The following is a summary of “Challenging follow-up of pregnancy in women with known thrombotic thrombocytopenic purpura: a single-center experience of a preemptive management protocol,” published in the October 2023 issue of Nephrology by Hamroun et al.

Researchers started a retrospective study to evaluate the management of subsequent pregnancies in women with established thrombotic thrombocytopenic purpura.

They involved women with hereditary thrombotic thrombocytopenic purpura or immune thrombotic thrombocytopenic purpura who experienced at least one subsequent pregnancy after their thrombotic thrombocytopenic purpura diagnosis between 2003 and 2022. Pregnant women with immune thrombotic thrombocytopenic purpura received regular platelet count monitoring and quarterly ADAMTS13 activity checks without routine prophylactic treatment. Women with hereditary thrombotic thrombocytopenic purpura received plasma infusions twice weekly until platelet count normalized when count dropped below 150,000/mm³ (with or without hemolysis relapse).

The results showed 13 patients (7 with hereditary thrombotic thrombocytopenic purpura and 6 with immune thrombotic thrombocytopenic purpura), with 20 planned pregnancies (11 and 9, respectively). All pregnancies resulted in live births, and maternal survival was 100%. In the hereditary thrombotic thrombocytopenic purpura group, there were significant improvements in pregnancy duration (37 [35;39] vs. 31 [24;38] weeks, P=0.037) and birth weights (3,265 [3,029;3,410] vs. 2,160 [1,240;2,705] grams, P=0.016). Plasma support was mostly initiated in the third trimester (5/7 patients, 7/11 pregnancies) for this group. One hereditary thrombotic thrombocytopenic purpura relapse resolved rapidly with intensified plasma support. There were no relapses in the immune thrombotic thrombocytopenic purpura group, with ADAMTS13 activity above 40% during pregnancy.

They concluded preemptive pregnancy monitoring was feasible in women with thrombotic thrombocytopenic purpura.

Source:: link.springer.com/article/10.1007/s40620-023-01790-x