Anesthetic Management in a Parturient with Thrombotic Thrombocytopenic Purpura for Cesarean Section: A Case Report and Literature Review

Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia linked to disseminated microvascular platelet rich-thrombi. TTP is specifically related to a severe deficiency of ADAMTS13, a cleaving protease for von Willebrand (vWF). TTP is occurring in between 1 and 13 cases per million people depending on geographic location, and 1 in 25,000 pregnancies. We present 40-yr-old parturient with TTP who underwent spinal anesthesia for cesarean delivery at 37 weeks of gestation. Treatment for our case included acetylsalicylic acid, methylprednisolone and administration of fresh frozen plasma (FFP). We emphasize the importance of a multidisciplinary team approach to succeed the best outcome for this patient. Literature is discussed.