A Rare Case of Thrombotic Thrombocytopenic Purpura After Cardiac Surgery

Here we report a case of postoperative thrombocytopenia (TTP) in a 77-year-old case that has been undergoing mitral valve replacement with combined coronary artery bypass grafting. In the 5th days of operation, his platelet count was reduced and despite platelet transfusion, his platelet count reaches to a minimum level of 15000 μg/mL on the 34th day of surgery. Despite platelet transfusion and plasmapheresis, platelet count continues to decrease and signs and symptoms of disseminated intravascular coagulation appeared by unexpectable renal and pulmonary bleeding. Finally high dose, steroid therapy was started and after some days, platelets count raised to 80000 μg/mL. DIC was recovered, but acute renal failure did not respond to medical and hemodialysis and the case expired with sudden cardiac arrest and ventricular fibrillation.we conclude that if the diagnosis of TTP was made earlier in the course of disease by consulting internist and steroids was instituted it might prevent ARF and its poor outcome.