IMPORTANCE OF INITIATING TREATMENT FOR PRESUMPTIVE DIAGNOSIS OF ACQUIRED THROMBOTIC THROMBOCYTOPENIC PURPURA

POSTER PRESENTATIONS

Introduction. Acquired thrombotic thrombocytopenic purpura (TTP) is a medical emergency with an incidence of 4-5 cases per million people per year. Diagnosis of TTP is based on clinical features and laboratory testing such as ADAMTS13 activity levels. Historically, untreated TTP had mortality rates of 100%. However, advances in treatment improved survival rates to 80-90%. Thus, prompt recognition and initiation of treatment is of the utmost importance. Case presentation. A 34-year-old African American male presented to the emergency department complaining of nausea, vomiting, and hematuria within the past 24 hours. His urine stream had significantly decreased since the start of his symptoms. The patient admitted having chills, headache, dizziness, shortness of breath, low back pain, and unintentional weight-loss. The patient was admitted and further workup started. Physical exam was unremarkable except for right CVA tenderness. Labs were suspicious for hemolytic anemia and decreased renal function. Imaging was negative for obstruction and hydronephrosis. Peripheral blood smear demonstrated schistocytes. Plasmapheresis was started the day of admission, before receiving results of ADAMTS13 activity levels. After 7 treatments, his anemia and renal function improved. Deviation From the Expected. The patient did not present with the classic pentad of symptoms for TTP, nor were laboratory results available for confirming TTP before initiating treatment. Discussion. This case demonstrated the prompt recognition and presumptive diagnosis of TTP leading to early treatment and optimal patient outcome. Conclusion. Further studies are needed to evaluate cost-effectiveness of early versus late treatment of TTP. Furthermore, guidelines for initiating TTP treatment need to be established. Grants. None