Thrombotic thrombocytopenic purpura following one anastomosis gastric bypass surgery: a rare case report.

INTRODUCTION AND

IMPORTANCE

One-anastomosis gastric bypass (OAGB) is a common bariatric intervention with recognized safety but rare hematologic complications. Thrombotic thrombocytopenic purpura (TTP) has not been reported following OAGB.

CASE PRESENTATION: A 20-year-old female with morbid obesity (BMI 49.5 kg/m2) underwent OAGB with no complications initially. On postoperative day 11, she presented with abdominal pain, convulsion, anemia, and severe thrombocytopenia. The patient underwent an exploratory laparoscopy that ruled out intra-abdominal pathology. Peripheral blood smear revealed schistocytes in favor of TTP. Then, the patient was transferred to a tertiary care center. Plasma exchange and corticosteroid therapy were initiated promptly, which led to rapid clinical improvement with an increase in platelet count from 30 × 103 to 271 × 103 after seven plasma exchange sessions, and Hb improved from 6.4 to 9.5 g/dL at discharge. She had a stable condition at discharge and appropriate weight loss in her follow-up.

CLINICAL DISCUSSION: TTP is recognized as an emergency medical condition that can mimic surgical postoperative complications. Unlike previous reports of TTP following sleeve gastrectomy or cardiac surgery, this case occurred after OAGB, which is a procedure not previously associated with this complication. In this case, early gastrointestinal symptoms initially suggested surgical causes, but the acute decrease in platelet count and microangiopathic hemolysis were two diagnostic indicators. Plasma exchange therapy remains the cornerstone in treatment and significantly increases survival rates when started early.

CONCLUSIONS

Although clinically rare, TTP should be considered in post-OAGB patients presenting with unexplained cytopenia and neurological symptoms. Early diagnosis and prompt initiation of plasma exchange are critical for lifesaving outcomes.