Presentation Of Thrombotic Thrombocytopenic Purpura Research Articles

Purtscher retinopathy as an initial presentation of thrombotic thrombocytopenic purpura

Purtscher retinopathy as an initial presentation of thrombotic thrombocytopenic purpura

Atypical presentations of thrombotic thrombocytopenic purpura: A review

Thrombotic thrombocytopenic purpura (TTP) is diagnosed by the presence of microangiopathic hemolytic anemia and thrombocytopenia in a patient who frequently presents with central nervous system involvement and, to a lesser extent, renal dysfunction. Recent understanding of the pathophysiology of TTP due to severe deficiency of von Willebrand factor cleaving protease, known as ADAMTS13, has improved diagnosis of TTP. Once the diagnosis is suspected, life-saving therapeutic plasma exchange therapy is initiated. Occasionally, an unusual clinical presentation makes TTP diagnosis difficult, thus resulting in a delay in the management of TTP. This review highlights a variety of atypical TTP presentations described in the literature. It is intended to bring unusual scenarios to the clinician's awareness, so that timely treatment can be delivered.

Clopidogrel-associated thrombotic thrombocytopenic purpura presenting with coronary artery thrombosis

Clopidogrel-associated thrombotic thrombocytopenic purpura presenting with coronary artery thrombosis

Outcome of severe adult thrombotic microangiopathies in the intensive care unit

Thrombotic microangiopathies, namely thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, are uncommon microvascular occlusive diseases. Despite the dramatic improvement in the outcome by exogenous plasma supply, either through plasma infusion or through plasma exchange, patients frequently require support in the intensive care unit. In the present study, we evaluated the outcome of a large cohort of patients with severe thrombotic microangiopathies. A retrospective multicenter study from January 1998 to June 2001. Fourteen French university hospital medical intensive care units. Sixty three adult patients with severe thrombotic microangiopathies. Of the 63 patients, 19 had a clinical presentation of thrombotic thrombocytopenic purpura, 18 had hemolytic uremic syndrome and 26 had combined neurologic and renal failures. Infections were the main etiology associated with thrombotic microangiopathies. The mortality rate was 35%. Of the survivors, all achieved complete remission. Whereas neurologic failure assessed through the Glasgow coma scale was an independent predictor of mortality [HR=0.845 (CI 95%: 0.759-0.940), P=0.002], renal impairment did not appear to be an adverse prognostic factor. The use of plasma exchange was independently associated with survival [HR=0.269 (CI 95%: 0.104-0.691), P=0.006]. Thrombotic microangiopathies with severe organ dysfunctions leading to hospitalization in the intensive care unit are associated with high mortality. Neurologic impairment appears to be the main adverse prognostic factor correlated to mortality, and the study confirms the importance of plasma exchange in the treatment of high-risk patients.

Various Clinical Manifestations in Patients with Thrombotic Microangiopathy

BackgroundThrombotic microangiopathy (TM) is characterized by thrombocytopenia and microangiopathic hemolytic anemia in association with diffuse microthrombi in the arteriolar capillaries of various organs. Its clinical manifestation is protean, and a...

Case report of a normal hemoglobin at presentation of thrombotic thrombocytopenic purpura

Case report of a normal hemoglobin at presentation of thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura presenting as bilateral flank pain and hematuria: a case report

Thrombotic thrombocytopenic purpura (TTP) is a rare disease whose incidence is now increasing. We present a case of a 37-year-old man who presented with bilateral flank pain and hematuria, subsequently diagnosed with TTP. Thrombotic thrombocytopenic purpura has classically been characterized by the pentad of fever, microangiopathic hemolytic anemia, neurologic symptoms, renal dysfunction, and thrombocytopenia. The pathogenesis of the disease has been a mystery until recently. We review the current literature regarding the pathophysiology and management of this disorder. Our discussion focuses on the importance of understanding this disease while considering the differential diagnosis of a patient presenting with anemia and thrombocytopenia because the common pitfall of rapidly administering platelets to a patient with TTP may lead to a disastrous outcome.

Serous retinal detachment as an early presentation of thrombotic thrombocytopenic purpura

A 23-year-old woman presented with abdominal pain and blurred vision in both eyes. Fundoscopy revealed large bullous detachments of her neurosensory retina with shifting subretinal fluids bilaterally. Laboratory studies showed a hemoglobin of 6.5 mmol/l, thrombocytes 20×10 9/l, and LDH 1098 U/l. A peripheral blood smear revealed red blood cell fragmentation. A diagnosis of thrombotic thrombocytopenic purpura was made. The patient was treated with four sessions of plasmapheresis followed by plasma infusions, which resulted in a complete recovery.

Acute thrombotic thrombocytopenic purpura presenting as expressive aphasia

Thrombotic thrombocytopenic purpura (TTP) is an uncommon and potentially fatal disease that is characterized by endothelial cell abnormalities, platelet dysfunction, microangiopathic hemolysis, fever, neurological abnormalities, and renal involvement. Before the introduction of plasmapharesis in the 1970s, TTP was fatal. This case report is presented to illustrate how subtly TTP can present, to discuss the updated criteria for TTP diagnosis, and to emphasize that with effective treatment now available, accurate and early diagnosis is essential to decrease morbidity and mortality.

Thrombotic Thrombocytopenic Purpura Presenting as a Sudden Headache With Focal Neurologic Findings

We report a case of thrombotic thrombocytopenic purpura presenting as a sudden headache with associated neurologic deficits. The diagnosis of this rare disorder is discussed, with special attention given to a potential pitfall in evaluation and treatment—platelet transfusion. [Bridgman J, Witting M: Thrombotic thrombocytopenic purpura presenting as a sudden headache with focal neurologic findings. Ann Emerg Med January 1996;27:95-97.]

THROMBOTIC THROMBOCYTOPENIC PURPURA PRESENTING WITH GYNAECOLOGICAL MANIFESTATIONS

THROMBOTIC THROMBOCYTOPENIC PURPURA PRESENTING WITH GYNAECOLOGICAL MANIFESTATIONS

Thrombotic thrombocytopenic purpura presenting as eclampsia.

Summary: A 29‐year‐old woman presented with mild thrombocytopenia in early pregnancy. In the third trimester she developed symptoms of eclampsia with severe focal neurological signs, renal failure and intravascular coagulation. Some benefit was obtained from anticoagulant therapy, which consisted of heparin in the acute phases of her illness and oral anticoagulants during several months' management as an outpatient. The disease process is discussed in relation to the clinical course, haematological abnormalities, and autopsy findings.