Postoperative Thrombotic Thrombocytopenic Purpura After Open Heart Operations

Darin J. Saltzman, Jae C. Chang, Juan C. Jimenez, John G Carson, Amir Abolhoda, Richard S. Newman, Jeffrey C. Milliken

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Background: Postoperative thrombotic thrombocytopenic purpura (pTTP) after cardiovascular operations has an alarmingly high mortality rate if untreated. Five patients after coronary artery bypass graft (CABG) procedure were diagnosed with pTTP when they were observed to have a persistent thrombocytopenia associated with symptoms of fever, renal insufficiency, thromboembolic events, or altered mental status in conjunction with a microangiopathic hemolytic anemia (MAHA). A guideline for early diagnosis, followed by timely treatment in these cases, is reviewed. Methods: A retrospective record review of postoperative patients with thrombocytopenia identified 5 patients that met the criteria for pTTP from 2004 to 2008. We examined these 5 cardiovascular surgical patients in terms of clinical presentation, laboratory data, and outcomes. Results: All patients had the combination of an unexplained thrombocytopenia (platelets < 50,000 mm3) in conjunction with a MAHA as determined by the presence of schistocytes. Symptoms of neurologic dysfunction and renal insufficiency developed in all patients. Thromboembolic events were noted in 1 patient. All patients underwent plasmapheresis. In 3 patients, response time to clinical recovery and normalization of hematologic laboratory values after plasmapheresis was 3, 4, and 8 days. Two patients did not recover and died. One patient had a clinical and laboratory recovery after 19 days of plasmapheresis; however, after 11 days, thrombocytopenia with MAHA developed and he died on day 53 from complications related to the operation. Conclusions: Postoperative TTP should be recognized as a possible pathophysiologic mechanism for unexplained postoperative thrombocytopenia and treatment should be initiated once the diagnosis is established.

Original languageEnglish (US)
Pages (from-to)119-123
Number of pages5
JournalAnnals of Thoracic Surgery
Volume89
Issue number1
DOIs
StatePublished - Jan 2010

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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    Saltzman, D. J., Chang, J. C., Jimenez, J. C., Carson, J. G., Abolhoda, A., Newman, R. S., & Milliken, J. C. (2010). Postoperative Thrombotic Thrombocytopenic Purpura After Open Heart Operations. Annals of Thoracic Surgery, 89(1), 119-123. https://doi.org/10.1016/j.athoracsur.2009.09.019