The diagnostic dilemma of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in the obstetric triage and emergency department: lessons from 4 tertiary hospitals.
Am J Obstet Gynecol
; 200(4): 381.e1-6, 2009 Apr.
Article
em En
| MEDLINE
| ID: mdl-19110215
ABSTRACT
OBJECTIVE:
We report a series of occurrences of thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS) in pregnancy that emphasizes early diagnosis. STUDYDESIGN:
Fourteen pregnancies with TTP (n = 12) or HUS (n = 2) were studied. Analysis focused on clinical and laboratory findings on examination, initial diagnosis, and treatment.RESULTS:
There were 14 pregnancies in 12 patients; 2 cases of TTP were diagnosed as recurrent. Five women were admitted to the emergency department (ED), and 7 patients were admitted to an obstetrics triage. Patients who were evaluated by an obstetrician were treated initially for hemolysis, elevated liver enzymes and low platelets syndrome/preeclampsia, whereas patients who were seen in the ED had a diagnosis that is commonplace in the ED (panic attack, domestic violence, gastroenteritis). Latency from the onset of symptoms to diagnosis ranged from 1-7 days. Plasmapheresis treatments in early gestation resulted in favorable maternal-neonatal outcome. Maternal and perinatal mortality rates were 25% each.CONCLUSION:
TTP/HUS is a challenging diagnosis in obstetric triage and ED areas. We propose a management scheme that suggests how to triage patients for early diagnosis in pregnancy.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Complicações Hematológicas na Gravidez
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Púrpura Trombocitopênica Trombótica
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Triagem
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Síndrome Hemolítico-Urêmica
Tipo de estudo:
Diagnostic_studies
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Observational_studies
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Screening_studies
Limite:
Adult
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Female
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Humans
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Pregnancy
Idioma:
En
Revista:
Am J Obstet Gynecol
Ano de publicação:
2009
Tipo de documento:
Article
País de afiliação:
Estados Unidos