sigh
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Female. Hx of hysterectomy 2 mo ago after what she began estrogen replacement therapy. Fever 102, bp 140/90, ps 98, resp. 20. She appears disoriented to time and place. Complains on headache, jaundice for 1 week. Physical exam: jaundice, purpura on the trunk, bleeding gums.
Labs: Platelets-25,000
Ht-24%
Creat- 4.9
LDH elevated
Indirect bilirubin elevated
coagulation normal
bleeding time increased
fibrin-split products negative
Coombs negative
blood smear:schistocytes, helmet-shaped cells, cells with triangular shape
What is the most likely diagnosis?
A. Autoimmune hemolytic anemia
B. DIC
C.Hemolytic-uremic syndrome
D.Idiopathic thrombocytopenic purpura
E.Thrombotic thrombocytopenic purpura
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| Tiff
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E
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| shumaila
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E?
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| GhostSurgeon
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d
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| spinal shock
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B
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| new_n_lost
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DIC gets ruled out due to no FDPs
ITP gets rules out due presence of Hemolysis. ( ITP is an isolated reduction in platelet count)
HUS its not possible in this group
Auto-immune its not cos of no signs of drug-induced anemia.
The presence of Fever and the absence of FDPs make it go highly in favor of TTP.
But one thing bugs me how is coagulation normal when bleeding time is increased. need to think over it.
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| hottie99
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it's ttp bc it has 'FAT RN'
F - fever
A - anemia (microangiopathic hemolysis --> schistocytes)
T - thrombocytopenia
R - renal involvement (his CREA is off the charts!)
N - neurologic sx (he's disoriented)
it's coomb's negative, so not AIHA; d-dimers neg so not DIC; and not isolated platelets down so not ITP
hope that helps! i always get TTP wrong too, but now i got it down after getting it wrong so many times! 
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| sigh
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I got it wrong, I pick up C....and I hope now will remember...
EEEEEEEEEEEEEEEEEEEEEEEEEEEEEE is correct
TTP is a rare disease of unknown etiology.It is characterized by an increased bleeding time but a decreased platelet count. It causes purpura, fever, renal failure, microangiopathic hemolytic anemia, and microthrombi, frequently in young women. Elevated indirect bilirubin and high LDH are characteristic, as are schistocytes in the blood smear, renal dysfunction, and neurologic, and systemic symptoms. TTP iis thought to be initiated by endothelial injury, which causes platelet aggregation. May be precipitated by pregnancy/use of estrogens.
No fibrin split products--- not B
Coombs negative----not A
D is not correct because systemic illness is not present in ITP which is characterized by isolated thrombocytopenia without other hematologic abnormalities.
C is very close to TTP. These two conditions are considered manifestations of the same pathogenetic spectrum. However, the vascular bed of the CNS is not involved in HUS. Thus, mental status changes are not part of the clinical picture of HUS.
From Kaplan Q-bank
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| hottie99
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yeah i just think of TTP as HUS + Neuro sx, so if u see HUS type problem but there is any inkling of neurologic sx, then think of TTP; and know the tx of TTP (i had it on my ck and at the last minute i realized what it was and got it wrong bc time ran out!!) Tx of TTP? plasmapharesis!!
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| Ig F
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yes its E....TTP.......
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