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Stroke in a young patient treated by alteplase heralding an acquired thrombotic thrombocytopenic purpura
Author(s) -
Sevy Amandine,
Doche Emilie,
Squarcioni Christian,
Poullin Pascale,
Serratrice Jacques,
Nicoli Francois,
Weiller PierreJean
Publication year - 2010
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.20276
Subject(s) - medicine , thrombotic thrombocytopenic purpura , schistocyte , adamts13 , stroke (engine) , microangiopathic hemolytic anemia , thrombolysis , pediatrics , haptoglobin , purpura (gastropod) , complication , hemolytic anemia , platelet , surgery , myocardial infarction , mechanical engineering , ecology , engineering , biology
Background and purpose: Thrombotic thrombocytopenic purpura (TTP) is a life‐threatening multisystem disorder characterized by thrombocytopenia and fluctuating neurological symptoms due to microinfarcts. In rare cases, large cerebral arteries can be occluded. Summary of the case: We report on a 30‐year‐old woman with a first‐ever acute stroke related to a right proximal MCA M1 occlusion. Platelet count was normal at admission and progressively decreased 6 days after intravenous thrombolysis with the occurrence of a hemolytic anemia with schistocytes. Most biological anomalies reversed after plasma exchange. No hemorrhagic complication occurred. Diagnosis of initial TTP was confirmed by low ADAMTS13 activity and positivity of anti‐ADAMTS13 antibody. Conclusion: This observation highlights the fact that even if platelet count and hemoglobin rate are normal in the beginning, an acute ischemic stroke in a young patient can be related to TTP. Faced with subsequent thrombopenia, practitioners should be aware of acquired TTP, and, thus, schistocytes, haptoglobin, and LDH assays should be performed. Early diagnosis is paramount to start the life‐saving plasma exchanges. J. Clin. Apheresis, 2011. © 2010 Wiley‐Liss, Inc.