Thrombotic thrombocytopenic purpura differential diagnosis: Difference between revisions
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[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Thrombotic_thrombocytopenic_purpura]] | |||
{{CMG}} {{AE}} {{S.G.}} | {{CMG}} {{AE}} {{S.G.}} | ||
==Overview== | ==Overview== | ||
The main differential diagnosis of TTP is [[hemolytic-uremic syndrome]]. TTP should be diffrential from the other | The main differential [[diagnosis]] of TTP is [[hemolytic-uremic syndrome]]. TTP should be diffrential from the other [[Disease|disaeses]] such as [[TMA]] [[Syndrome|syndromes]], disseminated [[intravascular]] [[coagulation]] [[Hypertension|,hypertension]], [[Idiopathic thrombocytopenic purpura|immune thrombocytopenic purpura]] ([[Idiopathic thrombocytopenic purpura|ITP]]) | ||
* [[Malignant hypertension]] | * [[Malignant hypertension]] | ||
* [[Hematological]] [[abnormalities]] | * [[Hematological]] [[abnormalities]] | ||
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== Differential Diagnosis == | == Differential Diagnosis == | ||
The main differential diagnosis of TTP is [[hemolytic-uremic syndrome]] ([[Hemolytic-uremic syndrome|HUS]], which has neurosymptoms, [[renal failure]], [[hypertension]] and [[fever]]). Note that [[ADAMTS13]] [[Activity (chemistry)|activity]] is [[normal]] in [[Hemolytic-uremic syndrome|HUS]].<ref name="JolyCoppo2017">{{cite journal|last1=Joly|first1=Bérangère S.|last2=Coppo|first2=Paul|last3=Veyradier|first3=Agnès|title=Thrombotic thrombocytopenic purpura|journal=Blood|volume=129|issue=21|year=2017|pages=2836–2846|issn=0006-4971|doi=10.1182/blood-2016-10-709857}}</ref> | The main differential [[diagnosis]] of TTP is [[hemolytic-uremic syndrome]] ([[Hemolytic-uremic syndrome|HUS]], which has neurosymptoms, [[renal failure]], [[hypertension]] and [[fever]]). Note that [[ADAMTS13]] [[Activity (chemistry)|activity]] is [[normal]] in [[Hemolytic-uremic syndrome|HUS]].<ref name="JolyCoppo2017">{{cite journal|last1=Joly|first1=Bérangère S.|last2=Coppo|first2=Paul|last3=Veyradier|first3=Agnès|title=Thrombotic thrombocytopenic purpura|journal=Blood|volume=129|issue=21|year=2017|pages=2836–2846|issn=0006-4971|doi=10.1182/blood-2016-10-709857}}</ref> | ||
TTP must be differentiated from | TTP must be differentiated from | ||
* [[TMA]] [[Syndrome|syndromes]] | * [[TMA]] [[Syndrome|syndromes]] | ||
* Disseminated intravascular coagulation | * Disseminated [[intravascular]] [[coagulation]] | ||
* Hypertension | * [[Hypertension]] | ||
* Immune | * [[Idiopathic thrombocytopenic purpura|Immune hrombocytopenic purpura]] ([[Idiopathic thrombocytopenic purpura|ITP]]) | ||
* Malignant | * [[Malignant hypertension]] | ||
* Hematological abnormalities | * [[Hematological]] [[abnormalities]] | ||
* Ischemic manifestations linked to autoimmune diseases | * [[Ischemic]] manifestations linked to [[Autoimmune disease|autoimmune diseases]] | ||
===Differentiating TTP from other diseases on the basis of | ===Differentiating TTP from other diseases on the basis of Symptoms:=== | ||
On the basis | *On the basis [[thrombocytopenia]], MAHA, fluctuating [[neurological]] [[Medical sign|signs]], [[renal]] faluer and [[fever]], TTP must be differentiated from<ref name="KarpmanLoos2017">{{cite journal|last1=Karpman|first1=Diana|last2=Loos|first2=Sebastian|last3=Tati|first3=Ramesh|last4=Arvidsson|first4=Ida|title=Haemolytic uraemic syndrome|journal=Journal of Internal Medicine|volume=281|issue=2|year=2017|pages=123–148|issn=09546820|doi=10.1111/joim.12546}}</ref> | ||
* Autoimmune haemolysis | **[[Autoimmune]] [[Hemolysis|haemolysis]] | ||
* Evans syndrome | **[[Evans syndrome]] disseminated [[intravascular]] [[coagulation]] [[pregnancy]]-associated such as: | ||
* | ***[[HELLP syndrome|HELLP]] ([[Hemolysis|haemolysis]] | ||
* Drugs: | ***Elevated [[liver]] [[enzymes]] and low [[platelets]]) | ||
* Malignant hypertension | ***[[eclampsia]] | ||
* Infections (typically viral (cytomegalovirus, adenovirus, herpes simplex virus) | **[[Hemolytic-uremic syndrome|Haemolytic uraemic syndrome]] | ||
* Severe bacterial (meningococcus, pneumococcus) | **[[Drugs]]: | ||
* Fungal | ***[[Quinine]] | ||
* Vasculitis | ***[[simvastatin]] | ||
* Malignancy | ***[[interferon]] | ||
***[[Calcineurin]] [[Inhibitor|inhibitors]] | |||
**[[Malignant]] [[hypertension]] | |||
**[[Infection|Infections]] (typically [[viral]] ([[cytomegalovirus]], [[adenovirus]], [[herpes simplex]] [[Virus (biology)|virus]]) | |||
**Severe [[bacterial]] ([[meningococcus]], [[pneumococcus]]) | |||
**[[Fungal]] [[autoimmune]] [[disease]] ([[lupus nephritis]], [[Acute (medicine)|acute]] [[scleroderma]]) | |||
**[[Vasculitis]] [[Hemolytic-uremic syndrome|haemolytic uraemic syndrome]] ([[Diarrhea|diarrhoea]] positive/negative) | |||
**[[Malignancy]] [[catastrophic antiphospholipid syndrome]] | |||
{| | {| | ||
Latest revision as of 15:09, 6 March 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]
Overview
The main differential diagnosis of TTP is hemolytic-uremic syndrome. TTP should be diffrential from the other disaeses such as TMA syndromes, disseminated intravascular coagulation ,hypertension, immune thrombocytopenic purpura (ITP)
- Malignant hypertension
- Hematological abnormalities
- Ischemic manifestations linked to autoimmune diseases
Differential Diagnosis
The main differential diagnosis of TTP is hemolytic-uremic syndrome (HUS, which has neurosymptoms, renal failure, hypertension and fever). Note that ADAMTS13 activity is normal in HUS.[1]
TTP must be differentiated from
- TMA syndromes
- Disseminated intravascular coagulation
- Hypertension
- Immune hrombocytopenic purpura (ITP)
- Malignant hypertension
- Hematological abnormalities
- Ischemic manifestations linked to autoimmune diseases
Differentiating TTP from other diseases on the basis of Symptoms:
- On the basis thrombocytopenia, MAHA, fluctuating neurological signs, renal faluer and fever, TTP must be differentiated from[2]
- Autoimmune haemolysis
- Evans syndrome disseminated intravascular coagulation pregnancy-associated such as:
- Haemolytic uraemic syndrome
- Drugs:
- Malignant hypertension
- Infections (typically viral (cytomegalovirus, adenovirus, herpes simplex virus)
- Severe bacterial (meningococcus, pneumococcus)
- Fungal autoimmune disease (lupus nephritis, acute scleroderma)
- Vasculitis haemolytic uraemic syndrome (diarrhoea positive/negative)
- Malignancy catastrophic antiphospholipid syndrome
References
- ↑ Joly, Bérangère S.; Coppo, Paul; Veyradier, Agnès (2017). "Thrombotic thrombocytopenic purpura". Blood. 129 (21): 2836–2846. doi:10.1182/blood-2016-10-709857. ISSN 0006-4971.
- ↑ Karpman, Diana; Loos, Sebastian; Tati, Ramesh; Arvidsson, Ida (2017). "Haemolytic uraemic syndrome". Journal of Internal Medicine. 281 (2): 123–148. doi:10.1111/joim.12546. ISSN 0954-6820.