Case of acquired thrombotic thrombocytopenic purpura associated with influenza A (H1N1) virus and literature review

Ning, Junjie; Guan, Xiaoyan; Li, Xuemei

doi:10.1111/jpc.14846

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…TMA is not associated with coagulopathy, generally. As reported by Wada et al [ 11 ] and previous reports of TTP owing to influenza [ 12 – 15 ], TMA and DIC can be associated. It is important to diagnose TMA even in the presence of coagulopathy.…”

Section: Discussionsupporting

confidence: 56%

Acquired Thrombotic Thrombocytopenic Purpura Without Anti-ADAMTS13 Antibody Caused by Influenza A (H1N1) Virus Successfully Treated by Plasma Exchange: A Case Report

et al. 2021

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Patient: Female, 57-year-old Final Diagnosis: Acquired thrombocytopenic purpura • influenza A virus infection Symptoms: Hypoxemia Medication:— Clinical Procedure: Plasma exchange Specialty: Critical Care Medicine • Hematology Objective: Rare disease Background: Thrombotic microangiopathy, characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ damage by microvascular thrombosis, has a high mortality rate; therefore, early diagnosis and treatment are important. Thrombotic thrombocytopenic purpura is caused by a deficiency of a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTS13), and results in thrombotic microangiopathy. Influenza virus causes thrombotic thrombocytopenic purpura by inducing immunoglobulin G autoantibodies against ADAMTS13. We report a rare case of thrombotic thrombocytopenic purpura caused by influenza A without anti-ADAMTS13 antibody that was treated by plasma exchange. Case Report: A 57-year-old woman was admitted to our hospital because of hypoxemia. We diagnosed pneumonia and disseminated intravascular coagulation. Despite treatment, she developed thrombocytopenia, and we diagnosed thrombotic microangiopathy and started plasma exchange. With a PLASMIC score of 6 points and neuropsychiatric symptoms, we strongly suspected thrombotic thrombocytopenic purpura and started rituximab. However, ADAMTS13 activity by FRETS-VWF73 assay was 65%, and anti-ADAMTS13 antibody was negative. After 4 plasma exchanges and 2 rounds of rituximab, platelet numbers and lactate dehydrogenase and creati-nine concentrations normalized on the 16 th day of hospitalization. Subsequently, influenza A (H1N1) was identified in a nasopharyngeal swab collected on admission. Plasma enzyme-linked immunosorbent assay testing for chromogenic ADAMTS13 activity showed a significant decrease (<0.5%). Therefore, we diagnosed thrombotic thrombocytopenic purpura caused by influenza A without anti-ADAMTS13 antibody. Conclusions: We present a rare case of thrombotic thrombocytopenic purpura without anti-ADAMTS13 antibody caused by influenza A virus successfully treated by plasma exchange. Influenza A may reduce ADAMTS13 activity without inducing autoantibodies.

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Section: Discussionsupporting

confidence: 56%

Acquired Thrombotic Thrombocytopenic Purpura Without Anti-ADAMTS13 Antibody Caused by Influenza A (H1N1) Virus Successfully Treated by Plasma Exchange: A Case Report

et al. 2021

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“…Some relevant demographic, laboratory and clinical data are shown in Table 2. The diagnosis of TTP was made on clinical grounds in three cases [6, 7, 9], and reduced ADAMTS13 activity and the presence of ADAMTS13 inhibitors were documented in only four of the seven cases [8, 10–12]. One of the six non‐US cases died, receiving only three TPE procedures [8].…”

Section: Resultsmentioning

confidence: 99%

Influenza‐associated thrombotic thrombocytopenic purpura: A report of two cases and a brief review of the literature

Mangala

Sweeney

2021

Vox Sanguinis

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Background and Objectives: Thrombotic thrombocytopenic purpura (TTP) is often preceded by a recent history of an acute infection and influenza is the most implicated virus. Materials and Methods:We identified two cases of TTP, which were preceded by influenza between 2010 and 2021. In one patient, we epitope mapped the binding specificity of antibodies using an overlapping peptide approach of the stalk protein of Influenza B and the cysteine-rich spacer domain (CRSD) of ADAMTS13. A literature search was performed for reports of influenza-associated TTP over the period 1980-2021.Results: Two patients were identified in which TTP was preceded by influenza, one Influenza A and the other Influenza B. Epitope mapping of the latter's plasma identified target epitopes in both the stalk protein of Influenza B and CRSD of ADAMTS13. The literature review revealed only seven case reports, all but one from Europe or Asia and associated with Influenza A. Severe ADAMTS13 deficiency was demonstrated in only four cases. Conclusion:We report the first small case series of influenza-associated TTP. Moreover, it is the first case implicating Influenza B and a mechanism favouring polyclonal B-cell proliferation rather than molecular mimicry as the stimulus to form anti-ADAMTS13 auto-antibodies is suggested.

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Factors of the hemostasis system as biomarkers of severe course of acute viral infections

Skripchenko,

Alekseeva,

Zheleznikova

et al. 2024

Z. nevrol. psikhiatr. im. S.S. Korsakova

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Case of acquired thrombotic thrombocytopenic purpura associated with influenza A (H1N1) virus and literature review

Cited by 3 publications

References 16 publications

Acquired Thrombotic Thrombocytopenic Purpura Without Anti-ADAMTS13 Antibody Caused by Influenza A (H1N1) Virus Successfully Treated by Plasma Exchange: A Case Report

Acquired Thrombotic Thrombocytopenic Purpura Without Anti-ADAMTS13 Antibody Caused by Influenza A (H1N1) Virus Successfully Treated by Plasma Exchange: A Case Report

Influenza‐associated thrombotic thrombocytopenic purpura: A report of two cases and a brief review of the literature

Factors of the hemostasis system as biomarkers of severe course of acute viral infections

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