Postpartum microangiopathic disorders: A case report and review of the literature

• A primigravida, diagnosed with thrombocytopenia.
• In spite of overt microangiopathy signs, ADAMTS13 levels were borderline normal.
• Only after installation of plasmafiltration patient improved.
• Review of literature demonstrates diagnostic difficulties.

IntroductionThrombotic microangiopathic disorders (TMA's) consist of five overlapping disorders: severe pre-eclampsia; HELLP (haemolysis, elevated liver enzyme, and low platelet count) syndrome; thrombotic thrombocytopenic purpura (TTP); haemolytic–uremic syndrome (HUS) and systemic lupus erythematosus (SLE). Although several case reports are published on TTP during pregnancy, none of them has described TTP in the postpartum period.Case presentationWe present a case report that illustrates the clinical difficulties and uncertainties in diagnosing TTP in a peripartum period. After repeatedly borderline ADAMTS13 tests and deteriorating TMA abnormalities in the first 72 h postpartum, treatment with plasma filtration, fresh frozen plasma and prednisolone resulted in a quick clinical and laboratory response.ConclusionTreatment for TTP should be strongly considered in case of an on-going TMA more than 72 h after delivery.