A Case of Thrombotic Thrombocytopenic Purpura after Pancreatoduodenectomy

Yuichi Kataoka, Hideo Miyamoto, Hiroyuki Takano, Takashi Toyokawa, Toru Ito, Hiroshi Onuma, Hitoshi Yokota, Hiroyuki Nishimura

Department of Surgery, Hokushin General Hospital

A 63-year-old man underwent a pancreatoduodenectomy for pancreatic tumor. On the 52nd postoperative day, platelet counts and hemoglobin concentration rapidly declined. The next day the patient suddenly went into a convulsion and coma followed by left hemiplegia, and he had a sudden onset of fever. The initial diagnosis was cerebral infarction and DIC due to sepsis, but treatment for cerebral infarction and sepsis was not effective. Thrombocytopenia, hemolytic anemia with fragmented red blood cells, unexplained encephalopathy, and fever indicated a diagnosis of thrombotic thrombocytopenic purpura (TTP). The patient received plasma exchange with fresh frozen plasma and showed marked improvement. He achieved complete remission after five plasma exchanges. This was a case of postoperative TTP and the cause is unknown. After discharge, no relapse has occurred for 6 months. An accurate diagnosis and early treatment of TTP are essential to patient survival.

Key words
thrombotic thrombocytopenic purpura, postoperative TTP, plasma exchange

Reprint requests
Yuichi Kataoka Department of Surgery, Hokushin General Hospital
1-5-63 Nishi, Nakano, 383-0021 JAPAN

Accepted
January 14, 1998

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