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Thrombotic Thrombocytopenic Purpura (TTP) – Physical Exam
Physical examination in a patient with thrombocytopenic purpura (TTP).
Most findings are associated with end-organ involvement from microvascular occlusion. The nervous system is the most commonly affected visceral organ at presentation, occurring in 40% to 60% of cases. Neurological manifestations include headache, cognitive changes, focal deficit, syncope, seizure, visual disturbance, stroke and coma. Most patients have normal imaging findings. Ophthalmologic signs of TTP include retinal hemorrhage, serous retinal detachment, or arterial/venous occlusion. While gastrointestinal symptoms are common in TTP (35%-40%), including include nausea, vomiting, abdominal pain, or diarrhea, physical findings referable to the abdomen are rare. Renal dysfunction is not as marked as in hemolytic uremic syndrome, with median creatinine at presentation of 0.9 to 1.4 mg/dL, and 4-15% of patients requiring dialysis. Fever (one constituent of the classic pentad in TTP, the other 4 criteria being macroangiopathic hemolytic anemia, thrombocytopenia, neurological manifestations and renal dysfunction) is present in only 20% of patients. TTP may also be associated with mucocutaneus bleeding owing to thrombocytopenia (median platelet count at presentation 10-17 x 10
/L). Examples include epistaxis, bruising, petechiae, gingival bleeding, hematuria, menorrhagia, gastrointestinal bleeding, retinal hemorrhage and hemoptysis. Percentages in brackets represent % of patients presenting with physical finding.
Source: Hematology Am Soc Hematol Educ Program. 2018 Nov 30;2018(1):530-538