SHM Converge Scientific Abstract ePoster Gallery-TTP Presenting With Aml

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This case report describes a rare occurrence of thrombotic thrombocytopenic purpura (TTP) in a 71-year-old man newly diagnosed with acute myeloid leukemia (AML). He initially presented with three weeks of fatigue, fevers, chills, dyspnea, severe anemia, thrombocytopenia, leukocytosis, and peripheral blasts, raising concern for acute leukemia.<br /><br />The patient was first treated for disseminated intravascular coagulation (DIC), but his condition worsened, including acute kidney injury and persistent pancytopenia. Because TTP can mimic other thrombotic microangiopathies in cancer patients, diagnosis was difficult. ADAMTS13 testing, obtained early but resulted later, showed markedly reduced activity at 10% with a detectable inhibitor, confirming acquired TTP.<br /><br />Plasma exchange (PLEX) was started immediately after the diagnosis and continued for 15 days. ADAMTS13 activity was monitored during treatment and improved to 68% and then 86%, suggesting biochemical response, though the patient remained clinically fragile. Unfortunately, he later died from Candida bacteremia.<br /><br />The report emphasizes several key points: TTP in the setting of AML is exceptionally rare; distinguishing TTP from cancer-associated thrombotic microangiopathy or DIC is challenging; and ADAMTS13 testing should be obtained whenever hemolytic anemia and thrombocytopenia are present, even if the initial suspicion for TTP is low. The authors also caution that PLASMIC score interpretation may be limited in patients with hematologic malignancies and that ADAMTS13 recovery may not perfectly correlate with clinical remission.

Asset Subtitle

Ijele Adimora

Meta Tag

Author List Cristhiam Rojas Hernandez, Ijele Adimora

Category Clinical Vignettes

Concept Thrombotic Thrombocytopenic Purpura

Concept ADAMTS13

Concept Total Plasma Exchange

Concept Microangiopathic Hemolytic Anemia

Concept Thrombotic Microangiopathy

Distinguished Non-Finalist

Presenter Organization University of Texas at Houston Health Sciences

Presenting Author Ijele Adimora

Track Adult

Keywords

thrombotic thrombocytopenic purpura

TTP

acute myeloid leukemia

AML

ADAMTS13

plasma exchange

disseminated intravascular coagulation

thrombotic microangiopathy

thrombocytopenia

case report

Thrombotic Thrombocytopenic Purpura

ADAMTS13

Total Plasma Exchange

Microangiopathic Hemolytic Anemia

Thrombotic Microangiopathy