This patient presents with renal failure, seizure and this blood film. What diagnostic test should you order?
This patient likely has Thrombotic Thrombocytopenic Purpura (TTP) as evidenced by schistocytes and a lack of platelets seen on this blood film, as well as their clinical syndrome. The “Pentad” of TTP is:
- Renal Failure
- Hemolytic Anemia
- Altered Mental Status
TTP is part of a larger group of syndromes that present with renal failure and hemolytic anemia called thrombotic microangiopathies. However, when a patient presents with any combination of the pentad of TTP, you need to rule out the diagnosis by ordering an ADAMTS13 level (which will be low). TTP is almost 100% fatal if not treated with plasma exchange, so it is an important diagnosis to rule out.
This WCH CMR blog post/Morning Report summary covers Hemolytic anemias & TTP in more detail.