Read on Twitter
MaternalFetalMedicine #Blooducation conference. Topic: #TTP in pregnancy. We focused on thrombotic microangiopathic hemolytic anemias & 
shear wonder of the #schistocyte. Rock, Paper, Scissors, Shoot. Let's recap on the some of the topics. 
Follow the Tweetorial below
A 23 y/o G2P1 pregnant woman presents to the MFM clinic at 19 weeks gestation. She complained of intermittent headaches and feeling "more tired."
BP is 220/110!
Cr = 3.25, Hb/Hct = 5.4/18.6 Plt = 40
Notice the #schistocytes on her peripheral smear below
BP is 220/110! Cr = 3.25, Hb/Hct = 5.4/18.6 Plt = 40
Notice the #schistocytes on her peripheral smear below
Which of the following conditions can #schistocytes be found?
You got it! #Schistocytes are a RBC abnormality that can be seen in a number of conditions, and are caused by 
mechanical destruction of the RBC. In thrombotic microangioapathies (TTP/HUS), #Schistocytes are formed when sheared through microthrombi formed in small vessels.
mechanical destruction of the RBC. In thrombotic microangioapathies (TTP/HUS), #Schistocytes are formed when sheared through microthrombi formed in small vessels.
#TTP is a type of disease known as a thrombotic microangiopathy (TMA). It is a condition in which microthrombi form, leading to PLT consumption (thrombocytopenia). When this occurs RBCs are fragmented & become hemolyzed as they travel through microvessels. Organ failure ensues.
How is TTP diagnosed?
You got it! TTP is a hereditary or acquired condition that is defined by a severe deficiency (<10%) in ADAMTS13 enzyme, which is responsible for cutting von Willebrand factor into short multimers. The acquired forms are caused by an Ab directed against the enzyme.
ADAMTS13 results is not always available with a rapid turn around time, thereofre, it is extremely useful to use the #PLASMIC score to assess who might benefit from early initiation of plasma exchange while awaiting ADAMTS13 results. https://www.mdcalc.com/plasmic-score-ttp
#TherapeuticPlasmaExchange is considered first line therapy for 
TTP, and benefits the patient is 2 ways:
Removes patient's plasma - removes the autoantibody
Adds donor plasma - add ADAMTS13
Great news - it is safe in pregnancy!
TTP, and benefits the patient is 2 ways: Removes patient's plasma - removes the autoantibodyAdds donor plasma - add ADAMTS13Great news - it is safe in pregnancy!
Pregnancy is the most common trigger of adult-onset congenital TTP, and prophylactic treatment is associated with better outcomes. http://www.bloodjournal.org/content/133/15/1644http://www.bloodjournal.org/content/133/15/1644
At the end of our discussion, a great question was posed. 
Is it possible that pregnant patients diagnosed with HELLP who don't recover postpartum, have undiagnosed TTP?
Any additional pearls or experiences, please share below.
Thank you!
Is it possible that pregnant patients diagnosed with HELLP who don't recover postpartum, have undiagnosed TTP? Any additional pearls or experiences, please share below.
Thank you!
