SHM Converge Scientific Abstract ePoster Gallery-Stroke : Tip of the Deadly Thrombotic Thrombocytopenic Purpura Iceberg

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This case describes a 55-year-old woman who presented with expressive aphasia and headache and was found on CT to have multiple cerebral infarcts along with severe thrombocytopenia (platelets 26 K/uL). She left the initial emergency department visit against medical advice but returned two days later with worsening aphasia and new blurry vision. Repeat imaging showed progression of bilateral infarcts, including new acute and subacute ischemic lesions.<br /><br />Laboratory evaluation supported thrombotic thrombocytopenic purpura (TTP): platelets 27 K/uL, elevated LDH (970 U/L), low haptoglobin (10 mg/dL), schistocytes on blood smear, very low ADAMTS13 activity (0.03 IU/mL), and detectable ADAMTS13 inhibitor (1.2 BEU). She was treated with therapeutic plasma exchange and corticosteroids for suspected acquired TTP. Her platelet count improved to 342 K/uL by discharge, and LDH decreased to 292 U/L. However, after discharge she experienced relapsing TTP, suffered cardiac arrest, and died despite resuscitation.<br /><br />The authors emphasize that TTP should be considered in patients with multifocal ischemic stroke, especially when thrombocytopenia or anemia is present. They also stress that worsening neurologic symptoms during hospitalization may indicate new stroke and require prompt evaluation.

Asset Subtitle

Christian Schmidt

Meta Tag

Author List Christian Schmidt, FNU Ayesha, Tasneem Zahra

Category Clinical Vignettes

Concept Thrombotic Thrombocytopenic Purpura

Concept Total Plasma Exchange

Concept Hemolytic Anemia

Concept Thrombocytopenia

Concept ADAMTS13

Distinguished Non-Finalist

Presenter Organization Evms

Presenting Author Christian Schmidt

Track Adult

Keywords

thrombotic thrombocytopenic purpura

TTP

ischemic stroke

thrombocytopenia

ADAMTS13 deficiency

expressive aphasia

cerebral infarcts

plasma exchange

schistocytes

neurologic deterioration

Thrombotic Thrombocytopenic Purpura

Total Plasma Exchange

Hemolytic Anemia

Thrombocytopenia

ADAMTS13