Document Detail


Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955-2006.
MedLine Citation:
PMID:  18456236     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A review of pregnancy-associated thrombotic thrombocytopenic purpura (TTP) in 166 pregnancies was undertaken using 92 English-language publications from 1955 to 2006. Initial and recurrent TTP presents most often in the second trimester (55.5%) after 1-2 days of signs/symptoms; postpartum TTP usually occurs following term delivery. TTP with preeclampsia (n = 28) exhibits 2-4 times higher aspartate aminotransferase (AST) values and lower total lactate dehydrogenase (LDH) to AST ratios (LDH to AST ratio = 13:1), compared with TTP without preeclampsia (LDH to AST ratio = 29:1). Maternal mortality is higher with initial TTP (26% vs 10.7%), especially with concurrent preeclampsia (44.4% vs 21.8%, P < .02). Although maternal mortality with TTP has substantially declined when plasma therapy is utilized, delay of diagnosis and therapy for initial TTP confounded by preeclampsia/hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome remains a significant maternal-perinatal threat. Rapid and readily available laboratory testing to quickly diagnose TTP and HELLP syndrome/preeclampsia is desperately needed to improve care.
Authors:
James N Martin; Amelia P Bailey; Jonathan F Rehberg; Michelle T Owens; Sharon Dixon Keiser; Warren L May
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Publication Detail:
Type:  Journal Article; Review     Date:  2008-05-23
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  199     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-04     Completed Date:  2008-08-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  98-104     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, Divisions of Maternal-Fetal Medicine and Women's Health, University of Mississippi Medical Center, Jackson, MS, USA.
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MeSH Terms
Descriptor/Qualifier:
ADAM Proteins / blood
Aspartate Aminotransferases / blood
Female
HELLP Syndrome / diagnosis,  therapy
Humans
L-Lactate Dehydrogenase / blood
Maternal Mortality
Pregnancy
Pregnancy Complications, Cardiovascular / diagnosis*,  mortality,  therapy*
Purpura, Thrombotic Thrombocytopenic / diagnosis*,  mortality,  therapy*
Chemical
Reg. No./Substance:
EC 1.1.1.27/L-Lactate Dehydrogenase; EC 2.6.1.1/Aspartate Aminotransferases; EC 3.4.24.-/ADAM Proteins; EC 3.4.24.-/ADAMTS13 protein, human

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