A case of thrombotic thrombocytopenic purpura with a positive Coombs' test

Yoshimichi Urahama, Yosuke Saka, Takaaki Yaomura, Tomohiko Naruse, Yuzo Watanabe, Yukio Yuzawa, Seiichi Matsuo

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

We report a case of thrombotic thrombocytopenic purpura (TTP) with a positive Coombs' test. A 59-year-old female was admitted to our hospital in February, 1997 with symptoms of heart failure. Ultrasound cardiography showed moderate pericardiac effusion and she was diagnosed as having pericarditis. After admission she had anorexia and her urine volume was reduced. Laboratory tests showed anemia and thrombocytopenia. Her Coombs' test result was positive. Her renal function gradually worsened and her conscious level was reduced. We diagnosed her as TTP and judged that she needed hemodialysis. We performed plasma exchange and started steroid therapy. The renal biopsy was compat-ible with TTP. After treatment, her level of consciousness improved, but her renal function did not improve. On the 51st hospital day she fell into acute respiratory distress syndrome(ARDS) and entered ICU. We considered ARDS caused by infection and continued treatment, but she died of shock and lactate acidosis. Activity of von Willebrand factor-cleaving protease in our case was 15% before the first PE, and 25% just before death. A case of TTP without collagen disease usually shows a negative Coombs' test result. We think that this was a rare case in which autoimmune hemolytic anemia was supervened with TTP.

Original languageEnglish
Pages (from-to)468-473
Number of pages6
JournalJapanese Journal of Nephrology
Volume47
Issue number4
Publication statusPublished - 21-07-2005
Externally publishedYes

Fingerprint

Coombs Test
Thrombotic Thrombocytopenic Purpura
Adult Respiratory Distress Syndrome
Kidney
Autoimmune Hemolytic Anemia
Collagen Diseases
Plasma Exchange
Pericarditis
Anorexia
Acidosis
Consciousness
Thrombocytopenia
Renal Dialysis
Anemia
Shock
Lactic Acid
Therapeutics
Heart Failure
Steroids
Urine

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Urahama, Y., Saka, Y., Yaomura, T., Naruse, T., Watanabe, Y., Yuzawa, Y., & Matsuo, S. (2005). A case of thrombotic thrombocytopenic purpura with a positive Coombs' test. Japanese Journal of Nephrology, 47(4), 468-473.
Urahama, Yoshimichi ; Saka, Yosuke ; Yaomura, Takaaki ; Naruse, Tomohiko ; Watanabe, Yuzo ; Yuzawa, Yukio ; Matsuo, Seiichi. / A case of thrombotic thrombocytopenic purpura with a positive Coombs' test. In: Japanese Journal of Nephrology. 2005 ; Vol. 47, No. 4. pp. 468-473.
@article{0602841265e54a208817301e33ec2fcd,
title = "A case of thrombotic thrombocytopenic purpura with a positive Coombs' test",
abstract = "We report a case of thrombotic thrombocytopenic purpura (TTP) with a positive Coombs' test. A 59-year-old female was admitted to our hospital in February, 1997 with symptoms of heart failure. Ultrasound cardiography showed moderate pericardiac effusion and she was diagnosed as having pericarditis. After admission she had anorexia and her urine volume was reduced. Laboratory tests showed anemia and thrombocytopenia. Her Coombs' test result was positive. Her renal function gradually worsened and her conscious level was reduced. We diagnosed her as TTP and judged that she needed hemodialysis. We performed plasma exchange and started steroid therapy. The renal biopsy was compat-ible with TTP. After treatment, her level of consciousness improved, but her renal function did not improve. On the 51st hospital day she fell into acute respiratory distress syndrome(ARDS) and entered ICU. We considered ARDS caused by infection and continued treatment, but she died of shock and lactate acidosis. Activity of von Willebrand factor-cleaving protease in our case was 15{\%} before the first PE, and 25{\%} just before death. A case of TTP without collagen disease usually shows a negative Coombs' test result. We think that this was a rare case in which autoimmune hemolytic anemia was supervened with TTP.",
author = "Yoshimichi Urahama and Yosuke Saka and Takaaki Yaomura and Tomohiko Naruse and Yuzo Watanabe and Yukio Yuzawa and Seiichi Matsuo",
year = "2005",
month = "7",
day = "21",
language = "English",
volume = "47",
pages = "468--473",
journal = "Japanese Journal of Nephrology",
issn = "0385-2385",
publisher = "Japanese Society of Nephrology",
number = "4",

}

Urahama, Y, Saka, Y, Yaomura, T, Naruse, T, Watanabe, Y, Yuzawa, Y & Matsuo, S 2005, 'A case of thrombotic thrombocytopenic purpura with a positive Coombs' test', Japanese Journal of Nephrology, vol. 47, no. 4, pp. 468-473.

A case of thrombotic thrombocytopenic purpura with a positive Coombs' test. / Urahama, Yoshimichi; Saka, Yosuke; Yaomura, Takaaki; Naruse, Tomohiko; Watanabe, Yuzo; Yuzawa, Yukio; Matsuo, Seiichi.

In: Japanese Journal of Nephrology, Vol. 47, No. 4, 21.07.2005, p. 468-473.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A case of thrombotic thrombocytopenic purpura with a positive Coombs' test

AU - Urahama, Yoshimichi

AU - Saka, Yosuke

AU - Yaomura, Takaaki

AU - Naruse, Tomohiko

AU - Watanabe, Yuzo

AU - Yuzawa, Yukio

AU - Matsuo, Seiichi

PY - 2005/7/21

Y1 - 2005/7/21

N2 - We report a case of thrombotic thrombocytopenic purpura (TTP) with a positive Coombs' test. A 59-year-old female was admitted to our hospital in February, 1997 with symptoms of heart failure. Ultrasound cardiography showed moderate pericardiac effusion and she was diagnosed as having pericarditis. After admission she had anorexia and her urine volume was reduced. Laboratory tests showed anemia and thrombocytopenia. Her Coombs' test result was positive. Her renal function gradually worsened and her conscious level was reduced. We diagnosed her as TTP and judged that she needed hemodialysis. We performed plasma exchange and started steroid therapy. The renal biopsy was compat-ible with TTP. After treatment, her level of consciousness improved, but her renal function did not improve. On the 51st hospital day she fell into acute respiratory distress syndrome(ARDS) and entered ICU. We considered ARDS caused by infection and continued treatment, but she died of shock and lactate acidosis. Activity of von Willebrand factor-cleaving protease in our case was 15% before the first PE, and 25% just before death. A case of TTP without collagen disease usually shows a negative Coombs' test result. We think that this was a rare case in which autoimmune hemolytic anemia was supervened with TTP.

AB - We report a case of thrombotic thrombocytopenic purpura (TTP) with a positive Coombs' test. A 59-year-old female was admitted to our hospital in February, 1997 with symptoms of heart failure. Ultrasound cardiography showed moderate pericardiac effusion and she was diagnosed as having pericarditis. After admission she had anorexia and her urine volume was reduced. Laboratory tests showed anemia and thrombocytopenia. Her Coombs' test result was positive. Her renal function gradually worsened and her conscious level was reduced. We diagnosed her as TTP and judged that she needed hemodialysis. We performed plasma exchange and started steroid therapy. The renal biopsy was compat-ible with TTP. After treatment, her level of consciousness improved, but her renal function did not improve. On the 51st hospital day she fell into acute respiratory distress syndrome(ARDS) and entered ICU. We considered ARDS caused by infection and continued treatment, but she died of shock and lactate acidosis. Activity of von Willebrand factor-cleaving protease in our case was 15% before the first PE, and 25% just before death. A case of TTP without collagen disease usually shows a negative Coombs' test result. We think that this was a rare case in which autoimmune hemolytic anemia was supervened with TTP.

UR - http://www.scopus.com/inward/record.url?scp=21844479593&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=21844479593&partnerID=8YFLogxK

M3 - Article

VL - 47

SP - 468

EP - 473

JO - Japanese Journal of Nephrology

JF - Japanese Journal of Nephrology

SN - 0385-2385

IS - 4

ER -

Urahama Y, Saka Y, Yaomura T, Naruse T, Watanabe Y, Yuzawa Y et al. A case of thrombotic thrombocytopenic purpura with a positive Coombs' test. Japanese Journal of Nephrology. 2005 Jul 21;47(4):468-473.