Q: 47 year old male is brought to ER with fever and mental status change. Patient did not produce any urine while foley was inserted. Lab is still pending. A research student made following slide in ER. What is your presumptive diagnosis?
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Answer: Thrombotic thrombocytopenic purpura (TTP)
TTP is a life-threatening condition which may have a positive outcome if recognized early and medical intervention is initiated early with plasma exchange.
The classic pentad associated with TTP (fever, renal failure, neurological change, thrombocytopenia and microangiopathic hemolytic anemia) are not always easy to recognize. Lab finding of elevated LDH and schistocytosis (arrows in picture above) are very crucial for diagnosis of TTP.
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