Thrombotic thrombocytopenic purpura laboratory findings: Difference between revisions

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{{Thrombotic thrombocytopenic purpura}}
{{Thrombotic thrombocytopenic purpura}}
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==Overview==
An elevated concentration of [[Creatinine|creatinin]], indirect [[Bilirubin|bilirubi]]<nowiki/>n, [[Reticular cell|retic]] count, dark urinary, [[schistocytes]] in [[peripheral blood smear]] is diagnostic of TTP.
 
==Laboratory Findings==
==Laboratory Findings==
* '''CBC shows:'''
* '''CBC shows:'''
** Thrombocytopenia (median platelet count 10,000/microL)
** [[Thrombocytopenia|Thrombocytopeni]]<nowiki/>a (median platelet count 10,000/microL)
** Microangiopathic hemolytic anemia <ref name="pmid14014893">{{cite journal| author=BRAIN MC, DACIE JV, HOURIHANE DO| title=Microangiopathic haemolytic anaemia: the possible role of vascular lesions in pathogenesis. | journal=Br J Haematol | year= 1962 | volume= 8 | issue=  | pages= 358-74 | pmid=14014893 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14014893  }}</ref>:  
** [[Microangiopathic hemolytic anemia]] <ref name="pmid14014893">{{cite journal| author=BRAIN MC, DACIE JV, HOURIHANE DO| title=Microangiopathic haemolytic anaemia: the possible role of vascular lesions in pathogenesis. | journal=Br J Haematol | year= 1962 | volume= 8 | issue=  | pages= 358-74 | pmid=14014893 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14014893  }}</ref>:  
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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%
|}
|}
* '''Peripheral blood smear:''' Schistocytes, including helmet cells and triangular cells, polychromasia, microspherocytes and nucleated 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, proteinuria
* '''[[Urine|Urinalysis]]:''' [[Hematuria (patient information)|Hematuria]], [[proteinuria]]
* '''Serum creatinine:''' Increased
* '''[[Serum]] [[creatinine]]:''' Increased
* '''Urine output:''' Decreased  
* '''[[Urine]] output:''' Decreased  
* '''ADAMTS13 activity test:''' Decreased to < 10% during acute episodes of TTP.   
* '''[[ADAMTS13]] test:''' [[ADAMTS13]] [[Activity (chemistry)|activity]] or [[inhibitor]] provides information for the [[diagnosis]] of the types and causes of TTP;
* ADAMTS13 inhinbitors test:
** '''[[ADAMTS13]] activity:''' Decreased to < 10% during [[Acute (medicine)|acute]] episodes of TTP.   
* '''Genetic testing:''' Should be done in suspected cases
** '''[[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,
** Positive family history   
** Positive family history   
** Recurrent episodes   
** Recurrent episodes   
** Onset during childhood or pregnancy   
** Onset during [[childhood]] or [[pregnancy]]    
** Absence of inhibitors    
** Absence of [[inhibitor]]<nowiki/>s    
** Persistent ADAMTS13 deficiency   
** Persistent [[ADAMTS13]] [[deficiency]]    
* '''Imaging:'''   
* '''Imaging:''' In cases with higher suspicion of TTP, [[imaging]] is not necessary but with focal [[neurological]] [[Medical sign|signs]] [[Magnetic resonance imaging|MRI]] or [[CT]] may be considered  
* Blood culture:   
* '''Blood culture:''' Patients with [[fever]] or [[Medical sign|sign]]<nowiki/>s and [[symptom]]<nowiki/>s of [[Infection|infections]]    
* Stool exam:   
* '''Stool exam:''' [[Stool culture]] and [[toxin]] evaluation should be considered in [[Patient|patients]] with [[diarrhea]] as one of the main presentation especially [[Dysentery|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.  
* '''Pathology:''' [[Tissue (biology)|Tissue]] [[biopsy]] is not necessary for [[diagnosis]], but it may show classic changes of a [[thrombotic microangiopathy]] including [[platelet]] [[microthrombi]] in small [[Arteriole|arterioles]] or [[Capillary|capillaries]], or [[hyaline]] changes in and around [[Vessel wall|vessel walls]].  


==References==
==References==

Latest revision as of 16:49, 31 March 2019

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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

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

References

  1. 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.

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