Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening form of thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and ischemic injury to various organs. The underlying mechanism involves a severe deficiency of ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), an enzyme responsible for cleaving ultralarge von Willebrand factor (VWF) multimers into smaller, less active forms. When ADAMTS13 activity is markedly reduced, these ultralarge VWF multimers accumulate in the circulation and promote excessive platelet adhesion and aggregation within the microvasculature. The resulting platelet-rich thrombi cause disseminated microvascular occlusion, leading to hemolytic anemia, thrombocytopenia, and end-organ ischemia—hallmarks of TTP. Because the main pathophysiological mechanism of Thrombotic Thrombocytopenic Purpura (TTP) involves the formation of microthrombi in small blood vessels, most patients present with clinical manifestations of renal and neurological involvement. Cardiovascular complications, particularly acute myocardial infarction, are rarely reported. In this article, we present the case of a 73-year-old male diagnosed with thrombotic thrombocytopenic purpura complicated by acute anterior wall myocardial infarction and acute heart failure. Through this case, we aim to discuss the diagnostic challenges and management strategies for this rare clinical presentation.
A RARE CASE REPORT: EARLY MYOCARDIAL INFARCTION REVEALING THROMBOTIC THROMBOCYTOPENIC PURPURA
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Keywords
Thrombotic thrombocytopenia purpura, Microangiopathic hemolytic anemia, myocardial infarction, ADAMTS-13.
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