Thrombotic Thrombocytopenic Purpura-Induced Cardiomyopathy and Troponin Clearance with Plasmapheresis: True or False Reassurance?

Thrombotic thrombocytopenic purpura (TTP) is a rare microangiopathic hemolytic anemia caused by a deficiency in the von Willebrand factor-cleaving protease ADAMTS13, resulting in the formation of microthrombi. TTP is associated with severe cardiovascular complications, such as myocardial infarction, congestive heart failure, arrhythmias, and cardiogenic shock, which can lead to a poor prognosis. Although plasmapheresis is the cornerstone of TTP treatment, it complicates the interpretation of cardiac biomarkers due to the rapid clearance of these markers from the bloodstream. We present the case of a 19-year-old African American female diagnosed with TTP who had critically elevated levels of high-sensitivity troponin (HS troponin). Notably, her HS troponin levels declined rapidly with ongoing plasmapheresis, underscoring the difficulties in interpreting cardiac biomarkers in TTP and the effects of treatment on these values. This case highlights the challenges in diagnosing and managing cardiovascular complications associated with TTP and their impact on patient prognosis.