ArticleFrontiers in cardiovascular medicine2026
Sepsis-associated thrombotic microangiopathy-like syndrome following cardiac surgery: a case report.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Severe sepsis following cardiac surgery may be accompanied by a thrombotic microangiopathy (TMA)-like syndrome distinct from classic immune-mediated thrombotic thrombocytopenic purpura (TTP) and overt disseminated intravascular coagulation (DIC). We report a 62-year-old man who developed sepsis after mitral valve replacement, complicated by thrombocytopenia (nadir 45 × 10⁹/L), microangiopathic hemolysis (2.6% schistocytes), and multiple organ dysfunction. Laboratory findings revealed marked dysregulation of the von Willebrand factor (vWF)/ADAMTS13 axis, with markedly elevated vWF antigen levels (548%), moderately reduced ADAMTS13 activity (32.8%), and negative ADAMTS13 inhibitors. Despite meeting criteria for sepsis-induced coagulopathy (SIC), the patient did not fulfill diagnostic criteria for overt DIC, as fibrinogen levels remained elevated and D-dimer elevation was limited. The patient improved with comprehensive sepsis management and supportive care, including adjunctive plasma infusion. Marked vWF/ADAMTS13 imbalance with preserved fibrinogen and limited D-dimer elevation may help distinguish sepsis-associated TMA-like syndrome from overt DIC.
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