Acute thrombotic thrombocytopenic purpura following orthopedic surgery

Abstract

Release of unusually large von Willibrand factor (UL vWF) multimers and a deficiency of vWF metalloprotease may result in thrombotic thrombocytopenic purpura (TTP), a life threatening disease. Surgery has been associated with TTP, probably by releasing massive amounts of UL vWF. An association between TTP and orthopedic surgery has never been reported in the literature. We report a case of TTP following a total knee replacement surgery in which prior use of ticlopidine might have played a role.

Post‐appendectomy thrombotic thrombocytopenic purpura: A case report and review of the literature

“…A National Library of Medicine search identified only eight cases of postoperative TTP after abdominal or general surgical procedures: four cases after bowel resection, two after cholecystectomy, and two post-hysterectomy (Table I) [11][12][13][14][15][16][17]. Of the four cases occurring after bowel resection, two were performed for colon cancer and one for bowel adhesions [11][12][13][14].…”

“…Of the four cases occurring after bowel resection, two were performed for colon cancer and one for bowel adhesions [11][12][13][14]. One of the two cases of cholecystectomy was for acute cholecystitis, and one of the hysterectomy cases was for menometrorrhagia [11,15,17]. Surgical indication was not stated in the remaining three cases.…”

“…TTP occurring in the nontransplant postsurgical setting has only rarely been reported, but has been best described after cardiothoracic and vascular surgeries [9,10]. Case reports of TTP occurring after noncardiovascular surgeries are reported even less frequently, but have been described after abdominal and orthopedic surgeries as summarized in Table I [ [11][12][13][14][15][16][17]. The etiology of postoperative TTP remains uncertain, but may be due to endothelial damage and the subse-quent release of high molecular weight vWF multimers.…”

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

“…1 The occurrence of TTP after surgery is a rare clinical syndrome with considerable similarity to classic TTP in presentation. TTP has been described following vascular surgery, 3,4 coronary artery bypass grafting, 3,5 orthopedic surgery, 6,7 transurethral resection of the prostate, 1 abdominal surgeries, [8][9][10] and gynecologic cancer 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).…”