Rafique Soomal, Deeb Yara, Ghanem Fares, Bhattarai Mukul
Southern Illinois University School of Medicine, Springfield, IL, USA.
Hosp Pharm. 2025 Mar 20:00185787251328593. doi: 10.1177/00185787251328593.
Thrombotic thrombocytopenic purpura (TTP) is a rare microangiopathic hemolytic anemia caused by a deficiency in the von Willebrand factor-cleaving protease ADAMTS13, resulting in the formation of microthrombi. TTP is associated with severe cardiovascular complications, such as myocardial infarction, congestive heart failure, arrhythmias, and cardiogenic shock, which can lead to a poor prognosis. Although plasmapheresis is the cornerstone of TTP treatment, it complicates the interpretation of cardiac biomarkers due to the rapid clearance of these markers from the bloodstream. We present the case of a 19-year-old African American female diagnosed with TTP who had critically elevated levels of high-sensitivity troponin (HS troponin). Notably, her HS troponin levels declined rapidly with ongoing plasmapheresis, underscoring the difficulties in interpreting cardiac biomarkers in TTP and the effects of treatment on these values. This case highlights the challenges in diagnosing and managing cardiovascular complications associated with TTP and their impact on patient prognosis.
血栓性血小板减少性紫癜（TTP）是一种罕见的微血管病性溶血性贫血，由血管性血友病因子裂解蛋白酶ADAMTS13缺乏引起，导致微血栓形成。TTP与严重的心血管并发症相关，如心肌梗死、充血性心力衰竭、心律失常和心源性休克，这些可导致预后不良。尽管血浆置换是TTP治疗的基石，但由于这些标志物从血液中快速清除，它使心脏生物标志物的解读变得复杂。我们报告一例19岁非裔美国女性诊断为TTP，其高敏肌钙蛋白（HS肌钙蛋白）水平严重升高。值得注意的是，随着血浆置换的进行，她的HS肌钙蛋白水平迅速下降，凸显了在TTP中解读心脏生物标志物的困难以及治疗对这些值的影响。该病例突出了诊断和管理与TTP相关的心血管并发症的挑战及其对患者预后的影响。
