TACROLIMUS-INDUCED THROMBOTIC THROMBOCYTOPENIA PURPURA 92 WEEKS AFTER BILATERAL LUNG TRANSPLANTATION WITH COURSE COMPLICATED BY ACUTE METABOLIC ALKALOSIS SECONDARY TO PLASMAPHERESIS

TOPIC: Transplantation TYPE: Medical Student/Resident Case Reports INTRODUCTION: While, we find ample evidence of transplant associated-TTP (TA-TTP) secondary to calcineurin inhibitors (CNIs) after renal and hematopoietic stem cell transplantation, TA-TTP in solid organ (SOT) due CNI use remains a rare entity [1]. A few cases thrombotic microangiopathy have been reported lung, heart recipients. Majority TTP post lung recognized as common side effect inhibitor (tacrolimus) therapy [2]. Here report case 60-year-old male who was found tacrolimus induced 92 weeks bilateral transplant. CASE PRESENTATION: presented our facility on with complaints lethargy, generalized swelling. Of note, the patient had modification his immunosuppressive significant pancytopenia mycophenolic acid valganciclovir which were discontinued past. Initial work up revealed anemia, thrombocytopenia, elevated creatinine, bilirubin, reticulocyte count & lactate dehydrogenase, transaminitis, low haptoglobin. Peripheral smear presence schistocytes helmet cells denoting hemolysis (image B). ADAMTS 13 assay resulted normal range (> 10%), > 0.7. Patient then diagnosed TTP. Tacrolimus started cyclosporine high dose glucocorticoid. He also received four sessions therapeutic plasma exchange. Shortly advent medical therapy, improvement stabilization hemolytic markers noted. After exchange, noted metabolic alkalosis resolved soon cessation DISCUSSION: more delayed presentation is observed recipients; median interval 37 change regimen warranted at first sign associated An alternative approach switching can be implemented when CNIs cannot or continuation warranted. Another treatment modality for exchange however since autoantibodies against ADAMTS13 are not present TA-TTP, there seems less literature guidelines systematic patients Patients receiving FFP replacement fluid during higher probability developing usually resolves [3]. CONCLUSIONS: Early recognition its vital importance improving prognosis survival, most important factor being CNIs, another and/or therapy. REFERENCE #1: Verbiest, A., Pirenne, J., Dierickx, D. (2014). De novo non-renal transplantation. Blood Reviews, 28(6), 269–279. doi: 10.1016/j.blre.2014.09.001. #2: Hachem, R. R., Yusen, D., Chakinala, M. M., Aloush, A. Patterson, G. Trulock, E. P. (2006). Thrombotic Microangiopathy Lung Transplantation. Transplantation, 81(1), 57–63. doi:10.1097/01.tp.0000188140.50673.63 #3: Marques, B., Huang, S. T. (2001). thrombocytopenic purpura commonly develop Journal Clinical Apheresis, 16(3), 120–124. doi:10.1002/jca.1022 DISCLOSURES: No relevant relationships by Adedamola Adeboye, source=Web Response Tarek Amoun, Thiri Anandarangam, Umair Khan, Joshua Lee, Audai Ma'ayah, Corinne Raczek, Fatima Warraich,