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Hill KM, Moorman D, Mack J, Gonsalves C, Khalife R. A case of acute pancreatitis-induced microangiopathic hemolytic anemia with thrombocytopenia. J Thromb Thrombolysis 2019; 49:159-163. [PMID: 31493291 DOI: 10.1007/s11239-019-01946-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Microangiopathic hemolytic anemia and thrombocytopenia (MAHA-T) is a rare complication of acute pancreatitis (AP). Treatment with therapeutic plasma exchange (TPE) is used at many centers. The natural history of this disease is not well understood. We report a case of acute pancreatitis induced MAHA-T with end organ dysfunction and a normal ADAMTS13 level. Following three TPEs, the patient's clinical status, blood counts and hemolytic markers stabilized. Improvement occurred even after TPE was discontinued. The optimal management of AP-induced MAHA-T is poorly understood. Many centres are reporting good outcomes with the early initiation of TPE. MAHA-T associated with acute pancreatitis is often treated with early initiation of TPE. However, the value of TPE in altering the natural history of the condition is not well understood. Further study is required to understand the role of ADAMTS13 testing to guide treatment, and the role of TPE in management.
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Affiliation(s)
- Kevin M Hill
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. .,Department of Medicine, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
| | - Danielle Moorman
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Jonathan Mack
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Medicine, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Carol Gonsalves
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Medicine, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Roy Khalife
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Medicine, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
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Postendoscopic retrograde cholangiopancreatography pancreatitis: a rare cause of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Eur J Gastroenterol Hepatol 2011; 23:825-7. [PMID: 21716116 DOI: 10.1097/meg.0b013e328348e73a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Endothelial injury is perhaps the inciting factor leading to the microangiopathic process that initiates thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS). TTP-HUS after postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is extremely rare, but potentially is life threatening. Here, we describe a case of a 23-year-old man with a history of choledocholithiasis, who developed TTP-HUS, 2 days after the onset of post-ERCP pancreatitis. It is important that physicians recognize TTP-HUS as one of the potential causes of acute kidney injury in cases of acute pancreatitis and post-ERCP pancreatitis for adult patients, especially when there is concomitant thrombocytopenia and hemolytic anemia. The early initiation of plasma exchange has a major impact on the survival and preservation of renal function. Exchange transfusion of fresh frozen plasma remains the cornerstone treatment of TTP-HUS.
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