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11-10-2023 | Thrombotic Thrombocytopenic Purpura | original Article

The challenging follow-up of pregnancy in women with known thrombotic thrombocytopenic purpura: a single-center experience of a preemptive management protocol

Authors: Aghiles Hamroun, Camille Prouteau, Rémi Lenain, Camille Roger, Anne Bauters, Christophe Zawadzki, Damien Subtil, Jean-Baptiste Gibier, Morgane Stichelbout, Paul Coppo, Arnaud Lionet, Mehdi Maanaoui, Marc Hazzan, François Provôt

Published in: Journal of Nephrology | Issue 9/2023

Abstract

Background

Although thrombotic thrombocytopenic purpura frequently affects women of childbearing age, there is no clear recommendation for the management of subsequent pregnancies in women with established thrombotic thrombocytopenic purpura.

Methods

This single-center, retrospective, observational study included all women with hereditary thrombotic thrombocytopenic purpura or immune thrombotic thrombocytopenic purpura who had had at least one subsequent pregnancy after thrombotic thrombocytopenic purpura diagnosis between 2003 and 2022. The strategy comprised weekly surveillance of platelet count during pregnancy (and quarterly monitoring of ADAMTS13 activity) for women with immune thrombotic thrombocytopenic purpura, without any routine prophylactic treatment. In case of thrombocytopenia < 150,000/mm³ (with or without hemolysis relapse), women with hereditary thrombotic thrombocytopenic purpura systematically received plasma infusions twice weekly until platelet count normalized.

Results

A total of 13 patients were included (7 with hereditary thrombotic thrombocytopenic purpura and 6 with immune thrombotic thrombocytopenic purpura, with 20 planned pregnancies (11 and 9, respectively). All pregnancies resulted in live births, and all mothers survived. There was a marked improvement in pregnancy terms in the hereditary thrombotic thrombocytopenic purpura group compared to index pregnancies (37 [35;39] versus 31 [24;38] weeks, p = 0.037) and birth weights (3265 [3029;3410] versus 2160 [1240;2705] grams, p = 0.016), with need for plasma support mostly starting during the third trimester (5/7 patients, 7/11 pregnancies). A single hereditary thrombotic thrombocytopenic purpura relapse occurred, with rapid resolution after plasma support intensification. There were no relapses in the immune thrombotic thrombocytopenic purpura group, with ADAMTS13 activity systematically above 40% during all monitored pregnancies.

Conclusion

These real-life data support the feasibility of a preemptive approach to pregnancy monitoring in women with known thrombotic thrombocytopenic purpura who undergo active surveillance within a multidisciplinary network.

Graphical abstract

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Title: The challenging follow-up of pregnancy in women with known thrombotic thrombocytopenic purpura: a single-center experience of a preemptive management protocol
Authors: Aghiles Hamroun
Camille Prouteau
Rémi Lenain
Camille Roger
Anne Bauters
Christophe Zawadzki
Damien Subtil
Jean-Baptiste Gibier
Morgane Stichelbout
Paul Coppo
Arnaud Lionet
Mehdi Maanaoui
Marc Hazzan
François Provôt
Publication date: 11-10-2023
Publisher: Springer International Publishing
Keyword: Thrombotic Thrombocytopenic Purpura
Published in: Journal of Nephrology / Issue 9/2023
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-023-01790-x

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