A case of thrombotic thrombocytopenic purpura slowly progressing after surgery for gastric cancer

Abstract

A 79-year-old woman underwent a total gastrectomy with a D1+β lymph node dissection, cholecystectomy, and Roux-en-Y reconstruction for stage II gastric cancer T2 (MP) N1P0H0CYXM0 ; the postoperative diagnosis was T3 (SE) N0H0P0CY1M0 stage IV. Minor leakage was observed on the seventh postoperative day, but it was successfully treated by drainage. The patient was discharged on the 28th postoperative day. On the 60th postoperative day, blood testing showed thrombocytopenia. She was diagnosed as having thrombotic thrombocytopenic purpura (TTP) ; she subsequently developed a hemolytic anemia with schistocytes, impaired renal function, and intermediately decreased ADAMTS13 activity. Infusion of fresh frozen plasma (FFP) rapidly corrected the thrombocytopenia and hemolytic anemia. Thus, this treatment was continued intermittently for two months. No relapse has occurred since FFP infusion therapy was stopped. The most common cause of postoperative TTP is reported to be cardiovascular surgery. Most cases of postoperative TTP progress rapidly ; the patient's prognosis is generally poor. We report a rare case of TTP that occurred following surgery for gastric cancer that progressed slowly.