Thrombotic thrombocytopenic purpura laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Thrombotic thrombocytopenic purpura}} | {{Thrombotic thrombocytopenic purpura}} | ||
{{CMG}}{{AE}}{{ | {{CMG}}{{AE}}{{S.G.}} | ||
==Overview== | ==Overview== | ||
An elevated concentration of [[Creatinine|creatinin]], indirect [[Bilirubin|bilirubi]]<nowiki/>n, [[Reticular cell|retic]] count, dark urinary, [[schistocytes]] in [[peripheral blood smear]] is diagnostic of TTP. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
* '''CBC shows:''' | * '''CBC shows:''' | ||
** Thrombocytopenia (median platelet count 10,000/microL) | ** [[Thrombocytopenia|Thrombocytopeni]]<nowiki/>a (median platelet count 10,000/microL) | ||
** Microangiopathic hemolytic anemia <ref name="pmid14014893">{{cite journal| author=BRAIN MC, DACIE JV, HOURIHANE DO| title=Microangiopathic haemolytic anaemia: the possible role of vascular lesions in pathogenesis. | journal=Br J Haematol | year= 1962 | volume= 8 | issue= | pages= 358-74 | pmid=14014893 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14014893 }}</ref>: | ** [[Microangiopathic hemolytic anemia]] <ref name="pmid14014893">{{cite journal| author=BRAIN MC, DACIE JV, HOURIHANE DO| title=Microangiopathic haemolytic anaemia: the possible role of vascular lesions in pathogenesis. | journal=Br J Haematol | year= 1962 | volume= 8 | issue= | pages= 358-74 | pmid=14014893 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14014893 }}</ref>: | ||
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* LDH ↑ | * [[LDH]] ↑ | ||
* Indirect bilirubin ↑ | * Indirect [[bilirubin]] ↑ | ||
* Serum haptoglubin ↓ | * [[Serum]] haptoglubin ↓ | ||
* Retic count ↑ | * Retic count ↑ | ||
* Combs tests negative | * Combs tests negative | ||
* Hb ~7 g/dl, Hct ~21% | * Hb ~7 g/dl, Hct ~21% | ||
|} | |} | ||
* '''Peripheral blood smear:''' Schistocytes, including helmet cells and triangular cells, polychromasia, | * '''Peripheral blood smear:''' [[Schistocytes]], including helmet [[Cell (biology)|cells]] and triangular [[Cell (biology)|cells]], polychromasia, [[micro]] [[Spherocytosis|spherocyte]]<nowiki/>s and [[nucleated]] [[Red blood cell|RBCs]] | ||
* '''Urinalysis:''' Hematuria, proteinuria | * '''[[Urine|Urinalysis]]:''' [[Hematuria (patient information)|Hematuria]], [[proteinuria]] | ||
* '''Serum creatinine:''' Increased | * '''[[Serum]] [[creatinine]]:''' Increased | ||
* '''Urine output:''' Decreased | * '''[[Urine]] output:''' Decreased | ||
* '''ADAMTS13 test:''' ADAMTS13 activity or inhibitor provides information for the diagnosis of the types and causes of TTP; | * '''[[ADAMTS13]] test:''' [[ADAMTS13]] [[Activity (chemistry)|activity]] or [[inhibitor]] provides information for the [[diagnosis]] of the types and causes of TTP; | ||
** '''ADAMTS13 activity:''' Decreased to < 10% during acute episodes of TTP. | ** '''[[ADAMTS13]] activity:''' Decreased to < 10% during [[Acute (medicine)|acute]] episodes of TTP. | ||
** '''ADAMTS13 | ** '''[[ADAMTS13]] [[Inhibitor|inhibitors]] test:''' This test is performed for [[patient]]<nowiki/>s with severe [[deficiency]] of [[ADAMTS13]]. | ||
* '''Genetic testing:''' Should be done in suspected cases of, | * '''Genetic testing:''' Should be done in suspected cases of, | ||
** Positive family history | ** Positive family history | ||
** Recurrent episodes | ** Recurrent episodes | ||
** Onset during childhood or pregnancy | ** Onset during [[childhood]] or [[pregnancy]] | ||
** Absence of | ** Absence of [[inhibitor]]<nowiki/>s | ||
** Persistent ADAMTS13 deficiency | ** Persistent [[ADAMTS13]] [[deficiency]] | ||
* '''Imaging:''' In cases with higher suspicion of TTP, imaging is not necessary but with focal neurological signs MRI or CT may be considered | * '''Imaging:''' In cases with higher suspicion of TTP, [[imaging]] is not necessary but with focal [[neurological]] [[Medical sign|signs]] [[Magnetic resonance imaging|MRI]] or [[CT]] may be considered | ||
* '''Blood culture:''' Patients with fever or | * '''Blood culture:''' Patients with [[fever]] or [[Medical sign|sign]]<nowiki/>s and [[symptom]]<nowiki/>s of [[Infection|infections]] | ||
* '''Stool exam:''' Stool culture and toxin evaluation should be considered in patients with diarrhea as one of the main presentation especially bloody diarrhea | * '''Stool exam:''' [[Stool culture]] and [[toxin]] evaluation should be considered in [[Patient|patients]] with [[diarrhea]] as one of the main presentation especially [[Dysentery|bloody diarrhea]] | ||
* '''Pathology:''' Tissue biopsy is not necessary for diagnosis, but it may show classic changes of a thrombotic microangiopathy including platelet microthrombi in small arterioles or capillaries, or hyaline changes in and around vessel walls. | * '''Pathology:''' [[Tissue (biology)|Tissue]] [[biopsy]] is not necessary for [[diagnosis]], but it may show classic changes of a [[thrombotic microangiopathy]] including [[platelet]] [[microthrombi]] in small [[Arteriole|arterioles]] or [[Capillary|capillaries]], or [[hyaline]] changes in and around [[Vessel wall|vessel walls]]. | ||
==References== | ==References== | ||
Latest revision as of 16:49, 31 March 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]
Overview
An elevated concentration of creatinin, indirect bilirubin, retic count, dark urinary, schistocytes in peripheral blood smear is diagnostic of TTP.
Laboratory Findings
- CBC shows:
- Thrombocytopenia (median platelet count 10,000/microL)
- Microangiopathic hemolytic anemia [1]:
| Hemolytic anemia |
|---|
- Peripheral blood smear: Schistocytes, including helmet cells and triangular cells, polychromasia, micro spherocytes and nucleated RBCs
- Urinalysis: Hematuria, proteinuria
- Serum creatinine: Increased
- Urine output: Decreased
- ADAMTS13 test: ADAMTS13 activity or inhibitor provides information for the diagnosis of the types and causes of TTP;
- ADAMTS13 activity: Decreased to < 10% during acute episodes of TTP.
- ADAMTS13 inhibitors test: This test is performed for patients with severe deficiency of ADAMTS13.
- Genetic testing: Should be done in suspected cases of,
- Positive family history
- Recurrent episodes
- Onset during childhood or pregnancy
- Absence of inhibitors
- Persistent ADAMTS13 deficiency
- Imaging: In cases with higher suspicion of TTP, imaging is not necessary but with focal neurological signs MRI or CT may be considered
- Blood culture: Patients with fever or signs and symptoms of infections
- Stool exam: Stool culture and toxin evaluation should be considered in patients with diarrhea as one of the main presentation especially bloody diarrhea
- Pathology: Tissue biopsy is not necessary for diagnosis, but it may show classic changes of a thrombotic microangiopathy including platelet microthrombi in small arterioles or capillaries, or hyaline changes in and around vessel walls.
References
- ↑ BRAIN MC, DACIE JV, HOURIHANE DO (1962). "Microangiopathic haemolytic anaemia: the possible role of vascular lesions in pathogenesis". Br J Haematol. 8: 358–74. PMID 14014893.