Can COVID-19 Lead to Refractory Thrombotic Thrombocytopenic Purpura (TTP) During Pregnancy and Postpartum? A Case Report and a Review of the Literature.

Thrombotic thrombocytopenic purpura (TTP) is a rare but fatal blood disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, and multi-organ dysfunction. This condition often worsens during pregnancy and the postpartum period due to physiological changes. The present study reports a case of refractory TTP in a pregnant woman with a history of positive COVID-19 infection who required aggressive treatment throughout her pregnancy and postpartum recovery. A 41-year-old pregnant woman (G3P2L2; C/S × 2) presented at 6 weeks of gestation with sudden hematuria, fever, and a positive COVID-19 PCR test. Laboratory findings revealed the presence of schistocytes on the blood smear and a platelet count of 10,000/μL, strongly suggestive of TTP. Following hematology and gastroenterology evaluations, treatment was initiated immediately with methylprednisolone (1 mg/kg) and plasma exchange (PLEX). At 11 weeks of gestation, the patient's platelet count decreased to 12,000/μL, with evidence of hemolysis. She underwent eight sessions of PLEX and continued oral prednisolone therapy (1 mg/kg). The patient was subsequently discharged with a platelet count of 300,000/μL. Weekly outpatient PLEX and oral prednisolone were maintained throughout the pregnancy. At 36 weeks of gestation, the patient presented with labor pain and headache, leading to an emergency cesarean section. Postoperatively, she underwent 10 additional PLEX sessions and continued oral prednisolone treatment. She was discharged after 2 weeks in stable condition, without further complications. In conclusion, post-COVID-19 TTP could affect women and poses substantial therapeutic challenges. This case study highlights the complexities involved in managing refractory TTP during pregnancy and the postpartum period.