Post-partum Thrombotic Thrombocytopenic Purpura with Puerperal Sepsis- A Case Report

INTRODUCTION: Post-partum TTP is an uncommon thrombotic microangiopathy affecting about 1 in 200,000 pregnancies in contrast to preeclampsia and HUS, which have been reported commonly. CASE PRESENTATION: We report a case of a postpartum TTP following purpureal sepsis. The patient was brought with per vaginal bleed, vomiting, chest pain, yellow discoloration of sclera, and abdominal discomfort following a spontaneous vaginal delivery two days back at a hospital. CLINICAL FINDINGS AND INVESTIGATIONS: The workup revealed anemia and thrombocytopenia with deranged PT/INR. The renal profile deteriorated over one day and she also developed psychosis. Additionally, schistocytes were observed on the peripheral blood smear. INTERVENTIONS AND OUTCOME: The patient was subsequently treated with dialysis followed by plasmapheresis in addition to the antibiotics after the diagnosis of TTP and made a complete recovery. RELEVANCE AND IMPACT: 25% of TTP occurs in the intra or postpartum period. It is thus pivotal to keep it among differentials and intervened timely to reduce morbidity and mortality. Vigilance is required to prevent any relapse in subsequent pregnancies.