However, schistocytes not only are present in TTP, but may be encountered in other TMA’s as well, including SLE [4]. Martin and colleagues performed
a prospective study which included eighteen women diagnosed with HELLP syndrome [16]. These women were treated with plasma exchange postpartum because of 1) persistent evidence of atypical HELLP syndrome > 72 h after delivery (n = 9) or 2) evidence of worsening HELLP syndrome at any time postpartum in association with single- or multiple-organ injury (n = 9). Only patients with class 1 HELLP syndrome (platelet count ≤ 50 × 109/L; ASAT or ALAT ≥ 70 U/L; LDH ≥ 600 U/L) and progressive anaemia with abnormal red blood cell forms were included. Two out of nine patients from the second arm (with worsening HELLP syndrome) died despite the therapy. All patients in the first arm responded well to plasma exchange. GDC-0449 price An earlier study recommended that in case of doubt between
ongoing HELLP syndrome and TTP after delivery, one should wait at least 72 h before considering plasmapheresis [17]. McMinn & George support the ‘72-hour policy’ [18]. They provide additional clinical features for starting with plasma treatment, especially in pregnant or postpartum women who are more likely to have TTP-HUS. They recommend to start with plasma therapy if: – Severe thrombocytopenia and microangiopathic haemolytic anaemia progress for more than three days following delivery. Forskolin nmr TTP that occurs during pregnancy carries the risk of relapse after delivery as well as in subsequent pregnancies. Patients should be instructed about recognizing symptoms and reporting them immediately to a physician [7]. Relapses are common among those with congenital ADAMTS13 deficiency (approximately 40% will relapse), but very rare among patients without congenital ADAMTS13 deficiency.
Most of the relapses of non-congenital TTP occur within the first year and are a single event. Relapses after four years are rarely seen [9]. New onset thrombocytopenia during pregnancy should have a thorough work-up, including a peripheral blood smear to look for schistocytes, to exclude thrombotic microangiopathy’s (TMA’s). Also treatment for TTP should be strongly considered in case of an on-going TMA more than aminophylline 72 h after delivery. The authors declare that they have no conflicts of interests. C.H. Wessel: first draft, drafting, conception, revising, literature search, and final approval. C.E. Andreescu: drafting, revising, treating physician, and final approval. S. Rombout-De Weerd: drafting, revising, attending gynecologist, and final approval. M-D. Levin: drafting, revising, supervision, attending internal medicine physician, and final approval. “
“Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy or in the first postpartum year. It is the most common cause of invasive cancer in pregnant women and is estimated to occur at a rate of 6.5 per 100,000 live births [1] and [2].