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Pregnancy and non-pregnancy related immune thrombotic thrombocytopenic purpura in women of reproductive age

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Abstract

Pregnancy is a precipitating factor for immune thrombotic thrombocytopenic purpura (iTTP). We compared the clinical course and outcomes of iTTP in women of reproductive age, between those with pregnancy- and non-pregnancy-related iTTP. A review of all reproductive-aged women diagnosed with iTTP during 2010–2019 in seven university hospitals in Israel. Of 42 cases of iTTP, 12 (28.6%) were pregnancy-related. At presentation, the laboratory profiles did not differ significantly between those with pregnancy- and non-pregnancy-related iTTP, including hemoglobin (median 8.4 vs 8.0 g/dL), platelet count (12.5 vs. 11.5 X 109/L); and levels of bilirubin (1.23 vs. 1.82 mg/dL), lactate dehydrogenase (1615 vs. 1701 U/L), creatinine (0.61 vs. 0.79 mg/dL) and anti-ADAMTS13 antibodies titer (75 vs. 82 U/mL). The proportions of women with renal, neurologic, or hepatic involvement were similar between the groups. Cardiac involvement was more common among those with pregnancy-related disease (25.0% vs. 3.3%, P = 0.06). The median number of courses of plasma-exchange therapy was 11 for both groups. All the women were treated with parenteral corticosteroids and the rate of adjunctive treatments did not differ between the groups (P = 0.30). Four women (one-third) with pregnancy-related disease had preeclampsia. Two women (16.7%) with pregnancy-related iTTP died during the acute episode (P = 0.07); no deaths were observed in the non-pregnancy-related group. Among reproductive-aged women with iTTP, most clinical and laboratory profiles were similar between those with pregnancy- and non-pregnancy-related disease. However, the higher rates of cardiac involvement and mortality among women with pregnancy-related iTTP highlight its challenging management.

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Abbreviations

GA:

Gestational age

iTTP:

Immune thrombotic thrombocytopenia purpura

LDH:

Lactate dehydrogenase

PEX:

Plasma exchange

SGA:

Small for gestational age

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Acknowledgements

Shira Dor’s participation in this study was performed in fulfillment of the research requirements toward the MD degree. We thank Ms. Cindy Cohen for her editorial assistance.

Funding

No external funding was used in this conduct of this study.

Author information

Author notes

  1. Amihai Rottenstreich and Shira Dor have contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel

    Amihai Rottenstreich

  2. Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Shira Dor

  3. Thrombosis and Hemostasis Unit, The Bruce Rappaport Faculty of Medicine, Technion, Rambam Health Care Campus, Haifa, Israel

    Anat Keren-Politansky, Galit Sarig & Yona Nadir

  4. Institute of Hematology, Meir Medical Center, Kfar Saba, Israel

    Martin Ellis

  5. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Martin Ellis, Galia Spectre & Ilya Kirgner

  6. Coagulation Unit, Institute of Hematology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel

    Galia Spectre

  7. Division of Hematology, Sourasky Medical Center, Tel Aviv, Israel

    Ilya Kirgner

  8. Transfusion Medicine Institute, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Oleg Pikovsky

  9. Hematology Department, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel

    Ariela Arad & Yosef Kalish

  10. Blood Bank and Apheresis Unit, The Bruce Rappaport Faculty of Medicine, Technion, Rambam Health Care Campus, Haifa, Israel

    Eldad J. Dann

Authors
  1. Amihai Rottenstreich
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  2. Shira Dor
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  9. Oleg Pikovsky
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  12. Yosef Kalish
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Contributions

All authors-study concept, design, review and approval of the final manuscript. SD, AA, AR, YK, AKP, GS, YN, ME, GS, IK, OP, ED—data acquisition. AR, YK—data analysis and writing of the manuscript.

Corresponding author

Correspondence to Yosef Kalish.

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The authors declare that they have no conflicts of interest.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the local institutional review board of each of the participating hospitals.

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Institutional Review Board approval waiving informed consent was obtained for this retrospective study.

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Rottenstreich, A., Dor, S., Keren-Politansky, A. et al. Pregnancy and non-pregnancy related immune thrombotic thrombocytopenic purpura in women of reproductive age. J Thromb Thrombolysis 51, 187–193 (2021). https://doi.org/10.1007/s11239-020-02133-4

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  • DOI: https://doi.org/10.1007/s11239-020-02133-4

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