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.