naa a22 4500 510813755 CHVBK 20180411083455.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12328-013-0419-5 doi (NATIONALLICENCE)springer-10.1007/s12328-013-0419-5 Laparoscopic splenectomy for the treatment of refractory thrombotic thrombocytopenic purpura [Elektronische Daten] [Akira Umemura, Akira Sasaki, Hiroyuki Nitta, Toru Obuchi, Shigeaki Baba, Go Wakabayashi] Thrombotic thrombocytopenic purpura (TTP) is a serious hematologic disorder with a high rate of morbidity and mortality. We report here on the surgical and homological outcomes of laparoscopic splenectomy (LS) in a patient with refractory TTP. A 69-year-old Japanese woman was referred to our hospital because of purpura in the lower extremities. In addition to the marked thrombocytopenia, hemolytic anemia and progressive mental disorder were noted. The ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif 13) activity was undetectable and ADAMTS13 inhibitor was extremely increased. The diagnosis of TTP was made based on the clinical features and laboratory abnormalities. She received steroid-pulse therapy for 3days, low-dose methylprednisolone continuous infusion and plasma exchange (PE) daily for 14days. However, the patient was found to be refractory TTP to PE. The LS was performed at 15days after diagnosis. The ADAMTS13 inhibitor was not detected after LS, and in addition, the platelet count had increased to over 100,000/mm3 on postoperative day 17. The patient remains in remission 24months after surgery. The results of our case demonstrate that LS is a safe and reasonable treatment option for patients with TTP refractory to PE. Springer Japan, 2013 Thrombotic thrombocytopenic purpura nationallicence Plasma exchange nationallicence Laparoscopic splenectomy nationallicence A disintegrin and metalloprotease with thrombospondin type 1 motif 13 nationallicence Umemura Akira Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut Sasaki Akira Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut Nitta Hiroyuki Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut Obuchi Toru Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut Baba Shigeaki Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut Wakabayashi Go Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut Clinical Journal of Gastroenterology Springer Japan 6/6(2013-12-01), 420-423 1865-7257 6:6<420 2013 6 12328 https://doi.org/10.1007/s12328-013-0419-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12328-013-0419-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Umemura Akira Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut NATIONALLICENCE 700 1- Sasaki Akira Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut NATIONALLICENCE 700 1- Nitta Hiroyuki Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut NATIONALLICENCE 700 1- Obuchi Toru Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut NATIONALLICENCE 700 1- Baba Shigeaki Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut NATIONALLICENCE 700 1- Wakabayashi Go Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan aut NATIONALLICENCE 773 0- Clinical Journal of Gastroenterology Springer Japan 6/6(2013-12-01), 420-423 1865-7257 6:6<420 2013 6 12328 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer