Thrombotic thrombocytopenic purpura differential diagnosis

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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

Differential Diagnosis

The main differential diagnosis of TTP is hemolytic-uremic syndrome (HUS: which has neurosymptoms, renal failure, hypertension and fever). Note that ADAMTS13 activity is normal in HUS.[1]

TTP must be differentiated from

  • TMA syndromes
  • Disseminated Intravascular Coagulation
  • Hypertension
  • Immune Thrombocytopenic Purpura (ITP)
  • Malignant Hypertension
  • Hematological abnormalities
  • Ischemic manifestations linked to autoimmune diseases

Differentiating TTP from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis rombocytopenia, MAHA, fluctuating neurological signs, renal faluer and fever, TTP must be differentiated from[2]

  • Autoimmune haemolysis
  • Evans syndrome Disseminated intravascular coagulation Pregnancy-associated such as: HELLP (haemolysis, elevated liver enzymes and low platelets), eclampsia
  • haemolytic uraemic syndrome
  • Drugs: quinine, simvastatin, interferon, Calcineurin inhibitors
  • Malignant hypertension
  • Infections (typically viral (cytomegalovirus, adenovirus, herpes simplex virus)
  • Severe bacterial (meningococcus, pneumococcus)
  • Fungal Autoimmune disease (lupus nephritis, acute scleroderma)
  • Vasculitis Haemolytic uraemic syndrome (diarrhoea positive/negative)
  • Malignancy Catastrophic antiphospholipid syndrom

References

  1. Joly, Bérangère S.; Coppo, Paul; Veyradier, Agnès (2017). "Thrombotic thrombocytopenic purpura". Blood. 129 (21): 2836–2846. doi:10.1182/blood-2016-10-709857. ISSN 0006-4971.
  2. Karpman, Diana; Loos, Sebastian; Tati, Ramesh; Arvidsson, Ida (2017). "Haemolytic uraemic syndrome". Journal of Internal Medicine. 281 (2): 123–148. doi:10.1111/joim.12546. ISSN 0954-6820.

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