hematology and oncology
Thrombotic Thrombocytopenic Purpura (TTP)
Diagnosis of TTP
Complete blood count (CBC) with platelets, peripheral blood smear, reticulocyte count, direct antiglobulin (Coombs) test, lactate dehydrogenase (LDH), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, haptoglobin, and serum bilirubin (direct and indirect) Urinalysis and renal function tests ADAMTS 13 activity and autoantibody levels Exclusion of other thrombocytopenic disorders Thrombotic thrombocytopenic purpura is suspected in patients with suggestive symptoms, thrombocytopenia, and anemia. If the disorder is suspected, urinalysis and renal function tests, CBC, peripheral blood smear, reticulocyte count, serum LDH, haptoglobin,ADAMTS13activity and autoantibody (inhibitor) assays, serum bilirubin (direct and indirect), and direct antiglobulin test are done. Early recognition is important in order to initiate treatment as quickly as possible. Therapy may need to be initiated in suspected cases before the confirmatoryADAMTS13testing is completed if other manifestations of thrombotic thrombocytopenic purpura (TTP, clinical symptoms, thrombocytopenia, elevated LDH, peripheral blood smear examination) are consistent with this diagnosis. The diagnosis of TTP is suggested by Thrombocytopenia and anemia Fragmented red blood cells on the blood smear indicative of microangiopathic hemolysis (schistocytes: helmet cells, triangular RBCs, distorted-appearing RBCs) Evidence of hemolysis (falling hemoglobin level, polychromasia, elevated reticulocyte count, elevated serum LDH and bilirubin, reduced haptoglobin) Negative direct antiglobulin test Normal coagulation profile , are unlikely to respond to such therapies, and should be assessed for other causes of anemia and thrombocytopenia, including Disseminated Intravascular Coagulation (DIC) , Otherwise unexplained thrombocytopenia and Microangiopathic Hemolytic Anemia are sufficient evidence for a presumptive diagnosis. 