Microangiopatía trombótica como complicación de una pancreatitis aguda

  • Bruno Scarlatto Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Medicina Intensiva, Asistente. Médico Intensivista. MUCAM, Unidad de Medicina Intensiva, Médico de staff
  • Sofía Kohn Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Medicina Intensiva, Medicina Intensiva, Residente
  • William Manzanares Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Medicina Intensiva, Profesor Titular. Médico Intensivista. MUCAM, Unidad de Medicina Intensiva, Director
Palabras clave: PANCREATITIS AGUDA, PÚRPURA TROMBOCITOPÉNICA TROMBÓTICA

Resumen

La púrpura trombótica trombocitopénica (PTT) es una microangiopatía trombótica poco frecuente, que se caracteriza por anemia hemolítica y plaquetopenia, con una elevada morbimortalidad. Su forma más frecuente es la PTT inmune, también denominada adquirida, provocada por la deficiencia de la enzima disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13) secundaria a la presencia en plasma de autoanticuerpos. Presentamos el caso de un paciente con diagnóstico de pancreatitis aguda (PA) complicada con PTT, asociación de presentación excepcional en la práctica clínica.

Citas

1) George JN, Nester CM. Syndromes of thrombotic microangiopathy. N Engl J Med 2014; 371(19):1847-8. doi: 10.1056/NEJMc1410951.
2) Matsumoto M, Fujimura Y, Wada H, Kokame K, Miyakawa Y, Ueda Y, et al. Diagnostic and treatment guidelines for thrombotic thrombocy-topenic purpura (TTP) 2017 in Japan. Int J Hematol 2017; 106(1):3-15. doi: 10.1007/s12185-017-2264-7.
3) Reese JA, Muthurajah DS, Kremer JA, Vesely SK, Terrell DR, George JN. Children and adults with thrombotic thrombocytopenic purpura associated with severe, acquired Adamts13 deficiency: comparison of incidence, demographic and clinical features. Pediatr Blood Cancer 2013; 60(10):1676-82. doi: 10.1002/pbc.24612.
4) Swisher KK, Doan JT, Vesely SK, Kwaan HC, Kim B, Lämmle B, et al. Pancreatitis preceding acute episodes of thrombotic thrombocytope-nic purpura-hemolytic uremic syndrome: report of five patients with a systematic review of published reports. Haematologica 2007; 92(7):936-43. doi: 10.3324/haematol.10963.
5) Knöbl P, Rintelen C, Kornek G, Wiltschke C, Kalhs P, I Schwarzinger I, et al. Plasma exchange for treatment of thrombotic thrombocytopenic purpura in critically ill patients. Intensive Care Med 1997; 23(1):44-50. doi: 10.1007/s001340050289.
6) Bergmann IP, Kremer Hovinga JA, Lämmle B, Peter HJ, Schiemann U. Acute pancreatitis and thrombotic thrombocytopenic purpura. Eur J Med Res 2008; 13(10):481-2.
7) Shah J, Mandavdhare HS, Birda CL, Dutta U, Sharma V. Thrombotic thrombocytopenic purpura: A rare complication of acute pancreatitis. JGH Open 2019; 3(5):435-7. doi: 10.1002/jgh3.12156.
8) Swisher K, Doan J, Vesely S, Kwaan H, Kim B, Lämmle B, et al. Pan-creatitis preceding acute episodes of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: report of five patients with a systematic review of published reports. Haematologica 2007; 92(7):936-43. doi: 10.3324/haematol.10963.
9) Hill K, Moorman D, Mack J, Gonsalves C, Khalife R. A case of acute pancreatitis-induced microangiopathic hemolytic anemia with thrombocytopenia. J Thromb Thrombolysis 2020; 49(1):159-63. doi: 10.1007/s11239-019-01946-2.
10) Adragão F, Nabais I, Reis R, Pereira B, Ramos A. Acute pan-creatitis as a trigger for thrombotic microangiopathy: a case report. Cureus 2021; 13(12):e20103. doi: 10.7759/cureus.20103.
11) Page E, Kremer Hovinga J, Terrell D, Vesely S, George J. Thrombotic thrombocytopenic purpura: diagnostic criteria, clinical features, and long-term outcomes from 1995 through 2015. Blood Adv 2017; 1(10):590-600. doi: 10.1182/bloodadvances.2017005124.
12) Bendapudi P, Hurwitz S, Fry A, Marques M, Waldo S, Li A, et al. Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microangiopathies: a cohort study. Lancet Haematol 2017; 4(4):e157-64. doi: 10.1016/S2352-3026(17)30026-1.
13) Insagaray J, Lemos F, Rodríguez Grecco I, Menyou A, Barindelli P, Rivas G, et al. Hemaféresis terapéutica: actividad realizada en el período 2008-2012. Rev Méd Urug 2014; 30(4):255-60.
14) Padmanabhan A, Connelly-Smith L, Aqui N, Balogun R, Klingel R, Meyer E, et al. Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the writing Com-mittee of the American Society for Apheresis: the eighth special issue. J Clin Apher 2019; 34(3):171-354. doi: 10.1002/jca.21705.
15) Rock G, Shumak K, Buskard N, Blanchette V, Kelton J, Nair R, et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N Engl J Med 1991; 325(6):393-7. doi: 10.1056/NEJM199108083250604.
16) Zheng X, Vesely S, Cataland S, Coppo P, Geldziler B, Iorio A, et al. ISTH guidelines for treatment of thrombotic thrombocytopenic purpura. J Thromb Haemost 2020; 18(10):2496-502. doi: 10.1111/jth.15010.
17) Mingot Castellano M, Pascual Izquierdo C, González A, Viejo Llorente A, Valcarcel Ferreiras D, Sebastián E, et al. Recommendations for the diagnosis and treatment of patients with thrombotic throm-bocytopenic purpura. Med Clin (Barc) 2022; 158(12):630.e1-14. doi: 10.1016/j.medcli.2021.03.040.
18) Zheng X, Vesely S, Cataland S, Coppo P, Geldziler B, Iorio A, et al. ISTH guidelines for the diagnosis of thrombotic thrombocytopenic purpura. J Thromb Haemost 2020; 18(10):2486-95. doi: 10.1111/jth.15006.
19) George J. How I treat patients with thrombotic thrombocyto-penic purpura: 2010. Blood 2010; 116(20):4060-9. doi: 10.1182/blood-2010-07-271445.
20) Lim W, Vesely S, George J. The role of rituximab in the man-agement of patients with acquired thrombotic thrombocytopenic purpura. Blood 2015; 125(10):1526-31. doi: 10.1182/blood-2014-10-559211.
21) Owattanapanich W, Wongprasert C, Rotchanapanya W, Owat-tanapanich N, Ruchutrakool T. Comparison of the Long-Term Remis-sion of Rituximab and Conventional Treatment for Acquired Throm-botic Thrombocytopenic Purpura: A Systematic Review and Me-ta-analysis. Clin Appl Thromb Hemost 2019; 25:1076029618825309. doi: 10.1177/1076029618825309.
Publicado
2022-12-20
Cómo citar
1.
Scarlatto B, Kohn S, Manzanares W. Microangiopatía trombótica como complicación de una pancreatitis aguda. Rev. Méd. Urug. [Internet]. 20 de diciembre de 2022 [citado 3 de febrero de 2023];38(4):e38412. Disponible en: https://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/988