Postpartum thrombotic thrombocytopenic purpura: A refractory case successfully managed with therapeutic plasma exchange and steroids

Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially fatal hematological emergency. It is characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, renal dysfunction, and fever, which is most often associated with severe ADAMTS13 deficiency. Pregnancy and the postpartum period are well-recognized precipitating states for TTP, posing diagnostic challenges due to overlapping features with other thrombotic microangiopathies such as preeclampsia and HELLP syndrome. We reported a case of postpartum TTP that was initially responsive to therapeutic plasma exchange (TPE) but relapsed within days, ultimately requiring reinduction of TPE in combination with corticosteroids. This case highlights the importance of early recognition, prompt treatment, and the role of adjunctive immunosuppression in preventing relapses. It also underscores the need for vigilance in postpartum follow-up and the practical value of tapering plasma exchange sessions.