Acute postoperative thrombotic thrombocytopenic purpura following hysterectomy and lymphadenectomy for endometrial cancer

Hamilton, Chad A.; Kao, Jelena M.; Coutre, Steven; Teng, Nelson N.H.

doi:10.1016/j.ygyno.2007.04.005

Cited by 10 publications

(3 citation statements)

References 5 publications

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“…It has been postulated that there is widespread extensive endothelial cell activation because of cytokine storm (pancreatitis) or vascular injury (postop) with release of ultra large von Willibrand factor (UL-VWF) that can overwhelm low levels of ADAMTS13 in certain patients, e.g., heterozygous, with resultant microthromboses [30]. TPE should be initiated with plasma as a replacement fluid.…”

Section: Ttp Following Florid Inflammatory Conditionsmentioning

confidence: 99%

Atypical presentations of thrombotic thrombocytopenic purpura: A review

Sarode

2008

J of Clinical Apheresis

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Thrombotic thrombocytopenic purpura (TTP) is diagnosed by the presence of microangiopathic hemolytic anemia and thrombocytopenia in a patient who frequently presents with central nervous system involvement and, to a lesser extent, renal dysfunction. Recent understanding of the pathophysiology of TTP due to severe deficiency of von Willebrand factor cleaving protease, known as ADAMTS13, has improved diagnosis of TTP. Once the diagnosis is suspected, life-saving therapeutic plasma exchange therapy is initiated. Occasionally, an unusual clinical presentation makes TTP diagnosis difficult, thus resulting in a delay in the management of TTP. This review highlights a variety of atypical TTP presentations described in the literature. It is intended to bring unusual scenarios to the clinician's awareness, so that timely treatment can be delivered.

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Section: Ttp Following Florid Inflammatory Conditionsmentioning

confidence: 99%

Atypical presentations of thrombotic thrombocytopenic purpura: A review

Sarode

2008

J of Clinical Apheresis

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“…In both reviews, cardiovascular and vascular surgery were identified as the most common procedures leading to pTTP. 14,24 Less common procedures included, among others, abdominal, 25 gynecological, 31 and orthopedic 32 surgery.…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of the Pre-, Intra-, and Postoperative Kinetics of ADAMTS-13, von Willebrand Factor, and Interleukin-6 in Vascular Surgery

Häußler

Keese

Weber

et al. 2020

Clin Appl Thromb Hemost

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Postoperative thrombotic thrombocytopenic purpura (TTP) shows clinical presentation similar to classical TTP, whereas exact pathophysiological contexts remain unexplained. In this study, we investigated intraoperative and postoperative changes in ADAMTS-13 (a disintegrin and metalloprotease with thrombospondin type 1 motifs, member 13), von Willebrand factor (VWF), large VWF multimers, and interleukin-6 (IL-6) in vascular surgery patients. The objective was to compare the impact of endovascular, peripheral, and aortic surgery on target parameters which are supposed to play a role in surgery-associated TTP. A total of 93 vascular surgery patients were included and divided into 4 groups according to the specific type of intervention they underwent. Blood samples were taken preoperatively, intraoperatively, and postoperatively on days 2 and 4. The ADAMTS-13 activity decreased significantly in 3 of the 4 groups during surgery (from median 81% to 49%, P < .001, in the group undergoing aortoiliacal interventions), whereas the percentage of large VWF multimers increased in all groups of patients. von Willebrand factor antigen increased significantly in all groups on postoperative day 2 and IL-6 increased significantly in the intraoperative and early postoperative period. There was no significant correlation between the intraoperative decrease in ADAMTS-13 and the increase in VWF or IL-6. No patient in this study showed clinical picture of TTP; the precise cause and clinical significance of moderately reduced ADAMTS-13 activity in the perioperative setting have not yet been definitely determined.

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“…Cardiovascular surgeries were the most common procedure provoking TMA with coronary artery bypass grafts (CABG) [14][15][16][17][18] or a combination of CABG with another vascular procedure being the second most common. 14,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Of TMAs occurring after abdominal surgery, 26,[31][32][33][34][35][36][37] bowel resection accounted for the most common preceding procedure (n = 6). 17,33,[38][39][40][41][42] In addition, five patients developed TMA following orthopedic procedures.…”

Section: Literature Reviewmentioning

confidence: 99%

Postsurgical thrombotic microangiopathy: Case series and review of the literature

Sridharan

Hook

Leung

et al. 2019

European J of Haematology

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Objectives Describe the clinical presentation, treatment, and outcomes of postsurgical thrombotic microangiopathy (TMA). Methods In this retrospective study, records of individuals diagnosed with TMA developing within 30 days of a surgical procedure at Mayo Clinic from 2000 to 2016 were reviewed. Available literature regarding postsurgical TMA was comparatively reviewed. Results Twenty patients were diagnosed with TMA developing within 30 (median 6.5, range (1‐28)) days) following a procedure. Preceding procedures included orthopedic (n = 4), vascular (n = 4), abdominal (n = 8), thoracic (n = 2), and other (n = 2). Review of the literature identified 65 patients with postsurgical TMA and cardiovascular procedures were the most common preceding surgery. The majority of patients in the current cohort and literature were treated with therapeutic plasma exchange (TPE). Among the evaluable patients in the current cohort, 100% demonstrated response to TPE; however, 25% required the addition of other therapy including eculizumab to maintain a response 80% of patients in the literature demonstrated a response to TPE. Conclusions Although rare, early recognition and treatment of postsurgical TMA can lead to good outcomes. More research is necessary to determine the underlying pathophysiology and optimal treatment for postsurgical TMA.

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Acute postoperative thrombotic thrombocytopenic purpura following hysterectomy and lymphadenectomy for endometrial cancer

Cited by 10 publications

References 5 publications

Atypical presentations of thrombotic thrombocytopenic purpura: A review

Atypical presentations of thrombotic thrombocytopenic purpura: A review

Prospective Evaluation of the Pre-, Intra-, and Postoperative Kinetics of ADAMTS-13, von Willebrand Factor, and Interleukin-6 in Vascular Surgery

Postsurgical thrombotic microangiopathy: Case series and review of the literature

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