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Intensive Care Medicine

, Volume 44, Issue 6, pp 893–896 | Cite as

Does this patient with thrombotic thrombocytopenic purpura have a cardiac involvement?

  • Lara Zafrani
  • Lene Russell
  • Elie AzoulayEmail author
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Clinical vignette

A 53-year-old man was admitted to the intensive care unit (ICU) for thrombotic microangiopathy (TMA). His past medical history included hypercholesterolemia and smoking. In addition to profound thrombocytopenia (7 × 109/l) and mechanical haemolytic anemia (positive schistocytes on the blood smear and negative direct antiglobulin test), he exhibited diffuse purpura on his lower extremities. There was neither chest pain nor clinical features of congestive heart failure, and the electrocardiogram (ECG) was normal. However, cardiac troponin I measurement was 0.45 µg/l. The diagnosis of thrombotic thrombocytopenic purpura (TTP) was immediately suspected, and plasma exchange (PEX) and steroids were initiated within 3 h of ICU admission. The diagnosis was confirmed by undetectable ADAMTS-13 activity on a sample drawn prior to the first PEX. On day 2, the patient presented with atrial fibrillation. An echocardiogram revealed global left ventricular hypokinesis with a...

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.AP-HP, Saint-Louis Hospital, Medical Intensive Care Unit, Paris (LZ, EA), ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 INSERMParis Diderot, Sorbonne UniversityParisFrance
  2. 2.Department of Intensive Care 4131Copenhagen University Hospital, RigshospitaletCopenhagenDenmark
  3. 3.Department of AnaesthesiaZealand University HospitalRoskildeDenmark

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