Cases

Case: Abdominal pain, Malaise and bruise on the leg

Discussion

If TTP is suspected, laboratory testing should include lactate dehydrogenase (LDH), haptoglobin, and a smear for schistocytes to check for microangiopathic hemolytic anemia (MAHA). A test yo assess for ADAMTS-13 level may be considered. The next best step in treatment is to admit the patient to the intensive care unit (ICU) of the hospital with urgent hematology consult to begin plasmapheresis,TTP is a rare and serious condition of unknown etiology that is characterized by thrombocytopenia and MAHA. Clinical findings may include skin purpura as well as gastrointestinal and/or neurologic issues. The classic pentad can be remembered by the mnemonic PATCH: pyrexia, Azotemia. Thrombocytopenia, CNS findings, and Hemolysis; however, it is rare to find all 5 elements in a patient presenting with TTP. Stimulant drugs or certain medications may cause TTPP, as do infection, pregnancy, and cancer.

Treatment for TTP should begin with admission to the ICU of the hospital with urgent hematology consult for immediate initiation of Plasmapheresis. Complications that arise can be either hemorrhagic or thrombotic and may include myocardial infarction, cerebrovascular accident, organ ischemia, and central nervous system or gastrointestinal bleeding. Early treatment has been shown to decrease both morbidity and mortality from TTP.

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