A rare case of pregnancy-associated thrombotic thrombocytopenic purpura

Thrombotic Thrombocytopenic Purpura (TTP) is a rare but potentially life-threatening thrombotic microangiopathy that presents significant diagnostic and therapeutic difficulties during pregnancy due to overlap with conditions like HELLP syndrome and preeclampsia. We present the case of a previously healthy 28-year-old woman at 34 weeks of gestation presenting with fatigue, headache, and petechiae. Laboratory tests indicated anemia, thrombocytopenia, increased lactate dehydrogenase levels, and the presence of schistocytes in the peripheral smear. Low ADAMTS13 activity (<10%) confirmed TTP. The patient showed significant improvement after receiving corticosteroids and undergoing daily plasma exchange. For maternal stability, an elective caesarean section was performed at 36 weeks, resulting in good maternal and neonatal outcomes. Early detection requires the timely diagnosis of unexplained thrombocytopenia, hemolysis, and neurologic symptoms in the absence of hypertension or abnormal coagulation, which should prompt immediate ADAMTS13 testing. Diagnosis and treatment were guided by multidisciplinary management and ADAMTS13 testing, resulting in complete remission without relapsing at the six-week follow-up.