2000 Associates' Presentations
| Intro | Prev | Next | Last |
Cocaine Induced Thrombotic Thrombocytopenic Purpura
Kannappan A, Solis J, and Gennis M, Sinai Samaritan Medical Center, Milwaukee, WI
Case 1: A 52 year old African American male presented with abdominal pain and passing dark urine five days after smoking crack cocaine. He had a temperature of 99 and significant conjuctival pallor. Initial labs revealed Hb of 5.8; Hct of 16; platelet count of 23,000; Creatinine 2.1; bilirubin 2.0 and LDH 3220. Peripheral smear showed numerous schistocytes and Coomb's test was negative. Urine analysis showed hemoglobinuria. A diagnosis of Thrombotic Thrombocytopenic Purpura was made and Pt was started on plasma exchange for 14 days until his platelet count and LDH normalized.
Case 2: A 41 year old African American female, a frequent cocaine user presented with abdominal pain, nausea, and vomiting. Her initial labs were a platelet count of 7,000; LDH of 2656; Hb of 12.1; hct of 35 which dropped to 24 the following day and bilirubin of 3.0. Peripheral smear showed numerous schistocytes and Coomb's test was negative. Her urine tox screen was positive for cocaine. Subsequently she was diagnosed with TTP and was started on plasmapharesis and after 8 days her platelet count was normal.
Discussion: Cocaine can affect multiple organ systems. It is a known cause of thrombocytopenia and acute renal failure. The association of cocaine with microangiopathic hemolytic anemia and TTP is rare with just two cases reported in liturature. The pathophysiology, molecular and immunological bases for this are poorly understood. Possible mechanisms include endothelial injury from vasoconstriction and enhanced antiplatelet activity. In conclusion our two cases should alert physicians that cocaine should be recognized as a possible cause of TTP.
| Intro | Prev | Next | Last |
What's New
Contact Information
Sharon Haase, MD, FACP
Chapter Governor
Kelly Lang
Chapter Support Staff
Ph: 414-755-6280
E-mail: lang@svinicki.com