Myocardial Infarction in the Setting of Unsuspected Thrombocytopenia

Case Report

Austin J Clin Case Rep. 2017; 4(3): 1122.

Myocardial Infarction in the Setting of Unsuspected Thrombocytopenia

Ziffra J*, Samaddar S, Murray A and Tran P

Department of Cardiology, Mercy Medical Center – North Iowa, USA

*Corresponding author: Jeffrey Ziffra, Department of Cardiology, Mercy Medical Center – North Iowa, 1000 4th St. SW, Mason City, IA 50401, USA

Received: April 09, 2017; Accepted: July 20, 2017; Published: July 24, 2017


Immune Thrombocytopenic Purpura is a rare disorder characterized by autoimmune destruction of platelets. Thrombus formation in coronary arteries with underlying atherosclerosis is at the hallmark of acute coronary syndrome. Immune Thrombocytopenic Purpura has rarely been implicated in cases of acute coronary syndrome which presents a treatment challenge laden with increased risks of both bleeding and thrombosis. We describe a case of a 42-year-old female with chronic Immune Thrombocytopenic Purpura who presented with a ST-Elevation myocardial infarction. After review of the literature, dual antiplatelet therapy has been implemented successfully with preferential angiogram by radial artery access and use of a bare-metal stent.

Keywords: Myocardial infarction; Immune thrombocytopenic purpura; Acute coronary syndrome


Formation of an unstable thrombus in conjunction with atherosclerosis often precipitates acute coronary syndrome. Disorders including autoimmune thrombocytopenia are rare but have been reported to be associated with acute coronary syndrome. Given the need for antiplatelet therapy, this becomes a challenging medical conundrum. We describe a case of a 42-year-old female with a history of Immune ThrombocyticPurpura (ITP) who presents with an Inferior wall ST-Elevation Myocardial Infarction (STEMI). It is important for clinicians to recognize this challenging scenario to treat.

Case Presentation

We present the case of a 42-year-old female with a history of ITP status post splenectomy, history of preeclampsia with concern for HELLP syndrome, who presented to our facility with STEMI. The patient was transferred from an outside facility with STelevations in the inferior leads, minor ST-Elevations in the anterior leads on EKG (Figure 1). She was emergently taken to the cardiac catheterization lab with a very limited history and no laboratory data. In the cardiac catheterization lab she was found to have a 70% distal left anterior descending (LAD) artery stenosis and a right focal coronary artery (RCA) spasm (Figure 2,3). She received a successful percutaneous coronary intervention (PCI) of her LAD lesion with a 2.5 x 18 mm Bare Metal Stent. She also received intracoronary nitroglycerin, which resolved her focal RCA spasm. During the intervention, her labs returned for which she was found to be anemic and severely thrombocytopenic which was new compared to our last complete blood count. She was also found to have elevated lactate dehydrogenase and ferritin levels. A peripheral blood smear was performed which revealed spherocytes, shistocytes, polychromasia, basophilic stippling, Howell-jolly bodies, pappenheimer bodies and dimorphic population. After angiogram, she was transferred to a higher-level care facility for management of suspected Thrombotic ThrombocyticPurpura (TTP). Hematology was consulted for her thrombocytopenia and to rule out Disseminated Intravascular Coagulopathy, TTP, Hemolytic anemia or ITP.