title: A case report of total abdominal hysterectomy resulting in acute thrombotic thrombocytopenic purpura with pancreatitis and hepatitis: complete resolution with plasma exchange therapy.
abstract: Acute thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder that has previously been described associated with various types of surgery. An association between total abdominal hysterectomy (TAH) and TTP has never been reported. Thrombotic thrombocytopenic purpura is classically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, azotemia and neurological manifestations. Atypical manifestations of TTP include hepatitis, pancreatitis, acute respiratory distress syndrome, non-occlusive mesenteric ischemia and peripheral digital ischemia. This case report describes the occurrence of acute TTP following TAH and bilateral salpingo-oopherectomy, which manifested with typical and atypical features (i.e. hepatitis, pancreatitis). Plasma exchange therapy resulted in the complete resolution of the process.
authors.affiliation: Department of Medicine, Wright State University, Dayton, OH, USA. satish@kathula.com
authors.forename: Satheesh K
authors.initials: SK
authors.lastname: Kathula
authors.forename: Jhansi
authors.initials: J
authors.lastname: Koduri
authors.forename: Sunita
authors.initials: S
authors.lastname: Mall
authors.forename: Jae C
authors.initials: JC
authors.lastname: Chang
mesh_terms: D000208:Acute Disease; D000328:Adult; D001774:Blood Chemical Analysis; D005260:Female; D005500:Follow-Up Studies; D006505:Hepatitis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D010052:Ovariectomy / Q000009:adverse effects / Q000379:methods; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis; D010951:Plasma Exchange / Q000379:methods*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000175:diagnosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome