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

Patel, Nick N.; Shah, Jason A.; Sadlack, Christopher K.

doi:10.1155/2018/9716170

Cited by 5 publications

(8 citation statements)

References 16 publications

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“…16 Some of the most commonly cited surgeries associated with TTP are vascular and orthopedic procedures which tend to have high rates of hemolysis and shear stress that may predispose patients to developing TTP. 3 Consistent with these reports, injuries due to trauma likely also result in the mass destruction of endotheliallining vessels and red blood cells. It is possible that this may contribute to the rare occurrence of iTPP in patients with severe trauma resulting in hemorrhage and bone fracture.…”

Section: Discussionsupporting

confidence: 56%

“…Associations have been made between iTTP and connective tissue disorders, pregnancy, certain forms of cancer, and surgeries. [3][4][5][6][7] There have also been a few reported cases of iTTP secondary to severe trauma. 8 Here, we describe a case of spontaneous iTTP in a previously healthy 24-year-old male that highlights the variability in clinical presentation of iTTP and its unique management, focusing on emergency care.…”

Section: Introductionmentioning

confidence: 99%

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Case Report of Thrombotic Thrombocytopenic Purpura in a Previously Healthy Adult

Sea¹,

Gassner²,

Smart³

2021

Journal of Education and Teaching in Emergency Medicine

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This case report details the presentation of a 24-year-old male presenting with headache, palpitations, gingival bleeding, and pallor. The ultimate diagnosis of thrombotic thrombocytopenic purpura (TTP) is a rare but life-threatening condition which is typically hallmarked by thrombotic microangiopathy (TMA) and dysfunctional ADAMTS13 enzymatic activity. This patient displayed classically described findings, including marked anemia, thrombocytopenia, and acutely elevated creatinine as well as a brief period of newly onset word-finding difficulty while in the emergency department. His diminished ADAMTS13 activity level (<5%) and the presence of autoantibodies against ADAMTS13 confirmed a diagnosis of TTP. Fortunately, the patient's outcome was favorable after treatment with plasmapheresis, prednisone, and rituximab. This case report provides a review of the clinical presentation, diagnostic criteria, potentially confounding differential diagnosis, and expected course of treatment for patients with TTP.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Case Report of Thrombotic Thrombocytopenic Purpura in a Previously Healthy Adult

Sea¹,

Gassner²,

Smart³

2021

Journal of Education and Teaching in Emergency Medicine

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“… 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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Literature Reviewmentioning

confidence: 99%

“…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.…”

Section: Literature Reviewmentioning

confidence: 99%

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

Cited by 5 publications

References 16 publications

Case Report of Thrombotic Thrombocytopenic Purpura in a Previously Healthy Adult

Case Report of Thrombotic Thrombocytopenic Purpura in a Previously Healthy Adult

Postsurgical thrombotic microangiopathy: Case series and review of the literature

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

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