TTP Case 2

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Let’s start with the following lab data.

What can you say about this patient (more than one answer may apply)?

a
Likely has aHUS
b
Likely has TTP
c
By definition has TTP
d
Has congenital, not acquired TTP
e
Has HELLP

What do you predict her CBC and reticulocyte count to show (more than one answer may apply):

a
Anemia
b
Thrombocytopenia
c
Leukopenia
d
Low reticulocyte count
e
Elevated reticulocyte count

What do you predict her other labs to show:

a
Elevated haptoglobin
b
Elevated LDH
c
Positive Coombs test
d
Elevated creatinine
e
Elevated AST: ALT ratio

Are these data consistent with hemolysis?

a
Yes
b
No

This patient most likely presented to:

a
PCP
b
Physical therapist
c
Urgent care
d
Psychiatrist

The patient most likely presented with:

a
Bleeding
b
Large vessel thrombosis

Let’s meet the patient: 

32-year-old female, previously well, presents to the ED after labs at urgent care showed platelet count of 7kShe reports having right frontal/periorbital headaches last week which were somewhat different than her intermittent chronic headaches. She went to Milton ED on 4/19 and was discharged after evaluation. Did not have blood work there. Then on Friday 4/21 she noted a dotted rash on her elbows and thighs for which she went to urgent care. She had blood work there which showed Hb ~10 and platelets 7. She was asked to come to the ED... Currently she denies having headaches, bleeding issues, fevers, chills. No confusion, weakness, numbness noted. She is urinating well and denies dysuria. She also denies having bloody diarrhea.

The smear showed findings similar to the following:

The ADAMTS13 result shown on the first slide was not available for several days. In the meantime, we have to rely on clinical prediction rules to determine the pretest probability of having ADAMT13 activity level < 10%. The most popular of these is called the PLASMIC score. There are seven parameters in the PLASMIC score. Which of the following is/are included?

a
MCV
b
INR
c
aPTT
d
Troponin
e
Creatinine

This patient was previously well – no history of cancer or transplantation. If you plug in her data, you end up with a PLASMIC score of 7 (this is the maximum you can have), which is high probability of having TTP.

True or false: the use of TPE in TTP has never been studied in a randomized controlled trial.

a
True
b
False
vs. plasma infusion

TheBloodProject-logo-initials

How do steroids work in TTP?

Click for Answer

Suppress production of ADAMTS13 antibodies

True or false: this patient is not a candidate for caplacizumab.

a
True
b
False
Recommended in this setting by clinical practice guidelines

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