A 26-year-old female was referred to our hospital in the 20th week of a second pregnancy because of severe intra-uterine growth restriction, hypertension, thrombocytopenia and proteinuria. Working diagnosis was thrombotic thrombocytopenic purpura, but it was difficult to differentiate it from haemolysis, elevated liver enzymes, and low platelet count. Therapeutic plasma exchange was urgently initiated and pregnancy was terminated with prostaglandin induction. The activity level of ADAMTS13 (a disintegrin and metalloproteinase with trombospondin type-1 motifs 13, the von Willebrand Factor cleaving protease), was immeasurably low. Furthermore, the patient was positive for ADAMTS13 inhibitor, which confirmed a diagnosis of acquired thrombotic thrombocytopenic purpura.

(BELG J HEMATOL 2014;5(3):106–9)