Differential diagnosis of thrombocytopenia in pregnancy includes HELLP syndrome, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and gestational thrombocytopenia. Which feature MOST strongly distinguishes TTP from HELLP syndrome?

• A Presence of microangiopathic hemolytic anemia
• B Thrombocytopenia below 50,000/µL
• C Elevated LDH levels
• D Severe neurological symptoms and absence of hypertension/proteinuria ✓

Explanation

TTP and HELLP both cause microangiopathic hemolytic anemia with thrombocytopenia and elevated LDH — features common to both. The distinguishing features of TTP are: severe neurological manifestations (fluctuating confusion, seizures, focal deficits), absent or mild hypertension, and no proteinuria. HELLP syndrome is associated with hypertension and proteinuria of pre-eclampsia. TTP also typically occurs earlier in pregnancy (1st–2nd trimester) and is caused by ADAMTS13 deficiency. Treatment of TTP is plasma exchange; delivery resolves HELLP.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.