{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:23:18Z","timestamp":1787318598982,"version":"build-2736575974"},"reference-count":6,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,10]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>\n                    Pregnancy-associated thrombotic microangiopathy poses a significant diagnostic challenge because of the overlap between hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP syndrome) and thrombotic thrombocytopenic purpura (TTP). We report a case of postpartum immune TTP in a 30-week gravida 3 para 1 woman with pre-existing type 2 diabetes mellitus who initially presented with features consistent with HELLP syndrome and imminent eclampsia. Despite emergency delivery, she developed persistent severe thrombocytopenia and microangiopathic haemolytic anaemia. Further evaluation revealed severe\n                    <jats:italic>\n                      <jats:bold>a d<\/jats:bold>\n                      isintegrin\n                      <jats:bold>a<\/jats:bold>\n                      nd\n                      <jats:bold>m<\/jats:bold>\n                      etalloproteinase with a\n                      <jats:bold>t<\/jats:bold>\n                      hrombo\n                      <jats:bold>s<\/jats:bold>\n                      pondin type 1 motif, member\n                      <jats:bold>13<\/jats:bold>\n                    <\/jats:italic>\n                    deficiency with inhibitor positivity, confirming immune TTP. Prompt initiation of plasma exchange and corticosteroid therapy resulted in haematological recovery. This case highlights the importance of reconsidering the diagnosis when laboratory abnormalities fail to improve after delivery.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2026-273172","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:50:13Z","timestamp":1787313013000},"page":"e273172","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Postpartum immune thrombotic thrombocytopenic purpura masquerading as haemolysis, elevated liver enzymes and low platelets syndrome: overcoming a diagnostic dilemma"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8740-9093","authenticated-orcid":false,"given":"Manisha","family":"Kumari","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeshwari","family":"Bhat","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krupa","family":"Shah","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"2026082105202228000_19.8.e273172.1","doi-asserted-by":"crossref","unstructured":"McCrae KR . Thrombotic microangiopathy in pregnancy. Hematology Am Soc Hematol Educ Program 2010;397\u2013403.","DOI":"10.1182\/asheducation-2010.1.397"},{"key":"2026082105202228000_19.8.e273172.2","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-9-8","article-title":"The HELLP syndrome: clinical issues and management. A Review","volume":"9","author":"Haram","year":"2009","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026082105202228000_19.8.e273172.3","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15006"},{"key":"2026082105202228000_19.8.e273172.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp053024"},{"key":"2026082105202228000_19.8.e273172.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-020-01865-y","article-title":"Severe HELLP syndrome masquerading as thrombocytopenic thrombotic purpura: a case report","volume":"21","author":"Mousseaux","year":"2020","journal-title":"BMC Nephrol"},{"key":"2026082105202228000_19.8.e273172.6","article-title":"A Rare Case of Pregnancy-Associated Thrombotic Thrombocytopenic Purpura: Challenges in Diagnosis and Management","volume":"17","author":"Albousaeed","year":"2025","journal-title":"Cureus"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-273172","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:24:35Z","timestamp":1787315075000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-273172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":6,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,21]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bcr-2026-273172"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-273172","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}