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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Comparison of typical clinical features and specific management of disorders associated with a platelet count <80,000/microL occurring after 20 weeks gestation

Comparison of typical clinical features and specific management of disorders associated with a platelet count <80,000/microL occurring after 20 weeks gestation
Clinical feature Preeclampsia/HELLP TTP C-TMA ITP Hemorrhage/DIC Sepsis/DIC
Incidence 100 in 10,000 pregnancies 1 in 10,000 pregnancies Unknown. May be similar to TTP. 3 in 10,000 pregnancies 2 in 10,000 pregnancies 1 in 10,000 pregnancies
Time of occurrence By definition, occurs after 20 weeks of gestation; more common near term and within three days postpartum May occur throughout pregnancy, but most common near term and several weeks postpartum May occur throughout pregnancy, but most common postpartum Any time during pregnancy Most commonly at delivery and postpartum Most commonly at delivery and postpartum
Vital signs Hypertension, by definition, BP ≥160/110 Normal BP, fever may be present but is rare Hypertension due to AKI Normal, unless hypotension and tachycardia from bleeding Hypotension, tachycardia (may have been transient) Fever, hypotension, tachycardia
Neurologic abnormalities Headache, vision changes. Less commonly eclamptic seizures, PRES, stroke. Severe in 41% (transient focal defects, seizure, stroke); minor in 30% None None Probably none Probably none
Microangiopathic hemolysis/schistocytes Moderate Severe Moderate None Variable Variable
Kidney injury Usually mild, but severe AKI is possible. Dialysis is rarely required. Usually mild or absent; severe AKI requiring dialysis in <5% Severe, typically dialysis is required None Severe ATN, reversible May have ATN, reversible
Liver function tests: ALT, AST From normal to markedly increased Normal or slightly increased Normal Normal May be markedly increased May be increased
Typical course following delivery Stabilization or improvement within 48 hours No stabilization or improvement within 48 hours Increasing serum creatinine Most unchanged, but may improve after delivery Recovery after source of hemorrhage corrected Recovery after appropriate treatment
Specific management Delivery of infant is curative

For immune TTP, plasma exchange and immunosuppression.

For hereditary TTP, plasma infusion (or other source of ADAMTS13). 		Anti-complement agent Glucocorticoids, IVIG, and maybe additional immunosuppressive agents and/or a thrombopoietin receptor agonist (TPO-RA) for refractory disease Identify and correct source of hemorrhage. May require additional laparotomy. Antibiotics
The incidence of preeclampsia with severe features is 1 case per 100 pregnancies. The incidence of TTP during pregnancy is estimated from data from the Oklahoma TTP Registry (frequency of TTP during pregnancy), and the CDC (birth rate per population).
PE/HELLP: preeclampsia/hemolysis, elevated liver enzymes, low platelets; TTP: thrombotic thrombocytopenic purpura; C-TMA: complement-mediated thrombotic microangiopathy; ITP: immune thrombocytopenia; DIC: disseminated intravascular coagulation; PRES: posterior reversible encephalopathy syndrome; AKI: acute kidney injury; ATN: acute tubular necrosis; AST: aspartate aminotransferase; ALT: alanine aminotransferase; IVIG: intravenous immune globulin; CDC: US Centers for Disease Control and Prevention.
Courtesy of James N George, MD and Jennifer J McIntosh, DO, MS.
Graphic 111517 Version 5.0

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