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Postpartum Thrombotic Thrombocytopenic Purpura (TTP) Complicating Pregnancy-Associated Immune Thrombocytopenic Purpura (ITP)

Martee Olenich, MD; and Elaine Schattner, MD
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From The New York Hospital-Cornell Medical Center, New York, New York. Requests for Reprints: Elaine Schattner, MD, Division of Hematology-Oncology, Room C-606, The New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, NY 10021.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(10):845-847. doi:10.7326/0003-4819-120-10-199405150-00005
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Although immune thrombocytopenic purpura in pregnancy is common, thrombotic thrombocytopenic purpura is rare and requires aggressive therapy. We report the case of a young pregnant woman with refractory immune thrombocytopenic purpura who developed postpartum thrombotic thrombocytopenic purpura and was successfully treated with plasmapheresis. The case emphasizes the importance of reviewing peripheral blood smears for evaluation of thrombocytopenia even when the diagnosis is felt to be clear. The coexistence of these two disorders has not been previously reported in the English-language literature.

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Figure 1.
Peripheral blood smear showing conversion to microangiopathic hemolytic anemia. Top.Bottom.

Prepartum peripheral blood smear with thrombocytopenia and normochromic red blood cells at 36 weeks. Thrombocytopenia with a new schistocytosis and polychromasia on postpartum day 3.

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