Thrombotic thrombocytopenic purpura laboratory findings

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Laboratory Findings

• CBC shows:
  • Thrombocytopenia (median platelet count 10,000/microL)
  • Microangiopathic hemolytic anemia :

Hemolytic anemia
LDH ↑ Indirect bilirubin ↑ Serum haptoglubin ↓ Retic count ↑ Combs tests negative Hb ~7 g/dl, Hct ~21%

• Peripheral blood smear: Schistocytes, including helmet cells and triangular cells, polychromasia, microspherocytes and nucleated RBCs
• Urinalysis: Hematuria, proteinuria
• Serum creatinine: Increased
• Urine output: Decreased
• ADAMTS13 activity test: Decreased to < 10% during acute episodes of TTP.
• ADAMTS13 inhinbitors test:
• Genetic testing: Should be done in suspected cases
  • Positive family history
  • Recurrent episodes
  • Onset during childhood or pregnancy
  • Absence of inhibitors
  • Persistent ADAMTS13 deficiency
• Imaging:
• Blood culture:
• Stool exam:
• 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.