516 posters, 59 topics, 63 sessions, 1,127 authors, 352 institutions

2026 SOAP Annual Meeting

April 29 - May 3, 2026 | Montreal, Quebec Canada

2341941

Pregnancy-Associated Thrombotic Thrombocytopenic Purpura Presenting as Severe Thrombocytopenia With Fetal Compromise

PREECLAMPSIA and COAGULOPATHY

Background

•Thrombocytopenia in pregnancy develops in 5-10% of healthy women by the 3rd trimester

•Most common etiologies in 3rd trimester vary by platelet count

Case Presentation

•43yo otherwise healthy G1P0 at 30w2d

•Presented to triage with decreased fetal movement, 1-2 days of petechiae, and “highlighter orange” urine

•BPP 2 out of 10 for +amniotic fluid

Case Progression

•Plt 8; Hematology consulted, decision to treat for presumptive ITP while additional workup expedited

•Betamethasone and magnesium completed, 1u Plt administered, TXA started

•GA induced, liveborn male w/APGARS 3, 8, & 9

•IVIG administered

•Significant oozing noted in field and with attempted OGT placement, additional 1u Plt administered

•Upon extubation, hematology reported schistocytes on peripheral smear, c/f TTP

•Haptoglobin <10, LDH 807, Retic Index 1.47

•Plasmic Score 7-> 72% risk of severe ADAMTS13 deficiency, plasma exchange therapy initiated

Key Takeaways

•Thrombocytopenia features often overlap, but management can vary significantly

•A clear diagnostic framework enables rapid identification and target management