The Hemostatic Conundrum of Thrombotic Thrombocytopenic Purpura: a Case Report.

ABSTRACT

BACKGROUND: In thrombotic thrombocytopenic purpura (TTP), von Willebrand factor (VWF)-platelet rich thrombi form in the microvasculature with ischemia in vital organs. The pathogenesis relates to deficiency of the VWF cleaving protease, ADAMTS-13. METHODS: A case study of a 58-year-old female with previously undiagnosed HIV (human immunodeficiency virus) infection, left hemiparesis, and soft tissue hemorrhages. RESULTS: Investigations revealed microangiopathic hemolytic anemia and a left basal ganglia infarct on magnetic resonance imaging (MRI). A diagnosis of acquired, HIV-related TTP was made and therapeutic plasma exchange and antiretroviral therapy were initiated. CONCLUSIONS: The combined thrombotic and hemorrhagic manifestations of TTP pose therapeutic challenges.