Document Detail


The diagnostic dilemma of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in the obstetric triage and emergency department: lessons from 4 tertiary hospitals.
MedLine Citation:
PMID:  19110215     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We report a series of occurrences of thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS) in pregnancy that emphasizes early diagnosis. STUDY DESIGN: Fourteen pregnancies with TTP (n = 12) or HUS (n = 2) were studied. Analysis focused on clinical and laboratory findings on examination, initial diagnosis, and treatment. RESULTS: There were 14 pregnancies in 12 patients; 2 cases of TTP were diagnosed as recurrent. Five women were admitted to the emergency department (ED), and 7 patients were admitted to an obstetrics triage. Patients who were evaluated by an obstetrician were treated initially for hemolysis, elevated liver enzymes and low platelets syndrome/preeclampsia, whereas patients who were seen in the ED had a diagnosis that is commonplace in the ED (panic attack, domestic violence, gastroenteritis). Latency from the onset of symptoms to diagnosis ranged from 1-7 days. Plasmapheresis treatments in early gestation resulted in favorable maternal-neonatal outcome. Maternal and perinatal mortality rates were 25% each. CONCLUSION: TTP/HUS is a challenging diagnosis in obstetric triage and ED areas. We propose a management scheme that suggests how to triage patients for early diagnosis in pregnancy.
Authors:
Caroline L Stella; John Dacus; Edwin Guzman; Pushpinder Dhillon; Kristin Coppage; Helen How; Baha Sibai
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2008-12-25
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  200     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-25     Completed Date:  2009-04-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  381.e1-6     Citation Subset:  AIM; IM    
Affiliation:
University of Cincinnati College of Medicine, Department of Obstetrics & Gynecology, Cincinnati, OH, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Emergency Service, Hospital
Female
Hemolytic-Uremic Syndrome / diagnosis*
Humans
Pregnancy
Pregnancy Complications, Hematologic / diagnosis*
Purpura, Thrombotic Thrombocytopenic / diagnosis*
Retrospective Studies
Triage*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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