Friday October 3, 2008


Case: 58 year male brought to ER with high fever along with mental status change. In ER patient had a witnessed seizure. Urine output is marginal. You received following lab values

Hb 7 gm/dl, Platelets: 14 /μL, Cr.: 2.6 mg/dl

Your next line of action along with treating rescuing airway and treating seizure is: (choose one)

A) Initiate Sepsis protocol
B) Perform Lumbar punture (to rule out meningitis)
C) Transfue platelets
D) Call for plasmapheresis
E) Initiate Dialysis



Answer: D

This patient most probably has thrombotic thrombocytopenic purpura (TTP). It has 5 basic criteria

• thrombocytopenia,
• Microangiopathic hemolytic anemia,
• CNS dysfunction,
• fever, and
• renal failure

The therapeutic effects of plasmapheresis in the critically ill patient with TTP are often dramatic: Severe neurologic manifestations may disappear, and laboratory abnormalities may diminish in a few hours. Platelet transfusions should be avoided because they have been accompanied by marked deterioration in either renal or neurologic status. The treatment of seizures in TTP is the same as for seizures with other complicated hematologic disorders.

Splenectomy is a reasonable treatment option for TTP patients refractory to standard TPE or who have experienced multiple and/or complicated relapses 2.


Review at emedicine.com: Thrombotic thrombocytopenic purpura (TTP)



Reference: Click to get abstrat

1. Thrombotic thrombocytopenic purpura: Treatment with plasmapheresis - American Journal of Hematology, Vol. 24 issue 4, Pages 329 - 339, Published Online: 11 Jul 2006

2. Role of splenectomy in patients with refractory or relapsed thrombotic thrombocytopenic purpura. Aqui NA, Stein SH, Konkle B, Abrams CS, Strobl FJ. Journal of Clinical Apheresis 2003;18:51-54.