Thrombotic thrombocytopenic purpura following plastic surgery: A case report

Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, and potential multi-organ involvement. Typically, TTP is associated with underlying conditions such as autoimmune diseases, infections, cancer, or hereditary factors. To date, very few cases of post-operative TTP have been reported. We report the first known case of TTP following plastic surgery. A 19-year-old female initially recovered uneventfully after breast reduction surgery but presented on postoperative day 7 with a persistent hematoma, worsening anemia, and thrombocytopenia. The diagnosis of TTP was confirmed following hematoma evacuation, with laboratory results showing severe hemolysis and a marked reduction in ADAMTS13 activity. The patient was promptly treated with plasma exchange, corticosteroids, and rituximab, which led to significant clinical improvement and resolution of hematological abnormalities. This case underscores the rarity of TTP following plastic surgery, where it is more often linked to other medical conditions. Early recognition and management of TTP, particularly with plasma exchange, are crucial to preventing complications and improving patient outcomes. Although endothelial damage during surgery may contribute to the onset of TTP, the causal link in this case remains uncertain. Awareness of TTP as a potential postoperative complication is essential, especially when dealing with persistent anemia, bleeding, or thrombocytopenia.