Table 3.

Clinical features suggesting a diagnosis of thrombotic thrombocytopenic purpura (TTP) and consideration for plasma exchange treatment in pregnant/postpartum women.

Adapted from reference 14. These abnormalities may all be due to severe preeclampsia/eclampsia/HELLP syndrome, and may all resolve spontaneously following delivery with only continued observation and supportive care. However, the clinical features described here suggest progressive disease and are appropriate indications for plasma exchange treatment, for presumptive TTP. 
Hematologic abnormalities 

  • Severe thrombocytopenia and microangiopathic hemolytic anemia that continue to worsen > 3 days after delivery

  • Normal coagulation parameters, or resolving DIC

 
Neurologic parameters 

  • Severe mental status abnormalities

  • Focal abnormalities (e.g., aphasia or focal motor deficits)

  • Seizures not associated with severe hypertension, or occurring > 3 days after delivery

 
Renal abnormalities 

  • Oliguric acute renal failure

 
Systemic abnormalities 

  • Resolving hypertension

  • Progressive abnormality of serum lactate dehydrogenase (LDH) associated with resolving abnormalities of liver function tests (serum alanine aminotransferase [ALT] and aspartate aminotransferase [AST])

 
Adapted from reference 14. These abnormalities may all be due to severe preeclampsia/eclampsia/HELLP syndrome, and may all resolve spontaneously following delivery with only continued observation and supportive care. However, the clinical features described here suggest progressive disease and are appropriate indications for plasma exchange treatment, for presumptive TTP. 
Hematologic abnormalities 

  • Severe thrombocytopenia and microangiopathic hemolytic anemia that continue to worsen > 3 days after delivery

  • Normal coagulation parameters, or resolving DIC

 
Neurologic parameters 

  • Severe mental status abnormalities

  • Focal abnormalities (e.g., aphasia or focal motor deficits)

  • Seizures not associated with severe hypertension, or occurring > 3 days after delivery

 
Renal abnormalities 

  • Oliguric acute renal failure

 
Systemic abnormalities 

  • Resolving hypertension

  • Progressive abnormality of serum lactate dehydrogenase (LDH) associated with resolving abnormalities of liver function tests (serum alanine aminotransferase [ALT] and aspartate aminotransferase [AST])

 
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