Refractory Acquired Thrombotic Thrombocytopenic Purpura in the Third Trimester of Twin Pregnancy: A Case Report.
Jeya Sushimitha Jawahar Kanth, Morrish Obol Okello, Thuparambil M Ravi Anish et al.
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Case in brief
A 29-year-old woman in her third trimester of a twin pregnancy presented with symptoms including palpitations, dyspnea, and oral bleeding, alongside severe thrombocytopenia. Initial assessments ruled out preeclampsia/HELLP syndrome. An emergency cesarean section was performed, resulting in the delivery of two healthy infants. Diagnosis of acquired TTP was confirmed post-delivery, and despite initial treatment, the patient experienced a relapse, requiring further management. Ultimately, she achieved sustained recovery and was discharged with her infants in good health.
What made this case unusual
The case highlights refractory TTP in a twin pregnancy, which poses unique diagnostic and therapeutic challenges due to overlapping symptoms with common obstetric conditions.
Diagnostic / clinical pearl
Clinicians should maintain a high index of suspicion for TTP in pregnant patients presenting with thrombocytopenia and hemolysis, even in the absence of hypertension.
Why it matters
This case underscores the necessity of rapid ADAMTS13 testing and multidisciplinary care to differentiate TTP from other obstetric conditions, ensuring timely and effective treatment.