ACUTE-PANCREATITIS AS A TRIGGERING FACTOR FOR THROMBOTIC THROMBOCYTOPENIC PURPURA

Thrombotic thrombocytopenic purpura (TTP) constitutes a poorly underst ood multisystemic disease of vascular origin that may involve any orga n by thrombotic occlusions of the small vessels. Treatment with plasma pheresis is the best therapeutic option at this present moment. Involv ement of the pancreas is a well established feature of this disease, w hich has generally been interpreted as a consequence of pancreatic vas cular compromise. However, there are a few cases in the literature in which the clinical signs of TTP developed well after the clinical and laboratory demonstration of acute pancreatitis (AP), Therefore, the po ssibility of pancreatic inflammation as a triggering factor of TTP may need to be considered. This cause-effect relationship between AP and TTP remains unclear. We report a patient with chronic pancreatitis pre senting with two episodes of TTP, triggered by acute relapses of pancr eatitis. TTP may, thus, constitute a hematological complication of AP, We discuss the pathophysiological aspects of this association, along with therapeutical options. (C) 1998 by Am. Cell. of Gastroenterology.