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Thrombotic Thrombocytopenic Purpura, Emergency Medicine

Hany Y. Atallah Reviewed 06/2017
 


Basics

Description

  • Thrombotic thrombocytopenic purpura (TTP) is a severe disorder of abnormal clotting affecting multiple organ systems.

  • Classically characterized by pentad of:

    • Thrombocytopenia

    • Hemolytic ...

Diagnosis

Signs and Symptoms

5 major clinical features: Classic pentad 
  • Thrombocytopenia:

    • Platelet count <20,000/mm3

  • Microangiopathic and hemolytic anemia:

    • Hb <10 g/dL (<6 g/dL in 40%)

  • Neurologic s...

Treatment

Pre-Hospital

  • ABCs

  • Evaluate for other possible causes of altered mental status (hypoglycemia, overdose)

Initial Stabilization/Therapy

  • ABCs

  • 0.9% normal saline (NS) IV fluid resuscitation for shock ...

Follow-Up

Disposition

Admission Criteria

  • Newly diagnosed serious platelet disorder, especially with bleeding complications or altered mental status or renal dysfunction

  • ICU admission for TTP with active ...

Pearls and Pitfalls

  • TTP can be confused with HELLP syndrome in pregnant females.

  • Because of the high mortality of untreated TTP, recognition of the disease and initiation of treatment is key.

Additional Reading

  • George  JN. Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med.  2006;354:1927–1935.

  • George  JN. How I treat patients with thrombotic thrombocytopenic purpura:...

Codes

ICD9

446.6 Thrombotic microangiopathy 

ICD10

M31.1 Thrombotic microangiopathy 

SNOMED

  • 78129009 Thrombotic thrombocytopenic purpura (disorder)

  • 439007008 Acquired thrombotic thrombocytopenic purpura

  • 4413...

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