SEVERE THROMBOCYTOPENIA AND NEUROLOGICAL SYMPTOMS IN PREGNANCY: A DIAGNOSTIC CHALLENGE BETWEEN HEMOLYSIS, ELEVATED LIVER ENZYMES, AND LOW PLATELET SYNDROME AND THROMBOTIC THROMBOCYTOPENIC PURPURA-WHAT IS YOUR DIAGNOSIS?

Halenur Öner SOY, Hasan SÜT, Özhan ÖZDEMİR

Journal of the Turkish-German Gynecological Association - 2026;27(1):61-64

This case illustrates the diagnostic challenge of thrombocytopenia in pregnancy, where HELLP syndrome, ITP and TTP can present with overlapping features. Initially, HELLP syndrome was suspected due to the combination of hemolysis leading to anemia, elevated liver enzymes, and thrombocytopenia, but the presence of mucocutaneous bleeding and isolated severe thrombocytopenia without schistocytes made ITP more likely. However, the sudden onset of a focal neurologic deficit (aphasia) on the second day of hospitalization raised concern for TTP. An ischemic stroke was considered, but the brain MRI was unremarkable, and eclampsia was deemed less likely in the absence of severe hypertension or seizures. The diagnosis of TTP was confirmed when a repeat peripheral blood smear revealed schistocytes and ADAMTS13 activity <10%. This chronological evolution illustrates that TTP can initially mimic ITP or HELLP syndrome, and that the hallmark of TTP of microangiopathic features may only become evident over time.