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Acute pancreatitis-induced thrombotic thrombocytopenic purpura with recurrent acute pancreatitis

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Abstract

Recent successive reports on acute pancreatitis-induced thrombotic thrombocytopenic purpura (TTP) have revealed that TTP-related microvascular damage is an aggravating factor of acute pancreatitis. Here, we report the case of a 26-year-old man diagnosed with acute pancreatitis due to high alcohol consumption. The patient was unconscious as he had taken an overdose of medication, and presented with fever and renal failure due to acute pancreatitis on admission. Although the pancreatitis subsequently improved, the symptoms were still observed; on the next day, he exhibited hemoglobinuria, anemia, and thrombocytopenia. Moreover, general blood examinations indicated the presence of schistocytes and reduced activity of ADAMTS13 (a disintegrin-like metalloproteinase with thrombospondin type 1 motif 13) to 47 %. Thus, the patient was diagnosed with TTP, and plasma exchange was performed. After the development of TTP, the acute pancreatitis recurred, but a severe pathogenesis was prevented by plasma exchange. Thus, ADAMTS13 activity may be useful for predicting a severe pathogenesis of acute pancreatitis. In ADAMTS13-deficient cases, plasma exchange may be an effective technique for preventing aggravation of acute pancreatitis.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan

    Yasuhisa Fujino, Yoshihiro Inoue, Makoto Onodera, Satoshi Kikuchi, Masayuki Sato, Masahiro Kojika & Hisaho Sato

  2. Department of Laboratory Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan

    Keijiro Suzuki

  3. Department of Blood Transfusion Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8521, Japan

    Masanori Matsumoto

Authors
  1. Yasuhisa Fujino
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  2. Yoshihiro Inoue
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  3. Makoto Onodera
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  4. Satoshi Kikuchi
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  5. Masayuki Sato
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  8. Keijiro Suzuki
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  9. Masanori Matsumoto
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Correspondence to Yasuhisa Fujino.

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Conflict of Interest:

Yasuhisa Fujino, Yoshihiro Inoue, Makoto Onodera, Satoshi Kikuchi, Masayuki Sato, Masahiro Kojika, Hisaho Sato, Keijiro Suzuki, and Masanori Matsumoto declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all patients for inclusion in the study.

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Fujino, Y., Inoue, Y., Onodera, M. et al. Acute pancreatitis-induced thrombotic thrombocytopenic purpura with recurrent acute pancreatitis. Clin J Gastroenterol 9, 104–108 (2016). https://doi.org/10.1007/s12328-016-0632-0

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  • DOI: https://doi.org/10.1007/s12328-016-0632-0

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