Thrombotic thrombocytopenic purpura history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
History and symptoms
Classically, the following five symptoms are indicative of this elusive disease. The full 'pentad' is not seen in all cases and clinical suspicion and acumen are the foremost necessity.
- Fluctuating neurological symptoms, such as bizarre behavior, altered mental status, stroke or headaches (65%);
- Kidney failure (46%);
- Fever (33%);
- Thrombocytopenia (low platelet count; most < 50,000), leading to bruising or purpura;
- Microangiopathic hemolytic anemia (anemia, jaundice, elevated LDH and a characteristic blood film showing schistocytes or fragmented erythrocytes).
A patient may notice dark urine from the hemolytic anemia. Because of the many small areas of ischemia produced by clots in the microvasculature, symptoms may be diffuse and fluctuating, including the classical bruising, confusion, or headache, but also nausea and vomiting (from ischemia in the GI tract or from central nervous system involvement), chest pain from cardiac ischemia, seizures, muscle and joint pain, etc.