Thrombotic thrombocytopenic purpura differential diagnosis

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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

The main differential diagnosis of TTP is hemolytic-uremic syndrome. TTP should be diffrential from the other desaeses such as TMA syndromes, disseminated intravascular coagulation ,hypertension, immune thrombocytopenic purpura (ITP)

Differential Diagnosis

The main differential diagnosis of TTP is hemolytic-uremic syndrome (HUS, which has neurosymptoms, renal failure, hypertension and fever). Note that ADAMTS13 activity is normal in HUS.[1]

TTP must be differentiated from

Differentiating TTP from other diseases on the basis of Symptoms:

  • On the basis rombocytopenia, MAHA, fluctuating neurological signs, renal faluer and fever, TTP must be differentiated from[2]
    • Autoimmune haemolysis
    • Evans syndrome disseminated intravascular coagulation pregnancy-associated such as:
    • haemolytic uraemic syndrome
    • Drugs: quinine, simvastatin, interferon, Calcineurin inhibitors
    • Malignant hypertension
    • Infections (typically viral (cytomegalovirus, adenovirus, herpes simplex virus)
    • Severe bacterial (meningococcus, pneumococcus)
    • Fungal Autoimmune disease (lupus nephritis, acute scleroderma)
    • Vasculitis Haemolytic uraemic syndrome (diarrhoea positive/negative)
    • Malignancy Catastrophic antiphospholipid syndro

References

  1. Joly, Bérangère S.; Coppo, Paul; Veyradier, Agnès (2017). "Thrombotic thrombocytopenic purpura". Blood. 129 (21): 2836–2846. doi:10.1182/blood-2016-10-709857. ISSN 0006-4971.
  2. Karpman, Diana; Loos, Sebastian; Tati, Ramesh; Arvidsson, Ida (2017). "Haemolytic uraemic syndrome". Journal of Internal Medicine. 281 (2): 123–148. doi:10.1111/joim.12546. ISSN 0954-6820.

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