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Thrombotic Thrombocytopenic Purpura and Human Immunodeficiency Virus Complicating Pregnancy

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Medicine & Dentistry of New Jersey–Robert Wood Johnson Medical School/Saint Peter’s University Hospital, New Brunswick, New Jersey; and Saint Peter’s University Hospital, New Brunswick, New Jersey

Address reprint requests to: Angela C. Ranzini, MD, UMDNJ-RWJMS/Saint Peter’s University Hospital, 254 Easton Avenue, MOB-4th Floor, New Brunswick, NJ 08903-0591; E-mail: ranzinac{at}umdnj.edu.

ABSTRACT

BACKGROUND: Thrombotic thrombocytopenic purpura is a rare but serious medical complication, but is relatively common among patients with human immunodeficiency virus (HIV) infection. It is characterized by the pentad of thrombocytopenia, microangiopathic hemolytic anemia, neurological symptoms, fever, and renal abnormalities.However, the pentad is often incomplete, especially in HIV-positive patients.

CASE: An HIV-positive patient complained of easy bruising, hematuria, fever, myalgias, and headache during the second trimester of pregnancy. Laboratory testing revealed hemolytic anemia and severe thrombocytopenia. Bone marrow biopsy was consistent with thrombocytopenic purpura. The patient recovered after plasmapheresis. At 36 weeks’ gestation, she was delivered for preeclampsia and fetal growth restriction.

CONCLUSION: Absence of the classic pentad seen in thrombocytopenic purpura among pregnant HIV-positive patients may make the diagnosis of thrombocytopenic purpura challenging. Frequent monitoring of patients with thrombotic thrombocytopenic purpura for signs and symptoms of preeclampsia and fetal growth assessment is suggested.

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