We spoke with Dr Chetna Jain, Senior Director – Department of Obstetrics and Gynaecology at Cloudnine Group of Hospitals, Chandigarh, to understand TTP during pregnancy, its symptoms, diagnosis and management.
What Is TTP During Pregnancy?
Thrombotic thrombocytopenic purpura is a rare condition in which very small blood clots form inside tiny blood vessels. These clots can use up platelets and interfere with normal blood flow to your organs.TTP is usually linked to very low levels of an enzyme called ADAMTS13. This enzyme normally helps control a protein called von Willebrand factor, which plays a role in blood clotting. When ADAMTS13 is severely reduced, unusually large forms of this protein can cause platelets to stick together and form small clots.
What Are the Symptoms of TTP in Pregnancy?
Most common symptoms of TTP in pregnancy include:- Extreme tiredness or weakness
- Pale or yellowish skin
- Easy bruising or small red or purple spots on the skin
- Headache
- Confusion or difficulty concentrating
- Blurred vision or other changes in vision
- Nausea or vomiting
- Abdominal discomfort
- Shortness of breath
- Reduced urine output
- Fever in some cases
Why Can TTP Happen During Pregnancy?
Pregnancy naturally changes the balance of proteins involved in blood clotting. In women who already have a problem with ADAMTS13, these changes may increase the risk of a TTP episode.- In immune-mediated TTP, antibodies interfere with ADAMTS13.
- In congenital TTP, the body has an inherited deficiency of the enzyme.
How Is TTP Diagnosed During Pregnancy?
Doctors may suspect TTP when blood tests show very low platelets and red blood cell breakdown.Your Doctor may recommend:
- Complete blood count: Checks platelet and red blood cell levels.
- Blood smear: Looks for damaged red blood cells.
- Blood tests: Check LDH, bilirubin and haptoglobin levels.
- Kidney and liver tests: Check whether these organs are affected.
- ADAMTS13 test: Very low activity, usually below 10%, strongly supports TTP.
TTP vs Preeclampsia and HELLP Syndrome
“TTP during pregnancy can be challenging to diagnose because its symptoms and laboratory findings may overlap with conditions such as pre-eclampsia and HELLP syndrome. Timely evaluation is important for appropriate management.”- Dr Chetna Jain, Senior Director – Department of Obstetrics and Gynaecology at Cloudnine Group of Hospitals, Chandigarh
- TTP: Very low platelets, red blood cell breakdown and severely reduced ADAMTS13 activity.
- Preeclampsia: Usually involves high blood pressure and may affect the kidneys or other organs.
- HELLP syndrome: Commonly involves liver problems, low platelets and red blood cell breakdown.
How Is TTP Treated During Pregnancy?
TTP needs urgent medical treatment, usually under a specialist team.Treatment may include:
- Plasma exchange: Removes harmful antibodies and replaces missing ADAMTS13.
- Corticosteroids: Help reduce abnormal immune activity.
- Other medicines: Rituximab or caplacizumab may be considered in some cases.
- Congenital TTP: Plasma or recombinant ADAMTS13 may be used to replace the missing enzyme.
Can TTP Affect the Baby?
TTP can affect the baby, especially when the condition is severe or treatment is delayed. Possible risks include:- Poor fetal growth
- Pregnancy loss
- Pregnancy complications due to reduced blood flow
When Should You Seek Medical Help?
Contact your doctor promptly if you experience:- Unusual bruising or bleeding
- Severe weakness or tiredness
- Persistent headache or confusion
- Vision changes
- Abdominal pain
- Sudden changes in your health
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FAQs on Thrombotic Thrombocytopenic Purpura (TTP) in Pregnancy: Symptoms, Risks and Treatment
- Can a woman with a history of TTP become pregnant?
Yes. Pregnancy may be possible, but it should be planned with a haematologist and obstetrician. Close monitoring can help doctors identify changes early. - Can TTP come back during another pregnancy?
Yes. TTP can recur, particularly in women who have experienced it before. Doctors may monitor platelet counts and ADAMTS13 levels throughout pregnancy. - Is TTP the same as having low platelets during pregnancy?
No. Low platelets can happen for several reasons during pregnancy. TTP is a specific and serious blood disorder that also involves red blood cell breakdown and abnormal small blood clots.