{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T09:22:43Z","timestamp":1778750563750,"version":"3.51.4"},"reference-count":23,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,9,3]]},"abstract":"<jats:p>Thrombotic thrombocytopenic purpura (TTP) is a potentially reversible, life-threatening medical emergency. We present a case of a 21-year-old female with evidence of haemolytic anaemia based on the presence of positive markers of haemolysis. Negative Coomb\u2019s test, thrombocytopenia and placental infarcts raised suspicion for a thrombotic microangiopathy. She was diagnosed with TTP and managed with emergency plasma exchange. Her recovery was immediate.<\/jats:p>\n               <jats:p>A presumptive diagnosis of TTP should be based on the presence of microangiopathic haemolytic anaemia with thrombocytopenia and plasma exchange should be initiated while complete work up is pending. Using the regular pentad solely for diagnosis of TTP will lead to underdiagnosis of many cases and should be avoided.<\/jats:p>\n               <jats:p>Several microangiopathies can be seen during pregnancy including TTP\/atypical haemolytic uraemic syndrome, HELLP syndrome, pre-eclampsia, disseminated intravascular coagulopathy and antiphospholipid antibody syndrome. Distinction between each type will be the focus of our discussion as treatment decisions differ accordingly.<\/jats:p>","DOI":"10.1136\/bcr-2017-221648","type":"journal-article","created":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T00:40:24Z","timestamp":1516236024000},"page":"bcr-2017-221648","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Microangiopathies in pregnancy"],"prefix":"10.1136","volume":"2018","author":[{"given":"Jailan","family":"Elayoubi","sequence":"first","affiliation":[{"name":"Department of Hematology and Oncology, Michigan State University, Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavitha","family":"Donthireddy","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7950-8880","authenticated-orcid":false,"given":"Divyesh Reddy","family":"Nemakayala","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Michigan State University, Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,1,17]]},"reference":[{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.1","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1182\/blood.V80.8.1890.bloodjournal8081890","article-title":"Thrombotic microangiopathies in the 1980s: clinical features, response to treatment, and the impact of the human immunodeficiency virus epidemic","volume":"80","author":"Thompson","year":"1992","journal-title":"Blood"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(96)70162-X"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.3","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.3109\/14767058.2011.619603","article-title":"A high LDH to AST ratio helps to differentiate pregnancy-associated thrombotic thrombocytopenic purpura (TTP) from HELLP syndrome","volume":"25","author":"Keiser","year":"2012","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199204023261405"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.5","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318231934c"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.6","first-page":"223","article-title":"Disseminated intravascular coagulation in pregnancy","volume":"19","author":"Lester","year":"1977","journal-title":"J Reprod Med"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.7","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-199805000-00005"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.8","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-12-547067"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.9","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/01.SMJ.0000136231.83564.F6","article-title":"Thrombotic thrombocytopenic purpura without schistocytes on the peripheral blood smear","volume":"98","author":"Daram","year":"2005","journal-title":"South Med J"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.10","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1056\/NEJM197110212851717","article-title":"TTP treatment","volume":"285","author":"Kutell","year":"1971","journal-title":"N Engl J Med"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.11","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1002\/ajh.2830280215","article-title":"Intravenous high dose methylprednisolone for thrombotic thrombocytopenic purpura","volume":"28","author":"Ozsoylu","year":"1988","journal-title":"Am J Hematol"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.12","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/0955-3886(92)90124-Y","article-title":"Steroids: what role in TTP?","volume":"13","author":"","year":"1992","journal-title":"Transfus Sci"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.13","doi-asserted-by":"publisher","DOI":"10.1038\/35097008"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2005.01425.x"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.03.011"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(03)00199-4"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.17","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/j.1538-7836.2011.04341.x","article-title":"Natural history of Upshaw-Schulman syndrome based on ADAMTS13 gene analysis in Japan","volume":"9 Suppl 1","author":"Fujimura","year":"2011","journal-title":"J Thromb Haemost"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2014.07.004"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.19","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-07-271445"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.290.6474.1025"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.21","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-10-605493"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.22","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-02-553131"},{"key":"2025082623093707000_2018.jan17_1.bcr-2017-221648.23","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2003-12-4250"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-221648","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:09:51Z","timestamp":1756274991000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-221648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,17]]},"references-count":23,"alternative-id":["10.1136\/bcr-2017-221648"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-221648","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,17]]}}}