How we manage thrombotic microangiopathies in pregnancy

Differentiation between the thrombotic microangiopathies (TMAs) that present in pregnancy may be clinically challenging, but is critical to ensure correct management because of the impact on fetal and maternal outcomes. Thrombotic thrombocytopenic purpura (TTP) and atypical haemolytic uraemic syndrome (aHUS) are medical/obstetric emergencies that require specialist input, both at the time of acute diagnosis and follow-up in subsequent pregnancies. Features of preeclampsia and HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) may precede or be present in evolving TTP or aHUS. Clinicians need to be mindful of how a presumed diagnosis of a specific TMA in pregnancy may evolve and be prepared to frequently reassess signs and symptoms and revise the diagnosis and management plan accordingly.