IMR Press / CEOG / Volume 42 / Issue 1 / DOI: 10.12891/ceog1899.2015

Clinical and Experimental Obstetrics & Gynecology (CEOG) is published by IMR Press from Volume 46 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.

Open Access Case Report
Post-partum management in a patient affected by thrombotic thrombocytopenic purpura: case report and review of literature
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1 Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences. University of Messina, Messina
2 Department of Environmental Sciences, Safety, Territory, Food and Health. University of Messina, Messina, (Italy)
Clin. Exp. Obstet. Gynecol. 2015, 42(1), 90–94; https://doi.org/10.12891/ceog1899.2015
Published: 10 February 2015
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially lethal syndrome characterized by severe thrombocytopenia, microangiopathichaemolytic anaemia, and aspecific neurologic symptoms. This syndrome is the result of an abnormal intravascularplatelet aggregation which induces transient ischemia in various organs, especially in the central nervous system. Platelet aggregationcauses also fragmentation of erythrocytes, thus leading to the characteristic anaemia. The exact cause of TTP is unknown, but a largebody of evidence suggest that this syndrome might be due to acquired (immunological) or congenital ADAMTS13 deficiency. The dysregulationof ADAMTS13 activity could promote massive release of high molecular weight multimers of von Willebrand factor (VWF)from endothelium and, as a consequence, could cause intravascular platelet aggregation. Pregnancy is commonly associated with numerousmetabolic, immunological, and haemostatic changes which could increase thrombotic risk: during pregnancy, in fact, it is generallyobserved an increase of procoagulant activity and a decrease of fibrinolytic activity; moreover, at the end of pregnancy, it is notrare to find thrombocytopenia. All these reasons lead us to consider pregnancy itself as a triggering event for the onset of TTP. The authorsdescribe a case of TTP occurred during puerperium, in a patient who underwent caesarean section.
Keywords
Thrombotic thrombocytopenic purpura
Pregnancy
Plasma exchange
Plasma infusion
Post-partum complications
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