 产 0,末次月经为 32 周前,活动后 3 天出现胸闷、气促。

诊断

TTP。

干预措施

目前尚无预防措施。及时诊断和治疗是有用的。血浆置换和治疗患者的自身抗体,如丙种球蛋白、甲基强的松龙、利妥昔单抗和环孢素是有效的。

结果

患者生命体征稳定,检查结果正常,无并发症。我们在她出院后继续监测她的进展。

教训小节

TTP 的急性发作常与妊娠有关,因为它是一个触发因素。及时识别、准确诊断和全面的治疗方法,包括血浆置换、免疫抑制剂和终止妊娠,可以使大多数患者得到缓解和良好的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/305c/11098172/9af83272dd29/medi-103-e38112-g001.jpg

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