Title : Clinical case of thrombotic thrombocytopenia purpura
Abstract:
Thrombotic thrombocytopenic purpura (TTP) is one of the rare autoimmune diseases, with an incidence of about 3 per million each year [1]. Symptoms of the disease are quite different, it can be purpura from mild to severe level, with classic symptoms are intravascular hemolytic anemia, thrombocytopenia, fever, acute kidney injury and neurological symptoms [2]. A 48-year-old male patient went to our poison control center at Bach Mai hospital, Vietnam because of he was drowsiness, Glasgow coma scale of the patient was 10 points. The patient didn’t have meningeal syndrome, tendon reflexes of the patient was normal, but accompanied by symptoms of subcutaneous hemorrhage and jaundiced skin and mucosa. The patient was suddenly onset of neurological symptoms. We took magnetic resonance imaging of the brain and showed increase signal lesions in the temporal lobe, but there were no embolisms or lesions relate to stroke. At the time of admission, the platelet count was 89 Giga/L. Whole blood testing of after days, the patient's platelet count gradually decreased to 12 Giga/L. We decided to transfuse platelets, but after the transfusion, the platelet count continued to drop to 9 Giga/L, neurological symptoms of the patient didn’t improve, at this time we consulted with doctors in the hospital and we thought about thrombotic thrombocytopenia purpura. The patient was then tested for ADAMTS13 with results returning ADAMTS13 activity < 0.5%, while waiting for the results of the patient’s ADAMTS13 activity. we decided to exchange the plasma 5 times. As a result, the patient regained consciousness, platelets returned to normal and stable during 5 days later. Finally the patient was discharged from the hospital on the 11th day of treatment.
Keywords: Thrombotic thrombocytopenic, Hemorrhage purpura, Plasma exchange.
