Image of the week Follow Up

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:

  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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