A Race against the Clock: A Case Report and Literature Review Concerning the Importance of ADAMTS13 Testing in Diagnosis and Management of Thrombotic Thrombocytopenic Purpura during Pregnancy
Abstract
:1. Introduction
2. Case Report
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Differential Diagnosis | ||
---|---|---|
Diagnostic | Characteristics | |
TTP |
| |
DIC |
| |
Disseminated Lupus Erythematosus (Vasculitis from Antiphospholipid syndrome) |
| |
HELLP Syndrome and Preeclampsia |
| |
not more than in PTT | ||
Hemolytic Uremic Syndrome |
| |
Viral Infection Acute Sepsis COVID-19, Vaccination with Pfizer BioNTech (BNT2b2) |
| |
Acute Fatty Liver |
|
Time of Admission | |||||||||
---|---|---|---|---|---|---|---|---|---|
19 April 2021 | 20 April 2021 | 21 April 2021 | 22 April 2021 | ||||||
Tests | Result 1 | Result 2 | Result 1 | Result 2 | Result 1 | Result 2 | Result 1 | Result 2 | Normal Value |
Leukocytes (WBC) | 14.7 × 109/L | 16.2 × 109/L | 14.2 × 109/L | - | 14.8 × 109/L | 17.4 × 109/L | 15.8 × 109/L | - | 4.00–10.00 × 109/L |
Hemoglobin (HGB) | 5.3 g/dL | 5.5 g/dL | 6.9 g/dL | - | 6.1 g/dL | 8.0 g/dL | 7.7 g/dL | - | 11.5–16 g/dL |
Hematocrit (HCT) | 17.2% | 17.4% | 23% | - | 20.7% | 26.5% | 25.5 | - | 35–48% |
Platelets (PLT) | 13 × 109/L | 11 × 109/L | 18 × 109/L | - | 22 × 109/L | 32 × 109/L | 26 × 109/L | 150–450 × 109/L | |
INR (International Normalized Ratio) | 1.05 | - | 1.09 | - | 1.1 | - | 1.04 | - | 0.8–1.2 |
APTT | 29.1 | - | 25.1 | - | 25.5 | - | 26.5 | 25–38 s | |
Fibrinogen | 410 mg/dL | - | 453 mg/dL | - | 387 mg/dL | - | 415 mg/dL | - | 180–450 mg/dL |
Creatinine | 1.36 mg/dL | 1.38 mg/dL | 1.54 mg/dL | - | 1.48 mg/dL | 1.62 mg/dL | 1.56 mg/dL | - | 0.50–0.90 mg/dL |
Urea | 53 mg/dL | 50.47 mg/dL | 51.03 mg/dL | - | 60.06 mg/dL | 58.86 mg/dL | 69.96 mg/dL | - | 16–43 mg/dL |
Uric Acid | 6.94 mg/dL | 6.97 mg/dL | - | - | - | - | - | - | 2.3–6.10 mg/dL |
Total Bilirubin | - | - | 1.30 mg/dL | - | 1.66 mg/dL | - | 1.39 mg/dL | - | 0.30–1.10 mg/dL |
Direct Bilirubin | - | - | 0.37 mg/dL | - | 0.31 mg/dL | - | 0.49 mg/dL | - | 0.10–0.40 mg/dL |
C Reactive Protein (CRP) | 75.5 mg/L | 79.04 mg/L | 85.47 mg/L | - | 84.5 mg/L | - | 0.00–5.00 mg/L | ||
Lactate dehydrogenase (LDH) | - | - | - | - | 1374 U/L | 1582 U/L | 1764 U/L | - | 0.00–247.00 U/L |
Total Protein | - | - | 5.6 g/dL | - | 5.26 g/dL | 5.71 g/dL | 5.84 g/dL | - | 6.60–8.30 g/dL |
Peripheral Blood Smear | Frequent target erythrocytes and schizocytes, aspect that is consistent | ||||||||
Reticulocytes | Reticulocytes 66 per 1000 red blood cells are found (normal is 5–15 per 1000 red blood cells) | ||||||||
Troponin I | 7.11 ng/mL | <0.5 ng/mL | |||||||
D-dimers | >3000 ng/mL | <100 ng/mL | |||||||
COVID19 (PCR) | Negative | ||||||||
Cultures | All cultures were negative |
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Mitranovici, M.I.; Pușcașiu, L.; Oală, I.E.; Petre, I.; Craina, M.L.; Mager, A.R.; Vasile, K.; Chiorean, D.M.; Sabău, A.-H.; Turdean, S.G.; et al. A Race against the Clock: A Case Report and Literature Review Concerning the Importance of ADAMTS13 Testing in Diagnosis and Management of Thrombotic Thrombocytopenic Purpura during Pregnancy. Diagnostics 2022, 12, 1559. https://doi.org/10.3390/diagnostics12071559
Mitranovici MI, Pușcașiu L, Oală IE, Petre I, Craina ML, Mager AR, Vasile K, Chiorean DM, Sabău A-H, Turdean SG, et al. A Race against the Clock: A Case Report and Literature Review Concerning the Importance of ADAMTS13 Testing in Diagnosis and Management of Thrombotic Thrombocytopenic Purpura during Pregnancy. Diagnostics. 2022; 12(7):1559. https://doi.org/10.3390/diagnostics12071559
Chicago/Turabian StyleMitranovici, Melinda Ildiko, Lucian Pușcașiu, Ioan Emilian Oală, Izabella Petre, Marius Lucian Craina, Antonia Rebeka Mager, Kinga Vasile, Diana Maria Chiorean, Adrian-Horațiu Sabău, Sabin Gligore Turdean, and et al. 2022. "A Race against the Clock: A Case Report and Literature Review Concerning the Importance of ADAMTS13 Testing in Diagnosis and Management of Thrombotic Thrombocytopenic Purpura during Pregnancy" Diagnostics 12, no. 7: 1559. https://doi.org/10.3390/diagnostics12071559