Preventing maternal deaths due to acquired thrombotic thrombocytopenic purpura
Article first published online: 13 JUN 2012
© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology
Journal of Obstetrics and Gynaecology Research
Volume 39, Issue 1, pages 347–350, January 2013
How to Cite
Hunt, B. J., Thomas-Dewing, R. R., Bramham, K. and Lucas, S. B. (2013), Preventing maternal deaths due to acquired thrombotic thrombocytopenic purpura. Journal of Obstetrics and Gynaecology Research, 39: 347–350. doi: 10.1111/j.1447-0756.2012.01916.x
- Issue published online: 7 JAN 2013
- Article first published online: 13 JUN 2012
- Received: August 23 2011.; Accepted: January 22 2012.
- cardiac thrombosis;
- maternal death;
- thrombotic thrombocytopenic purpura
In order to identify the cause of maternal deaths due to thrombotic thrombocytopenic purpura (TTP) and identify future preventative measures we retrospectively reviewed all maternal deaths due to TTP in London from 2003 to 2008 that were confirmed on post-mortem examination. There were three maternal deaths due to sudden cardiac arrest within 1, 5 and 2 days of presentation, respectively. Post-mortem findings revealed they all died with intramyocardial microvascular thrombosis, the thrombi being characteristically platelet rich (CD61+, fibrin−). Platelet thrombi in the coronary microvasculature are the cause of early sudden death in TTP in pregnancy. If TTP cannot be excluded in the differential diagnosis of thrombotic microangiopathies of pregnancy, then plasmapheresis should be instituted as a medical emergency. ADAMTS-13 levels are helpful in making the diagnosis, but results should not be awaited before instituting plasmapheresis.