[Anesthetic management of thrombotic thrombocytopenic purpura]

A 46-year-old man, with TTP and renal failure, received splenectomy because complete remission was not achieved after the treatments such as plasma exchange, antiplatelet agents and corticosteroid. After the administration of methylprednisolone, anesthesia was induced with thiamylal and succinylcholine chloride and maintained with nitrous oxide, enflurane, fentanyl and vecuronium. Total blood loss was 1710 gram. Four units of packed red cell and 9 units of fresh frozen plasma were infused. The anesthetic course was uneventful. TTP is a rare and usually fatal disease and its etiology is unknown. Careless infusion of platelet or fresh blood may accelerate the disease process and multiorgan dysfunction may present other anesthetic problems. In this report, problems of anesthetic management for TTP were discussed.