eMedicine Specialties > Emergency Medicine > Hematology & Oncology

Thrombotic Thrombocytopenic Purpura: Follow-up

Author: Deborrah Symonette, MD, MPH, Healthcare Consultant, DSKSD, Inc
Coauthor(s): Deepak Sharma, Touro College of Osteopathic Medicine, New York; Priya S Abraham, Touro College of Osteopathic Medicine, New York; Vanessa Yoo, Touro College of Osteopathic Medicine, New York; Wafa Qamar, Touro College of Osteopathic Medicine, New York
Contributor Information and Disclosures

Updated: Sep 16, 2009

Follow-up

Further Inpatient Care

Emergency medicine is acute care management to stabilize the patient with thrombotic thrombocytopenic purpura (TTP) for continued care. Follow-up is referred to internal medicine.

Miscellaneous

Medicolegal Pitfalls

Thrombotic thrombocytopenic purpura (TTP) is a hematologic emergency. It is a multisystem disease that can cause rapid deterioration of the patient's neurologic, renal, and hematologic status. TTP is an uncommon disease with a high fatality rate if untreated or misdiagnosed. Rapid diagnosis and aggressive treatment by therapeutic plasma exchange are necessary to reduce the risk of a fatal outcome.

TTP is difficult to diagnose because the patient's presentation can be nonspecific and the characteristic pentad of symptoms may not occur together. Other disease entities can have some of the same symptoms.

To avoid the devastating pitfall of misdiagnosing a patient include TTP in the differential diagnosis of diseases in a patient with new-onset thrombocytopenia, schistocytosis, and marked elevation of LDH value. Treatment with platelet infusion can be fatal in patients with TTP but beneficial in DIC; therefore, including TTP in the differential diagnosis is critical.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Eric J Hoffman, DO, and of previous editor, Charles V Pollack, Jr, MD, to the development and writing of this article.



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Follow-up: Thrombotic Thrombocytopenic Purpura
Multimedia: Thrombotic Thrombocytopenic Purpura
References
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Further Reading

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Keywords

thrombocytopenic purpura, Moschcowitz disease, thrombotic thrombocytopenic purpura, TTP, multisystem disorder, plasma exchange, fresh-frozen plasma, FFP, microangiopathic hemolytic anemia, hemolytic uremic syndrome, HUS, familial thrombotic thrombocytopenic purpura, familial TTP, acquired idiopathic thrombotic thrombocytopenic purpura, acquired idiopathic TTP, von Willebrand factor multimers, vWF, vWF multimers, vWF-cleaving protease, anemia, petechiae, microscopic hematuria, disseminated microvascular thrombi, thrombocytopenia, renal dysfunction, Escherichia coli, E coli O157:H7, Shigalike toxin, microangiopathic hemolysis, platelet microthrombi, ultralarge von Willebrand factor multimers, ULVWF multimers, ADAMTS-13 gene mutations, ULVWF multimer–induced platelet thrombosis, ULVWF-cleaving protease, petechial hemorrhages, seizures, CNS bleeding, heart failure, arrhythmias, gross hematuria, purpuric spots, plasmapheresis, plasma transfusion, thrombotic microangiopathic

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Contributor Information and Disclosures

Author

Deborrah Symonette, MD, MPH, Healthcare Consultant, DSKSD, Inc
Deborrah Symonette, MD, MPH is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Deepak Sharma, Touro College of Osteopathic Medicine, New York
Disclosure: Nothing to disclose.

Priya S Abraham, Touro College of Osteopathic Medicine, New York
Priya S Abraham is a member of the following medical societies: Student Osteopathic Medical Association (SOMA)
Disclosure: Nothing to disclose.

Vanessa Yoo, Touro College of Osteopathic Medicine, New York
Disclosure: Nothing to disclose.

Wafa Qamar, Touro College of Osteopathic Medicine, New York
Wafa Qamar is a member of the following medical societies: Microscopy Society of America
Disclosure: Nothing to disclose.

Medical Editor

Miguel C Fernández, MD, FAAEM, FACEP, FACMT, FACCT, Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio
Miguel C Fernández, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jeffrey L Arnold, MD, FACEP, Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center
Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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