UMEM Educational Pearls

Category: Hematology/Oncology

Title: Thrombotic thrombocytopenia Purpura

Keywords: Thrombotic thrombocytopenia Purpura, TTP (PubMed Search)

Posted: 12/6/2008 by Michael Bond, MD (Updated: 9/21/2020)
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Just a quick remainder that Thrombotic thrombocytopenia Purpura, TTP, is typically described as a pentad of symptoms:

  1. Neurological symptoms such as altered mental status, stroke, or headache
  2. Renal failure
  3. Fever
  4. Thrombocytopenia (low platelets) associated with purpura
  5. Microangiopathic hemolytic anemia

Not all symptoms need to be present and it would be rare for you to see the full pentad.  Consider the diagnosis and request that the lab due a manual differentiation or blood smear.  It is there that they will notice schistocytes, fragmented RBCs, that will help clinch the diagnosis.

Most cases of TTP are idiopathic (~60%) but secondary TTP is known to occur with cancer, pregnancy, HIV, bone marrow transplantation, immunospressive drugs like cyclosporin and tacrolimus, and platelet aggregation inhibitors such as cloperidol.

Treatment consists of plasmapheresis, plasma exchange, immunospression with steroids, Rituximab, and other chemotherapies.