One case of thrombotic microangiopathy occurred in pregnancy

The incidence of thrombotic microangiopathy in pregnancy is high enough to suggest that the pregnant state per se may be a predisposing factor for development of this disease. Itʹs important to make a differential diagnosis with preeclampsia. Thrombotic microangiopathy may occur at any time in pregnancy, more frequently in the second and third trimester, and postpartum; preeclampsia occurs after 20 weeks gestation and usually after 36 weeks. Measurement of the plasma antithrombin III level has also important: this is typically low in preeclampsia and normal in thrombotic microangiopathy. Relapsing of thrombotic microangiopathy has occurred during pregnancy. We report one case of thrombotic microangiopathy occurred in 25-year-old-woman during the 35th weeks of an uneventful pregnancy. On admission she showed edema, hypertension and cephalea. A diagnosis of preeclampsia was made. She had used oral contraceptive until two years before the beginning of pregnancy. Four days after the admission a cesarean birth was carried out. A normal female infant was delivered with Apgar scores of 8 and 8 at 1 and 5 minutes respectively. One days after labour patientʹs laboratory data disclosed thrombocytopenia and microangiopathic anemia (table). A diagnosis of thrombotic microangiopathy was made. The patient had been scored 5 according to the severity score proposed by Rose and Eldor. Therapy was promptly instituted with plasma exchange (6 sessions), iloprost infusion (100 μg/daily for 10 onsecutive days) and packed red cell trasfusion (3 units) and the remission was achieved. Fourteen months later, after a six-days-period of flu-like syndrome, she relapsed (table). The diagnosis of relapse was made on the basis of isolated thrombocytopenia, without any microangiopathic change of red cells: indeed platelet count decrease is the first sign of this disorder and red cell fragmented and anemia generally occur after several days. Therapy with plasma exchange (6 sessions), methylprednisone, infusion of fresh frozen plasma (5 units) and iloprost infusion (100 μg/daily for 6 days) was started and the remission was achieved (table). Early recognition and proper treatment are important in the management of this life-threatening disorder.