Plasma infusion for thrombotic thrombocytopenic purpura during pregnancy.

Thrombotic thrombocytopenic purpura (TTP), a disease of unknown cause, has been reported relatively frequently during pregnancy. The disorder typically runs a fulminant course with a high mortality, and survival of both mother and fetus has been exceedingly rare. We report here the fourth case of TTP during pregnancy in which both the mother and fetus survived. Therapeutic approaches to TTP have included corticosteroids, antiplatelet agents, splenectomy, and, more recently, exchange plasmapheresis, exchange transfusion, and plasma infusion. The patient described herein was refractory to corticosteroids, antiplatelet agents, and only transiently responsive to exchange transfusion. The administration of plasma infusions achieved a sustained partial remission that allowed full gestation of the developing fetus. The patient attained full remission following cesarean section and simultaneous splenectomy.