SHM Converge Scientific Abstract ePoster Gallery-Recurrent Strokes in a Woman With TTP

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This case report describes a 53-year-old woman with a long history of thrombotic thrombocytopenic purpura (TTP), recurrent strokes, and multiple prior relapses triggered by pregnancy or surgery. She presented with three days of dizziness, imbalance, and nausea, and MRI showed a new ischemic stroke in the left anterior cerebral artery territory.<br /><br />Although TTP usually causes microangiopathic hemolytic anemia and thrombocytopenia, this patient had a normal hemoglobin and platelet count, only mildly elevated LDH, and normal haptoglobin on admission. Because of her history, hematology suspected TTP despite the atypical labs. A peripheral smear showed rare schistocytes, and she was treated with two units of fresh frozen plasma and discharged with close follow-up.<br /><br />After discharge, ADAMTS13 activity returned at 3%, with an inhibitor present, indicating acquired TTP rather than hereditary TTP. This was important because her earlier history initially suggested congenital disease, but the antibody inhibitor supported an autoimmune acquired form.<br /><br />The report emphasizes that thrombosis and end-organ ischemia, including stroke, may occur before classic laboratory abnormalities appear in either congenital or acquired TTP. It also highlights the importance of maintaining a high index of suspicion for TTP in patients with unexplained stroke, even when platelet counts and other hemolysis markers are near normal.<br /><br />The authors conclude that this patient’s prior strokes may also have been manifestations of TTP. They note that prophylactic plasma infusions, typically used in hereditary TTP, may still be worth considering in patients with frequent relapse and recurrent ischemic events, even when genetic confirmation is unavailable.

Asset Subtitle

Ijele Adimora

Meta Tag

Author List Bingnan Zhang, Ijele Adimora, Modupe Idowu

Category Clinical Vignettes

Concept Thrombotic Thrombocytopenic Purpura

Concept ADAMTS13

Concept ADAMTS13 Deficiency

Concept Total Plasma Exchange

Concept ADAMTS13 Inhibitor

Distinguished Non-Finalist

Presenter Organization University of Texas at Houston Health Sciences

Presenting Author Ijele Adimora

Track Adult

Keywords

thrombotic thrombocytopenic purpura

TTP

ischemic stroke

ADAMTS13 deficiency

acquired TTP

platelet count

microangiopathic hemolysis

schistocytes

fresh frozen plasma

recurrent relapse

Thrombotic Thrombocytopenic Purpura

ADAMTS13

ADAMTS13 Deficiency

Total Plasma Exchange

ADAMTS13 Inhibitor