Internal and Emergency Medicine

, Volume 13, Issue 5, pp 709–712 | Cite as

What is behind a relapse of thrombotic thrombocytopenic purpura?

  • Marco CapecchiEmail author
  • Andrea Artoni
  • Maria Domenica Cappellini
  • Giovanna Graziadei

Case presentation

Dr. Capecchi and Dr. Graziadei

We present the case of a 64-year-old woman. She was diagnosed with thrombotic thrombocytopenic purpura (TTP) in 2006, at the age of 54 years because of an acute neurological episode of confusion with the presence of schistocytes in the blood smear. Platelet count was up to 100,000/mm3, hemoglobin level was 13 g/dl, with a mean cell volume of 65 fl. She was treated with plasma exchange and steroids with complete resolution of the clinical manifestations, and the follow-up was started. Notably, ADAMTS-13 had not been determined during the acute episode, and at follow-up ADAMTS-13 levels were always within normal limits.

In 2015, the patient came to our attention. She was admitted to the emergency department of our hospital with cholangitis and sepsis; she suddenly developed acute neurological impairment, and, because of her history of TTP, she was immediately treated with plasma exchange, even if ADAMTS-13 levels were in the normal range,...


Compliance with ethical standards

Conflict of interest


Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human and animals performed by any of the authors.

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Copyright information

© SIMI 2017

Authors and Affiliations

  1. 1.Dipartimento di Scienze Cliniche e di comunità, Scuola di Specializzazione in EmatologiaFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanoItaly
  2. 2.Centro Emofilia e Trombosi Angelo Bianchi BonomiFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanoItaly
  3. 3.Dipartimento di Medicina Interna, Centro Malattie RareFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanoItaly
  4. 4.Dipartimento di Scienze Cliniche e Comunità, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversità di MilanoMilanoItaly

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