Thrombotic thrombocytopenic purpura associated with pregnancy

Thrombotic thrombocytopenic purpura (TTP), a disorder of unknown etiology, appears to be a syndrome often associated with infectious, vascular, or autoimmune diseases. When it occurs in pregnancy, TTP can mimic other gestational complications. Two patients with TTP associated with pregnancy form the basis of this report. On patient is the second person known to have survived longer than 2 years after concurrent TTP and pregnancy. This patient had underlying glomerulonephritis and was treated with corticosteroids and heparin. The other patient, in whom an underlying disease process was not identified, was treated unsuccessfully with most of the recommended therapeutic modalities. Patients with concurrent TTP and pregnancy have the same prognosis as nonpregnant patient with TTP. Both groups have a prolonged survival rate of only 10 per cent. Primary treatment should consist of corticosteroids and inhibitors of platelet aggregation. If a rapid response does not occur, splenectomy is indicated. Care must be taken to recognize the pregnancy complicated by TTP, a circumstance which appears to occur more frequently than past reports have indicated.