Eculizumab refractory thrombotic thrombocytopenic purpura secondary to post-endoscopic retrograde cholangiopancreatography pancreatitis in a patient

Figures & data

Fig. 1 (a, b) Arrow pointing toward common bile duct dilation.

Fig. 2 ERCP: failure to cannulate and explore CBD.

Fig. 3 Computed tomography abdomen pelvis: inflamed pancreas consistent with acute pancreatitis.

Table 1 Lab trends in days: platelets count, hemoglobin, and creatinine

Days	1	2	3	4	5	6	7	8	9
Platelets (K/UL)	239	226	213	216	28	29	31	28
Creatinine (mg/dL)	1.18	1.25	1.42	1.67	1.79	1.95	2.30	3.35	4.45
Hemoglobin (g/dL)	10.5	8.8	7.6	6.9	7.4	6.6	8.8	7.1

Table 2 Hemolytic anemia workup

Lab indices	Value
LDH	2,244 U/L
Direct bilirubin	14.1 mg/dL
Haptoglobin	<7 mg/dL
Reticulocyte count	153 K/UL
Reticulocyte percentage	8.1%
INR	1.2
PTT	28 sec
Fibrinogen	250 mg/dL
HIT panel	Negative
ADAMTS13	56%

HIT, heparin induced thromobocytopenia.

Algorithm 1.  Approach to Thrombotic Thrombocytopenic Purpura