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Rare Pregnancy Blood Disorders Can Elude Diagnosis

Last Updated: April 03, 2009.

 

Study finds lessons in the handling of past cases, offers recommendations to clinicians

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Clinicians need to be alert for the telltale signs of two rare but potentially lethal blood disorders that strike pregnant women, according to a report in the April issue of the American Journal of Obstetrics & Gynecology.

FRIDAY, April 3 (HealthDay News) -- Clinicians need to be alert for the telltale signs of two rare but potentially lethal blood disorders that strike pregnant women, according to a report in the April issue of the American Journal of Obstetrics & Gynecology.

Caroline L. Stella, M.D., of the University of Cincinnati College of Medicine in Ohio, and colleagues examined records from four medical centers where 12 pregnant women presented with thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS), two microangiopathic disorders that occur in 1 in 100,000 pregnancies. The analysis looked at laboratory tests, initial diagnosis, treatment and outcomes, which included the deaths of three of the women and three fetuses.

The investigators found that TTP/HUS was often mistaken for more common conditions that varied depending on whether the women went to an emergency department or saw an obstetrician. Some emergency clinicians mistook the disorder for a panic attack, gastroenteritis or, in one case, domestic violence, the report indicates. Obstetricians mistook the disease for hemolysis, elevated liver enzymes and low platelets syndrome/preeclampsia. Latency from onset of symptoms to diagnosis was as long as seven days, the researchers report.

"In summary, the spectrum of TTP/HUS is a diagnostic challenge that must be triaged methodically. When severe thrombocytopenia and hemolysis are present in the absence of hypertension in any trimester, the diagnosis of TTP needs to be strongly considered. If severe renal dysfunction is also present, HUS should be considered," the authors conclude.

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