Postpartum immune thrombotic thrombocytopenic purpura masquerading as haemolysis, elevated liver enzymes and low platelets syndrome: overcoming a diagnostic dilemma.

Pregnancy-associated thrombotic microangiopathy poses a significant diagnostic challenge because of the overlap between hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP syndrome) and thrombotic thrombocytopenic purpura (TTP). We report a case of postpartum immune TTP in a 30-week gravida 3 para 1 woman with pre-existing type 2 diabetes mellitus who initially presented with features consistent with HELLP syndrome and imminent eclampsia. Despite emergency delivery, she developed persistent severe thrombocytopenia and microangiopathic haemolytic anaemia. Further evaluation revealed severe a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 deficiency with inhibitor positivity, confirming immune TTP. Prompt initiation of plasma exchange and corticosteroid therapy resulted in haematological recovery. This case highlights the importance of reconsidering the diagnosis when laboratory abnormalities fail to improve after delivery.