Treatment of thrombotic microangiopathy in pregnancy with exchange: A report of two cases
Journal
Journal of the Formosan Medical Association
Journal Volume
101
Journal Issue
12
Pages
859-863
Date Issued
2002
Author(s)
Abstract
Thrombotic microangiopathy is a rare disease that can be induced and precipitated by pregnancy, and is associated with high maternal and fetal morbidity and mortality. It results from abnormal intravascular platelet aggregation that leads to transient ischemia in various organs, including the central nervous system, kidneys and placenta. Plasma exchange is the most widely accepted method of treatment for this condition. Delayed diagnosis is the main reason for morbidity and mortality, and results from difficulty in differentiating thrombotic microangiopathy from other obstetric emergencies. We report two cases of thrombotic microangiopathy that occurred antepartum and postpartum, respectively. The first patient was a 33-year-old woman who had two previous episodes of intrauterine fetal death in the 13th and 28th weeks of gestation, respectively. She received early plasma exchange at the 23rd week of gestation during this pregnancy and the fetus was delivered uneventfully. The second patient was a 28-year-old woman with progressive thrombocytopenia, anemia and deterioration of renal and liver function postpartum. She received early plasma exchange and it markedly improved her thrombocytopenia without sequelae. In conclusion, early diagnosis and early initiation of plasmapheresis may improve both maternal and fetal prognosis in thrombotic microangiopathy.
SDGs
Other Subjects
acetylsalicylic acid; heparin; lactate dehydrogenase; prednisolone; adult; anemia; article; brain ischemia; case report; clinical feature; controlled study; delivery; deterioration; differential diagnosis; disease association; disease course; early diagnosis; female; fetus death; fetus mortality; gestation period; human; kidney function; kidney ischemia; liver function; maternal morbidity; maternal mortality; perinatal morbidity; placenta perfusion; plasmapheresis; pregnancy; pregnancy complication; prenatal period; prognosis; puerperium; thrombocyte aggregation; thrombocyte count; thrombotic thrombocytopenic purpura; treatment outcome; Adult; Female; Hemolytic-Uremic Syndrome; Humans; Plasma Exchange; Pregnancy; Pregnancy Complications, Hematologic
Type
journal article