Acute Thrombotic Thrombocytopenic Purpura with Right Heart Failure Following Total Knee Replacement Surgery

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, renal insufficiency, neurological abnormalities, and fever. Cardiac involvement is not uncommon and can be fatal; however, right ventricular heart involvement after surgery is rare. Here, we report a case of TTP presenting with right ventricular heart failure after total knee replacement surgery. TTP was successfully treated with four rounds of plasma exchange. The patient made a full recovery and was discharged after 11 weeks.

Postoperative Thrombotic Thrombocytopenic Purpura after Total Hip Arthroplasty: A Case Report and Review of the Literature

“…Postoperative TTP following orthopaedic surgery is exceedingly uncommon as only four prior documented cases exist [ 9 – 12 ]. This case adds to the limited literature surrounding the topic and presents some unique features.…”

“…Occurrence of TTP after surgery is rare but has been described in the literature following vascular, cardiac, and gastrointestinal procedures [ 5 – 8 ]. TTP after orthopedic surgery is even more exceedingly rare with only four case reports existing in the literature to our knowledge [ 9 – 12 ]. We present the case of a patient who developed postoperative TTP after routine total hip arthroplasty and discuss pertinent issues regarding the identification and management of the condition.…”

Postsurgical thrombotic microangiopathy: Case series and review of the literature

“… In addition, five patients developed TMA following orthopedic procedures. Median time to clinical manifestations of TMA was 4 days (range, 1‐30). ADAMTS13 activity was performed in 18/65 (27.6%) individuals.…”

“…17,33,[38][39][40][41][42] In addition, five patients developed TMA following orthopedic procedures. [43][44][45][46][47] Median time to clinical manifestations of incompatible red blood cell transfusion. 15 Of the two patients requiring other therapy in addition to TPE, one patient who developed TMA after mitral valvuloplasty, underwent repeat valvuloplasty with improvement in TMA symptoms.…”

“…17,33,[38][39][40][41][42] In addition, five patients developed TMA following orthopedic procedures. [43][44][45][46][47] Median time to clinical manifestations of Outcomes of the five patients not receiving TMA directed treatment included death in three patients and it was reported that these patients had a delay in diagnosis of TMA. 17,39 Two patients who developed TMA after CABG or myocardial sarcoma resection 16 had spontaneous remissions, although the patient who developed TMA after CABG required amputation of several digits due to initial presentation with peripheral digit ischemia.…”