通讯作者: 严笑, yanxiao.nb@outlook.com

DOI：10.12201/bmr.202504.00053

A case of Systemic lupus erythematosus secondary to thrombotic thrombocytopenic purpura combined with pregnancy and review of the literature

• 摘要：血栓性血小板减少性紫癜（thrombotic thrombocytopenic purpura, TTP）是一种罕见的危重症，继发于系统性红斑狼疮（systemic lupus erythematosus, SLE）的怀孕患者更较为罕见。本文报告了一例孕12周确诊为SLE的患者突发TTP的临床诊疗过程。患者因间断发热、意识不清入院，各项实验室检查确诊免疫性TTP，紧急血浆置换联合糖皮质激素及利妥昔单抗治疗后因患者意识模糊、烦躁，行全麻下钳刮术+清宫术。治疗后血小板逐渐恢复至正常，ADAMTS13活性恢复100%，随访至今患者生存状态良好。本文通过对这一案例的回顾与总结，分析SLE妊娠患者继发TTP的相关特点及病理机制，为临床血小板显著减少患者的入院拓宽诊疗思路，以提高临床工作者对疾病的认识，减少漏诊、误诊率。

  关键词： 血栓性血小板减少性紫癜；妊娠；系统性红斑狼疮；血浆置换; ; ; 

   

  Abstract: Thrombotic thrombocytopenic purpura (TTP) is a rare and critical condition, and pregnant patients with secondary systemic lupus erythematosus (SLE) are even rarer. This article reports the clinical management of a patient diagnosed with SLE at 12 weeks gestation with sudden onset of TTP. The patient was admitted to the hospital due to intermittent fever and unconsciousness, and various laboratory tests confirmed the diagnosis of immune TTP, and after emergency plasma exchange combined with glucocorticoids and rituximab, the patient underwent forceps curettage and uterine evacuation under general anesthesia due to confusion and irritability. After treatment, platelets gradually returned to normal, and the ADAMTS13 activity recovered 100%, and the patients were in good survival status after follow-up. This article reviews and summarizes this case, analyzes the relevant characteristics and pathological mechanisms of TTP secondary to SLE pregnancy patients, and broadens the diagnosis and treatment ideas for patients with significant clinical platelet reduction, so as to improve clinicians understanding of the disease and reduce the rate of missed diagnosis and misdiagnosis.

  Key words: thrombotic thrombocytopenic purpura; pregnancy; Systemic lupus erythematosus; plasma exchange

  提交时间：2025-04-17

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2025-03-22	bmr.202504.00053V1	下载

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