{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T15:05:27Z","timestamp":1789743927591,"version":"4.0.1"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>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\u2009\u00d7\u200910\u2079\/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.<\/jats:p>","DOI":"10.3389\/fcvm.2026.1838488","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:17:20Z","timestamp":1789741040000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sepsis-associated thrombotic microangiopathy\u2013like syndrome following cardiac surgery: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Chujun","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan University of Science and Technology","place":["Wuhan, China"]},{"name":"School of Medicine, Department of Medicine, Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijing","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenlu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qimei","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1182\/blood-2017-04-636431","article-title":"Pathophysiology of thrombotic thrombocytopenic 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