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Acute thrombotic thrombocytopenic purpura following orthopedic surgery: a case report

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Abstract

Thrombotic thrombocytopenic purpura (TTP) or Moschowitz’s syndrome is characterized by release of unusually large von Willebrand factor (ULvWF) multimers and a deficiency of vWF metalloprotease. It is a very rare condition, but it causes serious problems. The etiology is still unknown, although surgical stress has been associated with TTP, probably by releasing massive amounts of ULvWF. TTP is an acute, recurrent disease of the circulatory system, consisting of thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological signs, and renal dysfunction. It has the strong possibility of being fatal and thus should be treated immediately, mostly by plasmapheresis. We report a case of TTP following a high tibial valgus osteotomy. An association between TTP and orthopedic surgery—as far as we know—has only once been reported in the literature. We suggest that orthopedic surgeons should be aware of this because, although very rare, postsurgical TTP could be a life-threatening postoperative complication, which needs prompt diagnosis and treatment.

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Notes

  1. The protease ADAMTS 13 belongs to the ADAMTS family of metalloproteases, which counts 19 members. The family name “ADAMTS” is an acronym for “a disintegrin-like and metalloprotease with thrombospondin type 1 repeats”.

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Authors and Affiliations

  1. Orthopaedic Department, Naoussa General Hospital Naoussa, 21 Filiaton-Ikarou Str, 55438, Thessaloniki, Greece

    Michael I. Iosifidis

  2. Anaisthesiology Department, Naoussa General Hospital Naoussa, 63 Viziinou Str, 59300, Alexandria, Greece

    Merkourios Ntavlis

  3. Orthopaedic Department, Naoussa General Hospital Naoussa, 6 Agiou Dimitriou Str, 59200, Naoussa, Greece

    Ioannis Giannoulis

  4. Orthopaedic Department, Naoussa General Hospital, Naoussa, 45 Chr. Lanara Str, 59200, Naoussa, Greece

    Leonidas Malioufas

  5. Anesthesiology Department, Naoussa General Hospital, Naoussa, Asomata, 59100, Veria, Greece

    Antonios Ioannou

  6. Orthopaedic Department, Naoussa General Hospital, Naoussa, 3 Ath. Diakou Str, 55236, Panorama Thessaloniki, Greece

    Georgios Giantsis

Authors
  1. Michael I. Iosifidis
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  2. Merkourios Ntavlis
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  3. Ioannis Giannoulis
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  4. Leonidas Malioufas
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  5. Antonios Ioannou
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  6. Georgios Giantsis
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Correspondence to Michael I. Iosifidis.

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Iosifidis, M.I., Ntavlis, M., Giannoulis, I. et al. Acute thrombotic thrombocytopenic purpura following orthopedic surgery: a case report. Arch Orthop Trauma Surg 126, 335–338 (2006). https://doi.org/10.1007/s00402-005-0014-4

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  • DOI: https://doi.org/10.1007/s00402-005-0014-4

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