A Case of Pregnancy-Induced Hereditary Thrombotic Thrombocytopenic Purpura Complicated by Cerebral Vasospasm

• Published in: Clinical laboratory (Heidelberg) Vol. 70; no. 4
• Main Authors: Jia, Yongqing, He, Enhui, Lu, Cancan, Zhao, Caifang
• Format: Journal Article
• Language: English
• Published: Germany 01-01-2024
• Subjects: Blood Component Transfusion - adverse effects; Female; Humans; Plasma; Pregnancy; Pregnancy Complications, Hematologic - diagnosis; Pregnancy Complications, Hematologic - therapy; Purpura, Thrombotic Thrombocytopenic - complications; Purpura, Thrombotic Thrombocytopenic - diagnosis; Purpura, Thrombotic Thrombocytopenic - therapy; Vasospasm, Intracranial - complications; Vasospasm, Intracranial - therapy
• ISSN: 1433-6510
• DOI: 10.7754/Clin.Lab.2023.231010

The aim was to explore the treatment of a case of congenital thrombotic thrombocytopenic purpura induced by pregnancy complicated with cerebral vasospasm.
We present a case study of congenital TTP where disease onset occurred during two separate pregnancies. Interestingly, the disease course exhibited distinct differences on each occasion. Additionally, following plasma transfusion therapy, there was a transient occurrence of cerebral vasospasm.
In this case, ADAMTS13 levels reached their lowest point three days after delivery during the first pregnancy, triggering morbidity. Remarkably, a single plasma transfusion of 400 mL sufficed for the patient's recovery. Nonetheless, a recurrence of symptoms transpired during her second pregnancy at 24 weeks of gestation. Plasma transfusions were administered during and after delivery. Sudden convulsions developed. ADAMTS13 ac-tivity returned to normal, but cranial MRA revealed constrictions in the intracranial segments of both vertebral arteries, the basilar artery, and the lumen of the anterior, middle, and posterior cerebral arteries. A subsequent cranial MRA conducted a month later showed no lumen stenosis, indicating spontaneous recovery.
These findings highlight the importance of careful consideration when administering plasma transfusions in congenital TTP during pregnancy. Moreover, the development of novel therapeutic approaches such as recombinant ADAMTS13 is crucial for minimizing complications and optimizing patient care.