Acute Pancreatitis-Induced Thrombotic Thrombocytopenic Purpura

  • Mohan Gurjar Department of Critical Care Medicine SGPGIMS, Lucknow-226014 Fax: +91-522-2668017
  • Saurabh Saigal
  • Afzal Azim
  • Samir Mohindra
  • Narayan Prasad
  • Gaurav Srivastava
Keywords: Pancreatitis, Plasmapheresis, Purpura, Thrombotic Thrombocytopenic


Context Acute pancreatitis due to thrombotic thrombocytopenic purpura is a well recognized condition. Here, we are reporting a rare converse phenomenon, in which thrombocytopenic purpura occurred secondary to acute pancreatitis. Case report A 19-year-old male referred to our intensive care unit with diagnosis of acute pancreatitis with multi-organ dysfunction. He had history of severe abdominal pain and recurrent vomiting about one month ago, requiring hospital admission. There, on diagnostic work-up at admission, abdominal ultrasonography was suggestive of pancreatitis. His serum amylase and lipase were 1,900 and 1,582 U/L, respectively. Other laboratory parameters were within normal limits. He was managed conservatively with intravenous fluids, antibiotics and analgesics; and discharged after about 2 weeks One week after discharge he was readmitted in same hospital with abdominal pain, multiple episodes of bilious vomiting and abdominal distention. Later on he was referred to our intensive care unit; having classical pentad of thrombocytopenic purpura, i.e., thrombocytopenia, micro-angiopathic hemolytic anemia, renal failure, encephalopathy, and fever. His condition improved with plasma exchange therapy and transferred out from our ICU to ward after 10 days of stay. Conclusion Thrombocytopenic purpura may be precipitate by acute pancreatitis due to multiple mechanisms. A high clinical suspicion is required to make an early diagnosis and allow early initiation of plasma exchange therapy, resulting in a good prognosis.


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George JN. Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med 2006; 354:1927-35.

Vesely SK, George JN, Lammle B, Studt JD, Alberio L, El-Harake MA, et al. ADAMTS13 activity in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: relation to presenting features and clinical outcomes in a prospective cohort of 142 patients. Blood 2003; 102: 60-8.

Sadler JE. Von Willebrand factor, ADAMTS13, and thrombotic thrombocytopenic purpura. Blood 2008; 112:11-8.

Ridolfi RL, Bell WR. Thrombotic thrombocytopenic purpura. Report of 25 cases and review of the literature. Medicine 1981; 60:413-28.

Chaudhry MS, Saweirs MWM. Thrombotic thrombocytopenic purpura precipitated by acute pancreatitis. Transf Apheres Sci 2011 .

Banno F, Kokame K, Okuda T, Honda S, Miyata S, Kato H, et al. Complete deficiency in ADAMTS13 is prothrombotic, but it alone is not sufficient to cause thrombotic thrombocytopenic purpura. Blood 2006; 107: 3161-6.

Bernardo A, Ball C, Nolasco L, Moake JF, Dong J. Effects of inflammatory cytokines on the release and cleavage of the endothelial cell-derived ultralarge von Willebrand factor multimers under flow. Blood 2004; 104:100-6.

Thachil J. Lessons from acute pancreatitis-induced thrombotic thrombocytopenic Purpura. Eur J Int Med 2009; 20: 739-43.

Mannucci PM, Parolari A, Canciani MT, Alemanni F, Camera M. Opposite changes of ADAMTS 13 and von Willebrand factor after cardiac surgery. J Thromb Haemost 2005;3:397-9.

Ruiz-Torres MP, Casiraghi F, Galbusera M, Macconi D, Gastoldi S, Todeschini M, et al. Complement activation: the missing link between ADAMTS-13 deficiency and microvascular thrombosis of thrombotic microangiopathies. Thromb Haemost 2005;93:443-52.

DiMagno MJ, Williams JA, Hao Y, Ernst SA, Owyang C. Endothelial nitric oxide synthase is protective in the initiation of caerulein induced acute pancreatitis in mice. Am J Physiol: Gastrointest Liver Physiol 2004; 287: 80-7.

Olson JS, Foley EW, Rogge C, Tsai AL, Doyle MP, Lemon DD. NO scavenging and the hypertensive effect of hemoglobin-based blood substitutes. Free Radic Biol Med 2004;36:685-97.

Schnog JJ, Jager EH, van der Dijs FP, Duits AJ, Moshage H, Muskiet FD, et al. Evidence for a metabolic shift of arginine metabolism in sickle cell disease. Ann Hematol 2004;83:371-5.

Sanjay Gandhi Postgraduate Institute of Medical Sciences
How to Cite
GurjarM., SaigalS., AzimA., MohindraS., PrasadN., & SrivastavaG. (2012). Acute Pancreatitis-Induced Thrombotic Thrombocytopenic Purpura. JOP. Journal of the Pancreas, 13(1), 80-82.