Q; 24 years old female with 31 weeks pregnancy came to ER with mental status change and diligently diagnosed with acquired thrombotic thrombocytopenic purpura (TTP). Your next line of treatment? 

A) Plasma exchange therapy (PEX)
B) Delivery of baby
C) IVIG infusion
D) Continue observation
E) Platelet transfusion


Answer:  A

Objective of above question is to signify the point that delivery of fetus/baby does not resolve TTP and if not treated mortality is almost 90%, so weighing risk vs benefit PEX should be initiated. Delivery should be considered only if there is concern for preeclampsia or HELLP syndrome. 

IVIG may cause increase viscosity issues and platelet transfusion is not recommended in TTP. 


References:

1. Scully M, Thomas M, Underwood M, et al. Thrombotic thrombocytopenic purpura and pregnancy: presentation, management, and subsequent pregnancy outcomes. Blood 2014; 124:211.

2. Ezra Y, Rose M, Eldor A. Therapy and prevention of thrombotic thrombocytopenic purpura during pregnancy: a clinical study of 16 pregnancies. Am J Hematol 1996; 51:1.