Abstract
Spontaneous hemothorax in the left pleural space occurred suddenly in a patient with thrombotic thrombocytopenic purpura (TTP). In spite of massive blood transfusion, the hemorrhage could not be stopped. The patient suffered shock due to tension hemothorax and hypovolemia, resulting in cardiac arrest. After successful cardiopulmonary resuscitation, surgical hemostasis was performed. The main cause of the bleeding was rupture of the left intercostal vein. TTP is a severe microvascular occlusive thrombotic microangiopathy that can induce congestion, vasculitis, and ischemia. This mechanism is thought to have been involved in the rupture of the intercostal vein in the present patient.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sadler JE, Moake JL, Miyata T, George JN. Recent advances in thrombotic thrombocytopenic purpura. Hematology Am Soc Hematol Educ Program. 2004;407–423.
Chang JC, Aly ES. Acute respiratory distress syndrome as a major clinical manifestation of thrombotic thrombocytopenic purpura. Am J Med Sci. 2001;321:124–128.
Martinez AJ, Maltby JD, Hurst DJ. Thrombotic thrombocytopenic purpura seen as pulmonary hemorrhage. Arch Intern Med. 1983;143:1818–1820.
Lapp H, Shin DI, Kroells W, Boerrigter G, Horlitz M, Schley P, Stoerkel S, Guelker H. Cardiogenic shock due to thrombotic thrombocytopenic purpura. Z Kardiol. 2004;93:486–492.
Brandenburg VM, Gaertner S, Lindemann-Docter K, Ortlepp JR, Westerhuis R, Ketteler M, Westenfeld R, Floege J. Underestimated complications in thrombotic thrombocytopenic purpura—haemolytic uraemic syndrome. Nephrol Dial Transplant. 2004;19:2142–2146.
Arnold PO, Klink D, Holmes AK. Fatal cardiac arrhythmia in a patient with thrombotic thrombocytopenic purpura. Am J Med Sci. 2006;331:320–321.
Mowad CM, Howe KL, Guzzo CA. Unexplained hemothorax, hemarthrosis, and palpable purpura. Hosp Pract (Off Ed). 1995;30:55–56.
Kara A, Yarali N, Fisgin T, Duru F. Spontaneous haemothorax: an uncommon presentation of Glanzmann thrombasthenia. Acta Paediatr. 2002;91:1139–1140.
Fromke VL, Schmidt WR. Hemothorax in idiopathic thrombocytopenic purpura (ITP). J Thorac Cardiovasc Surg. 1972;63:962–967.
Coe GC, Gault JT, Hirshfield HJ. Idiopathic thrombocytopenic purpura associated with accessory spleens and complicated by severe hemothorax and hemoperitoneum. Ill Med J. 1950;98:313–315.
Tsai HM. Thrombotic thrombocytopenic purpura: a thrombotic disorder caused by ADAMTS13 deficiency. Hematol Oncol Clin North Am. 2007;21:609–6032.
Liker CA. Blood. In: Tierney LM Jr, McPhee SJ, Papadakis MA, editors. Current medical diagnosis and treatment. 45th ed. New York: McGraw-Hill; 2006. p. 481–535.
Howard TP. Fulminant respiratory failure. A manifestation of thrombotic thrombocytopenic purpura. JAMA. 1979;242:350–351.
Bone RC, Henry JE, Petterson J, Amare M. Respiratory dysfunction in thrombotic thrombocytopenic purpura. Am J Med. 1978;65:262–2670.
Marino PL. Anemia and red blood cell transfusions in the ICU. In: Marino PL, editor. The ICU Book, 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 681–693.
Author information
Authors and Affiliations
About this article
Cite this article
Kubota, T., Koizumi, S., Miyata, A. et al. Life-threatening spontaneous hemothorax in a patient with thrombotic thrombocytopenic purpura. J Anesth 23, 129–131 (2009). https://doi.org/10.1007/s00540-008-0674-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-008-0674-7