Image of the week Follow Up

This patient presents with renal failure, seizure and this blood film.  What diagnostic test should you order?

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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:

  1. Renal Failure
  2. Thrombocytopenia
  3. Hemolytic Anemia
  4. Altered Mental Status
  5. Fever

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.

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