Tordon Bryan, Warkentin Theodore E, Moore Jane C, Arnold Donald M
Department of Medicine, Division of Hematology, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
Platelets. 2022 Apr 3;33(3):479-483. doi: 10.1080/09537104.2021.1912314. Epub 2021 Apr 14.
Thrombotic thrombocytopenic purpura (TTP) rarely complicates acute inflammatory conditions such as surgery, including post-cardiac surgery. Review of 32 previously-reported cases of post-cardiac surgery TTP indicates that this disorder often occurs as early as 2-3 days following surgery, which seems too soon to implicate new formation of anti-ADAMTS13 autoantibodies as a consequence of surgery itself. We diagnosed post-cardiac surgery TTP in a 60-year-old female that began approximately 3 days post-coronary artery bypass surgery in which anti-ADAMTS13 autoantibodies were implicated. We therefore investigated whether anti-ADAMTS13 autoantibodies were also present in a blood sample. Inhibitory (neutralizing) anti-ADAMTS13 autoantibodies were detectable in the preoperative blood sample, suggesting that the role of surgery in precipitating TTP might be due to effects such as abrupt increase in postoperative von Willebrand factor levels and associated proinflammatory factors, rather than effects of surgery itself leading to the formation of de novo anti-ADAMTS13 autoantibodies.
血栓性血小板减少性紫癜（TTP）很少并发急性炎症性疾病，如手术，包括心脏手术后。对32例先前报道的心脏手术后TTP病例的回顾表明，这种疾病通常在手术后2至3天就会出现，这似乎太早，以至于不能将其归咎于手术本身导致的抗ADAMTS13自身抗体的新形成。我们诊断出一名60岁女性在冠状动脉搭桥手术后约3天出现心脏手术后TTP，其中涉及抗ADAMTS13自身抗体。因此，我们调查了一份血样中是否也存在抗ADAMTS13自身抗体。术前血样中可检测到抑制性（中和性）抗ADAMTS13自身抗体，这表明手术引发TTP的作用可能是由于术后血管性血友病因子水平突然升高及相关促炎因子等影响，而非手术本身导致新形成抗ADAMTS13自身抗体的影响。
