Thrombotic thrombocytopenic purpura laboratory findings: Difference between revisions
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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% | ||
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* '''Peripheral blood smear:''' [[Schistocytes]], including helmet cells and triangular cells, polychromasia, micro [[Spherocytosis|spherocyte]]<nowiki/>s and [[nucleated]] [[Red blood cell|RBCs]] | * '''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 (patient information)|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 (chemistry)|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 (medicine)|acute]] episodes of TTP. | ** '''[[ADAMTS13]] activity:''' Decreased to < 10% during [[Acute (medicine)|acute]] episodes of TTP. | ||
** '''ADAMTS13 inhibitors test:''' This test is performed for [[patient]]<nowiki/>s with severe [[deficiency]] of [[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 | ||
Latest revision as of 16:49, 31 March 2019
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Thrombotic thrombocytopenic purpura Microchapters |
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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 |
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- 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.