Navigating recurrent immune-mediated thrombotic thrombocytopenic purpura (iTTP) in pregnancy: A case report and literature review

Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare and potentially fatal thrombotic microangiopathy characterized by thrombocytopenia and microangiopathic hemolytic anemia. It primarily affects women of childbearing age, with pregnancy being a significant precipitating factor. TTP overlaps with other pregnancy-related conditions, such as HELLP syndrome, complicating diagnosis and necessitating urgent clinical evaluation and intervention. Plasma-based therapies have significantly improved the prognosis for these patients. Additionally, serial follow-up of ADAMTS-13 activity is recommended at the preconception stage and throughout pregnancy for women with a history of TTP. In this report, we present a case of a 32-year-old patient with a recurrent iTTP on her 11-week gestation of the second pregnancy, which was successfully managed with therapeutic plasma exchange (TPE) and corticosteroids.