Thrombotic Thrombocytopenic Purpura in Acute Pancreatitis

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare syndrome of unknown cause with an estimated incidence of one case per million. The disease is characterized by a pentad of symptoms: thrombocytopenia, microangiopathic hemolytic anemia, neurologic changes, renal dysfunction, and fever. It causes thrombosis in the microvasculature of several organs, producing diverse manifestations. Acute pancreatitis (AP) is a well-described consequence of TTP. We report a patient who developed TTP after presenting with AP, suggesting pancreatitis to be the cause, rather than a consequence, of TTP.

Pancreatitis preceding acute episodes of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: report of five patients with a systematic review of published reports

“…[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Among these 16 patients, 13 were men, opposite to the gender disparity of TTP-HUS 25 but consistent with the greater frequency of acute pancreatitis among men. 43 The etiologies of the pancreatitis in these 16 patients were typical for acute pancreatitis among adults: 43,44 seven cases were related to chronic severe alcohol use, five to gallbladder disease, and four were idiopathic.…”

“…The diagnosis was supported by computed tomography scan or ultrasound demonstrating pancreatic abnormalities in eight patients; two patients required laparotomy for pancreatic necrosis and abscess formation. 29,36 TTP-HUS was diagnosed 2-15 days (median, 3 days) after the diagnosis of pancreatitis. In only two patients was the onset of TTP-HUS accompanied by neurologic abnormalities: patient 1 had slurred speech and patient 10 had right hemiparesis.…”

The Clinical Spectrum of Thrombotic Thrombocytopenic Purpura

“…41 Of interest is the older concept found in the published literature that acute pancreatitis may trigger TTP. [41][42][43][44][45] However, in light of the current understanding of the pathogenesis of TTP, it is unlikely that this is the sequence of events. Either these patients had TMA associated with the thrombophilia in acute pancreatitis and did not have TTP, or multiple microinfarctions of the pancreas due to TTP resulted in the clinical picture of acute pancreatitis.…”

Acute pancreatitis induced thrombotic thrombocytopenic purpura

“…Acute pancreatitis (AP) is a well-described consequence of TTP,[4] but TTP as a consequence of acute pancreatitis is rare.…”