Acute thrombotic thrombocytopenic purpura following orthopedic surgery: a case report

Abstract

Thrombotic thrombocytopenic purpura (TTP) or Moschowitz's syndrome is characterized by release of unusually large von Willebrand factor (ULvWF) multimers and a deficiency of vWF metalloprotease. It is a very rare condition, but it causes serious problems. The etiology is still unknown, although surgical stress has been associated with TTP, probably by releasing massive amounts of ULvWF. TTP is an acute, recurrent disease of the circulatory system, consisting of thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological signs, and renal dysfunction. It has the strong possibility of being fatal and thus should be treated immediately, mostly by plasmapheresis. We report a case of TTP following a high tibial valgus osteotomy. An association between TTP and orthopedic surgery--as far as we know--has only once been reported in the literature. We suggest that orthopedic surgeons should be aware of this because, although very rare, postsurgical TTP could be a life-threatening postoperative complication, which needs prompt diagnosis and treatment.

Thrombotic thrombocytopenic purpura following transurethral resection of the prostate

“…The syndrome is well described in patients undergoing vascular and cardiac surgery [9], and has also been reported following appendicectomy [10], hemicolectomy [11] and tibial osteotomy [12]. The diagnosis in this case was made without undue delay, and appropriate treatment instigated with good effect.…”

Thrombotisch-thrombozytopenische Purpura nach Zirkumzision

“…1). Charakterisiert ist das klinische Erscheinungsbild durch das Auftreten einer schweren Thrombozytopenie, einer hämolytischen Anämie, Fieber und häufig Organmanifestationen wie Niereninsuffizienz oder neurologischen Defiziten [1,[3][4][5].…”

Acute Thrombotic Thrombocytopenic Purpura Following Orthopedic Surgery: Case Report and Review of the Literature

“…The presence of postoperative thrombocytopenia, MAHA, fever, renal failure, and/or neurologic changes may be explained by the reasons such as heparin-induced thrombocytopenia (HIT) or other drug-induced thrombocytopenia, sepsis, disseminated intravascularly coagulation (DIC), complications of cardiac bypass, acute renal failure following cross-clamping of the aorta, large areas of denuded or damaged vascular endothelium, and operative or postoperative neurologic complications. 13 TTP was therefore a diagnosis of exclusion. Although the early diagnosis of postoperative TTP is difficult, prompt treatment is of vital importance for the survival of the patients.…”

“…A helpful index may be an assay for detecting an anti-ADAMTS 13 autoantibody, but it is not available at many institutions. 13 TTP development secondary to orthopedic surgery was first reported in the literature in 2002, following a total knee replacement surgery. But the authors were not sure whether TTP development was solely secondary to orthopedic surgery or was due to the prior use of ticlopidine.…”

“…6 Another case of TTP development secondary to orthopedic surgery was reported in 2006. 13 In this case the patient underwent a high tibial valgus osteotomy (HTO). Similarly in our case, TTP development was also secondary to an orthopedic operation that was performed for the correction of genu valgus deformity.…”