Thrombotic Thrombocytopenic Purpura During Pregnancy

Thrombotic thrombocytopenic purpura (TTP) is a problem of blood vessels that sometimes develops during pregnancy, either as a complication of a disease, or independently. Although TTP is overall fairly rare in society, about half of all severe, quickly-developing cases in women of child-bearing age occur during pregnancy. If you suffer from TTP, you may develop blood clotting problems, bleeding problems, or both. While clotting and bleeding problems sound like opposites of one another, they actually are connected. The disorders of bleeding and clotting occur together in TTP, because platelets (cells that form blood clots) produce many clots by clumping together with on another and with a certain protein. This over clotting consumes your platelets, so then it actually becomes more difficult to form clots, leading to bleeding.

A particular enzyme (a chemical that your cells make to helps chemical reactions run) normally prevents this chain of events, but certain diseases, and also pregnancy, can interfere with the enzyme. If you develop TTP, you will experience excessive bruising and bleeding, especially in the nose, gums, and from cuts. Your may produce dark stools may appear dark, because they contain blood, and your urine may be rose-colored, also because of blood. You may also experience extreme fatigue, pain in the side, or around your tummy, headaches, seizures, confusion, trouble bleeding, nausea, vomiting, diarrhea, lack of appetite, and various other symptoms.

As for diagnosis, TTP is what doctors call a clinical diagnosis. This means that the doctor decides that you probably have TTP because of bruising, bleeding, and  various other symptoms that have developed very quickly, over the course of a few days). The clinical diagnosis also depends on results of simple, quick urine and blood tests. One important finding that can help is that the number of platelets in your blood is too low. Another finding pointing to TTP is that there are pieces of broken red blood cells in your urine. Doctors also can test the activity of the specific enzyme that does not work well in TTP. The findings would provide a definite laboratory diagnosis for TTP, but usually there is not enough time to await the results of this test.

If TTP is not recognized early and treated, it is fatal 90 percent of the time.  In most cases, though, the condition is recognized and recovery is likely if you receive a treatment called plasma exchange. TTP can kill the fetus inside your womb, resulting in a spontaneous abortion (miscarriage). It also can cause a spontaneous abortion without first destroying the fetus. Another possible complication of TTP is what doctors called intrauterine growth retardation, which can end the pregnancy, or lead to low birth weight in the newborn.

The main medications that may be given as part of treatment for TTP during pregnancy are called corticosteroids. When administered intravenously, the usual steroid is methylprednisolone. A similar steroid called prednisolone is taken by mouth, but both drugs are thought to be safe for mother and fetus. Prednisolone also is considered safe in mothers who are breastfeeding. As for methylprednisolone during breastfeeding, there is some concern that it could enter breast milk. Mothers requiring methylprednisolone may be able to nurse if they pump and discard milk that that has accumulated for a few hours after intravenous administration of methylprednisolone.  Then, they can feed the infant on the milk that builds up later. This procedure is complicated though so you may prefer to use infant formula. The main treatment for TTP during pregnancy is plasma exchange. Pregnant women with TTP also may need transfusions of red blood cells.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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