deamino-arginine-vasopressin and Purpura--Thrombotic-Thrombocytopenic

Topics: Blood Platelet Disorders; Blood Transfusion; Deamino Arginine Vasopressin; Hemorrhage; Hepatitis, Viral, Human; Humans; Infant, Newborn; Plasma Exchange; Platelet Transfusion; Purpura; Purpura, Thrombocytopenic; Purpura, Thrombotic Thrombocytopenic; Thrombocytopenia; Transfusion Reaction; von Willebrand Diseases

Here we report of a patient who developed a Moschcowitz-like syndrome following a desmopressin treatment of severe postpartum hemorrhage. The patient got an anaphylactic reaction after cervical ripening with dinoproston, leading to an emergency cesarean. A postpartum uterine atony with a blood loss more than 1500 ml resulted in a disseminated intravascular coagulation that was treated with mass transfusion of blood products, including platelets and factor VII. Desmopressin is used as rescue medication in situations of severe bleeding. It was given in this life-threatening situation and presumably triggered a Moschcowitz-like syndrome. Desmopressin exerts its haemostatic effect by releasing von Willebrand factor, which is elevated in pregnancy per se. This results in an increased risk of developing microthrombi, leading to a Moschcowitz-like syndrome. In conclusion, desmopressin should not be administered in pregnant patients owing to its potential risk of triggering the development of thrombotic-thrombocytopenic purpura.

Topics: Adult; Blood Transfusion; Cesarean Section; Deamino Arginine Vasopressin; Dinoprostone; Disseminated Intravascular Coagulation; Female; Hemostatics; Humans; Oxytocics; Postpartum Hemorrhage; Pregnancy; Purpura, Thrombotic Thrombocytopenic; Uterine Inertia; von Willebrand Factor

Topics: ADAM Proteins; ADAMTS13 Protein; Administration, Intranasal; Child; Deamino Arginine Vasopressin; Enuresis; Female; Hemostatics; Humans; Purpura, Thrombotic Thrombocytopenic; Recurrence; Syndrome; Thrombosis

Thrombotic thrombocytopenic purpura (TTP) is a rare and often fatal disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, mental status changes, and renal dysfunction. Central diabetes insipidus (CDI) is a rare disease due to anatomic lesions of the hypothalamicpituitary system associated with various underlying diseases, or trauma. We present an unusual case of TTP and CDI in a 47 year-old African American female who was admitted to our hospital with crampy abdominal pain and nausea. The patient had tachycardia, fever and hypotension. The patient subsequently became confused, developed seizures, and her renal function deteriorated. Bone marrow analysis showed adequate megakaryocytes while a peripheral smear revealed severe thrombocytopenia, polychromasia and schistocytes. The diagnosis of thrombotic thrombocytopenic purpura (TTP) was made and plasmapharesis initiated. Over the next few days, the patient developed severe polyuria with a rise in serum sodium. Central diabetes insipidus was diagnosed and DDAVP (desmopressin acetate, 1-deamino-8-D-arginine vasopressin) was given. However, DDAVP was stopped several times due to worsening thrombocytopenia. Renal function worsened and the patient expired. A review of the literature revealed only one case of report of TTP and central diabetes insipidus. Our case was the only one reporting the use of DDAVP in such a setting.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Fatal Outcome; Female; Humans; Hypoglycemic Agents; Middle Aged; Plasmapheresis; Purpura, Thrombotic Thrombocytopenic; Respiration, Artificial

Topics: Adult; Contraindications; Deamino Arginine Vasopressin; Female; Humans; Platelet Transfusion; Purpura, Thrombotic Thrombocytopenic; Recurrence; Treatment Failure