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Table of Contents

Overview
Patient Presents
History
Physical Examination
Laboratory Findings
Differential Diagnosis
Etiology
Pathophysiology
Hospital Progress Report
Types of TTP
Interfering Substances
Treatment and Management
Morbidity / Mortality
Quiz
References

Authors:

Ihab Abumuhor, BS, MT (ASCP)

Ellen Hope Kearns, MS, SH(ASCP)H

Division of Health Sciences, School of Health, California State University Dominguez Hills, Carson, CA
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Thrombotic Thrombocytopenic Purpura

Routine Laboratory Findings


Table 1: Summary of the most significant laboratory findings
Test Result Normal Range
Hemoglobin 9.9 12.3-15.3 g/dL
Hematocrit 0.29 0.359-0.446
Red blood cells 3.26 4.1-5.1x1012/L
Platelet 11 150-450x109/L
Lactate dehydrogenase (LDH) 713 38-62 U/L
Total bilirubin 2.6 0.1-1.2 mg/dl
Prothrombin time (PT) 15 12-14 sec
Activated partial thromboplastin time (APTT) 37 <35 sec

Table 2: Results of urinalysis
Dipstick Test Result
Color Yellow
Clarity Clear
Leukocyte Negative
Nitrite Negative
Urobilinogen 1
Protein 2+
Blood 3+
Glucose 1+
Specific gravity 1.01
Bilirubin Negative
WBC 1/HPF
RBC 18/HPF

The following additional tests should be ordered:

  • CT Scan to assess for intracranial bleeding
  • Reticulocyte count
  • Direct Coombs
  • Coagulation studies
  • Repeat complete blood count (CBC) and slide review

Consult a clinical hematologist.


Table 3: Follow-up laboratory findings
Test Result
Reticulocyte count Elevated
Direct Coombs (DAT) Negative
Fibrinogen Within normal limits
Fibrin degradation products (FDP) Within normal limits

CT Scan

The CT scan was reviewed and indicated the presence of a slight intracranial hemorrhage.

Slide Review

A slide review of the blood smear indicated the presence of spherocytes, fragmented red blood cells (schistocytes) and large platelets.

Previous: Physical Examination
Next: Differential Diagnosis

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Last Update: August 29 2006