Case Report

A Rare Case of Thrombotic Thrombocytopenic Purpura After Cardiac Surgery


Here we report a case of postoperative thrombocytopenia (TTP) in a 77-year-old case that has been undergoing  mitral valve replacement with combined coronary  artery bypass grafting. In the 5th days of operation, his platelet count was reduced and despite platelet transfusion, his platelet count reaches to a minimum level of 15000 µg/mL on the 34th day of surgery. Despite platelet transfusion and plasmapheresis, platelet count continues to decrease and signs and symptoms of disseminated intravascular coagulation appeared by unexpectable renal and pulmonary bleeding.  Finally high dose, steroid therapy was started and after some days, platelets count raised to 80000 µg/mL. DIC was recovered, but  acute renal failure  did not respond to medical and hemodialysis and the case expired with sudden cardiac arrest and ventricular fibrillation.we conclude that if  the  diagnosis of TTP was made earlier in the course of disease by consulting internist  and steroids was instituted  it might prevent  ARF and its poor outcome.

Despotis GJ, Zhang L, Lublin DM. Transfusion risks and transfusion-related pro-inflammatory responses. Hematol Oncol Clin North Am. 2007;21:147–61. [PubMed]

Marques MB. Thrombotic thrombocytopenic purpura and heparin-induced thrombocytopenia: two unique causes of life-threatening thrombocytopenia. Clin Lab Med. 2009;29:321–338.[PubMed]

Sarode R. Atypical presentations of thrombotic thrombocytopenic purpura: a review. J Clin Apher. 2009;24:47–52. [PubMed]

Kessler CS, Khan BA, Lai-Miller K. Thrombotic thrombocytopenic purpura: a hematological emergency. J Emerg Med. 2012;43:538–544. [PubMed]

Gruel Y, Pouplard C. Post-operative platelet count profile: the most reliable tool for identifying patients with true heparin-induced thrombocypenia after cardiac surgery. J Thromb Haemost. 2010;8:27–29. [PubMed]

Swisher KK, Terrell DR, Vesely SK, Kremer Hovinga JA, Lammle B, George JN. Clinical outcomes after platelet transfusions in patients with thrombotic thrombocytopenic purpura.Transfusion. 2009;49:873–887. [PubMed]

Saltzman DJ, Chang JC, Jimenez JC, et al. Postoperative thrombotic thrombocytopenic purpura after open heart operations. Ann Thorac Surg. 2010;89:119–123. [PubMed]

Scully M, Hunt BJ, Benjamin S, et al. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol.2012;158:323–335. [PubMed]

Schiller O, Ash S, Schonfeld T, et al. Postoperative thrombotic thrombocytopenic purpura in an infant: case report and literature review. J Pediatr Surg. 2011;46:764–766. [PubMed]

Pineda AA, Brzica SM, Jr, Taswell HF. Hemolytic transfusion reaction. Recent experience in a large blood bank. Mayo Clin Proc. 1978;53:378–90. [PubMed]

Staropoli JF, Stowell CP, Tuncer HH, Marques MB. An inquiry into the relationship between ABO blood group and thrombotic thrombocytopenic purpura. Vox Sang. 2009;96:344–8.[PubMed]

Terrell DR, Williams LA, Vesely SK, Lammle B, Hovinga JA, George JN. The incidence of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: All patients, idiopathic patients, and patients with severe ADAMTS-13 deficiency. J Thromb Haemost. 2005;3:1432–6.[PubMed]

Zuberi L, Yerasuri D, Kuriakose P. Effect of blood group on idiopathic thrombotic thrombocytopenic purpura. J Clin Apher. 2009;24:131–3. [PubMed]

Tsai HM. The molecular biology of thrombotic microangiopathy. Kidney Int. 2006;70:16–23.[PMC free article] [PubMed]

Terrell DR, Motto DG, Kremer Hovinga JA, Lammle B, George JN, Vesely SK. Blood group O and black race are independent risk factors for thrombotic thrombocytopenic purpura associated with severe ADAMTS13 deficiency. Transfusion. 2011;51:2237–43.[PMC free article] [PubMed]

George JN. Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med.2006;354:1927–35. [PubMed]

Sadler JE. Thrombotic thrombocytopenic purpura: A moving target. Hematology Am Soc Hematol Educ Program. 2006:415–20. [PubMed]

Naqvi TA, Baumann MA, Chang JC. Post-operative thrombotic thrombocytopenic purpura: A review. Int J Clin Pract. 2004;58:169–72. [PubMed]

IssueVol 56, No 3 (2018) QRcode
SectionCase Report(s)
Thrombotic thrombocytopenic purpura Thoracic surgery Thrombocytopenia

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Heidari A, Sabzi F. A Rare Case of Thrombotic Thrombocytopenic Purpura After Cardiac Surgery. Acta Med Iran. 56(3):210-213.