Can a blood test could aid in the diagnosis of TTP/aHUS in pregnant women?


A blood test could aid in the diagnosis of TTP/AHUS in pregnant women, according to a new study.

A small study indicated that a blood test could help doctors distinguish between HELLP syndrome, a pregnancy complication, and thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (AHUS).

The test examines the ratio of two proteins that indicate tissue damage: lactate dehydrogenase (LDH) and aspartate aminotransferase (AST). The LDH:AST ratio was almost 30 times greater in women with TTP/aHUS than in those with HELLP syndrome, a pregnancy complication that can cause kidney or liver damage, according to the researchers.

According to the researchers, these data support the use of "the LDH:AST ratio as a viable screening tool for doctors to identify TTP/aHUS from HELLP syndrome."

The study was published in the International Journal of Gynecology and Obstetrics and was titled "Maternal morbidity and mortality in pregnant/postpartum women with suspected HELLP syndrome identifiable as probable thrombotic thrombocytopenic purpura or atypical hemolytic uremic syndrome by high LDH to AST ratio."

The HELLP syndrome, which stands for hemolysis, high liver enzymes, and low platelets, is a pregnancy condition that can cause kidney and liver damage. It is characterised by the destruction of red blood cells (hemolysis), an increase in liver enzymes, and a decrease in platelet counts. It usually occurs near the end of pregnancy or shortly after childbirth.

Because not all symptoms are visible and several other disorders have overlapping symptoms, diagnosing the condition can be difficult. TTP and aHUS, for example, are two illnesses in which blood clots form in small blood vessels. It's still difficult for clinicians to tell the difference between TTP/aHUS and HELLP syndrome.

The researchers wrote, however, that "it is critical to facilitate correct and prompt decisions for diagnosis and therapy of these disorders."

The researchers expanded on prior findings that women with TTP have a high LDH: AST ratio, which is always greater than 22:1. They now want to see if the LDH: AST ratio can assist differentiate TTP/aHUS from HELLP syndrome.

The study comprised 58 women who were pregnant or had recently given birth and had been diagnosed with HELLP syndrome. Eight of them had TTP/aHUS, which was defined by severe thrombocytopenia, or unusually low platelet counts, at the time of admission. Their platelet counts were less than 20,000 per microliter of blood in particular.

The mothers were on average 26.4 years old, and their kids were born at 35.4 weeks gestation.

TTP/aHUS was diagnosed in six of the women before they went into delivery. One woman survived plasma exchange treatment; the other two ladies died before plasma exchange treatment could begin. Plasma exchange is a type of treatment in which a patient's plasma — the clear liquid component of their blood — is replaced.

Three to five days after giving birth, the other two women were diagnosed with TTP/aHUS. They also exhibited significant thrombocytopenia and LDH levels that were abnormally high. One of the women survived a plasma exchange, but the other did not.

When researchers computed the mean LDH:AST ratio based on LDH and AST levels, they discovered that it was 32:1, much higher than the 22:1 ratio previously reported. The 42 women with confirmed HELLP syndrome had a mean LDH: AST ratio of 2:1. The ladies in this study were on average 29 years old, and their babies were born at a gestational age of 34 weeks.

According to the researchers, the lesson from the findings was clear: doctors should compute the LDH: AST ratio in women with probable HELLP syndrome.

The number of platelets and the activity of a protein called ADAMTS13, which is used to distinguish TTP from aHUS, should also be measured, according to the researchers.

"Implementation of the suggested screening approach could certainly minimise the chance of significant maternal morbidity and maternal death," they wrote, adding that this step could "shorten the detection to treatment time."

Previous Post Next Post