Thrombotic Thrombocytopenic Purpura: A Hematological Emergency

A Postoperative Thrombotic Thrombocytopenic Purpura in a Cardiac Surgery Patient: A Case Report

“…TTP after endothelial injury has been recognized for a long time, but postoperative TTP has only recently been appreciated as a distinct clinical syndrome in the surgical field. Furthermore, an unusual clinical presentation makes TTP diagnosis more difficult [2,3]. The conditions to be identified for differential diagnosis of thrombotic microangiopathies can include TTP, hemolytic uremic syndrome, DIC, severe hypertension, preeclampsia, eclampsia, hemolysis-elevated liver enzymes-low platelet count syndrome, systemic lupus erythematosus, drug-induced TTP, and disseminated malignancy [3].…”

“…Furthermore, an unusual clinical presentation makes TTP diagnosis more difficult [2,3]. The conditions to be identified for differential diagnosis of thrombotic microangiopathies can include TTP, hemolytic uremic syndrome, DIC, severe hypertension, preeclampsia, eclampsia, hemolysis-elevated liver enzymes-low platelet count syndrome, systemic lupus erythematosus, drug-induced TTP, and disseminated malignancy [3]. In our patient, the platelet count immediately after surgery was more than 50% of the preoperative count, unlike the phenomenon by cardiopulmonary bypass itself or heparin-induced thrombocytopenia [4].…”

“…Because a strong suspicion of postoperative TTP and its early treatment helps the patient's outcome, we started the treatment with a high dose of corticosteroid. Plasmapheresis is recognized as a primary treatment for TTP patients [3,6-8], but we could not perform plasmapheresis because of the persistently positive results of microorganism cultures in our patient's blood. After 5 days of 75 mg/day treatment with methylprednisolone, the platelet count reached over 50,000/µL.…”

Guía diagnóstica y terapéutica de las microangiopatías trombóticas del Grupo Español de Aféresis

“…Ante una anemia hemolítica microangiopá tica y trombocitopenia, en ausencia de otras causas, debe sospecharse una PTT e iniciar el RP inmediatamente, preferiblemente antes de transcurridas 4-8 h desde el diagnó stico 68 , ya que el 50% de las muertes por PTT se producen durante las primeras 24 h, y esta mortalidad con frecuencia está relacionada con un retraso en el inicio del RP. Solo en el caso de que no se pudiera realizar el RP se iniciaría la infusió n de plasma a dosis de 25-30 ml/kg 69 .…”

The Skin and Neurologic Disease

“…21-11) is a fulminant disorder that may be lethal if untreated. 74 Its clinical hallmark is rapid progression through confusion and obtundation to coma in the setting of thrombocytopenia resulting in cutaneous purpura, fever, Coombs-negative hemolytic anemia with fragmentation of erythrocytes, and renal failure. 75 Unlike lupus, this is not a vasculitis but a manifestation of pathologic aggregations of platelets.…”