Recurrent thrombotic thrombocytopenic purpura in early pregnancy: effect of uterine evacuation.

A 29-year-old woman developed thrombotic thrombocytopenic purpura on two occasions, each with onset at about the 13th week of gestation. Despite therapy during each episode with corticosteroids, platelet aggregation-modifying agents and repeated plasmapheresis, she experienced only transient improvement. In both instances, however, prompt hematologic recovery followed evacuation of the uterus. During an 18-month interval between pregnancies, her blood count remained normal and she continues in remission. The authors suggest that when thrombotic thrombocytopenic purpura appears in early pregnancy and its response to conventional management is minimal, immediate evacuation of the uterus may be an effective therapeutic alternative.