Background
Small vessel thrombosis ⇒ thrombocytopenia (like HUS... but):
- Haemolytic anemia (±dark urine)
- Thrombocytopenic purpura
- Neurologic abnormalities (more than in HUS)
- Fever (seen in 50%)
- Renal disease (less than in HUS)
Clinical
- Recent triggering infection (e.g. diarrhoea) or cancer or antiplatelet drugs
- Neurological dysfunction ± petechiae
Differential Dx
- Sepsis (DIC)
- Malignant hypertension
- ITP
Investigations
- Septic screen (& simultaneous resusc.)
- FBC (and smear in lab), INR
- U&E, LFT (LDH)
| Parameter | ITP | TTP | DIC |
|---|---|---|---|
| Aetiology | Antiplatelet antibodies | Endothelial defect | Thrombin excess |
| Clinical | Not sick | Sick | Sick |
| Red cells | NL | Schistocytes | Schistocytes ± |
| PT (INR) | NL | NL/↑ | ↑↑ |
| APTT | NL | NL/↑ | ↑↑ |
| Fibrinogen | NL | NL | ↓↓ |
| FDP / D-dimers | NL | ↑ | ↑↑ |
| Therapy | Steroids, IVIG, Splenectomy; | Plasma exchange | Treat cause, Plasma/platelets |
Management
- If any doubt, treat as septic (early fluid resusciattion, antibiotics, ±inotropes)
- Involve ITU and haematology early
- Octaplas in preference to FFP
- Plasma exchange (haematologist)