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Thrombotic Thrombocytopenic Purpura: Atypical Presentation in Er/An Approach to be Considered by Er Physicians

Gokul B., Shakti Shishodia, Pallavi Shegal, Dheeraj B. Nair

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Indian Journal of Emergency Medicine 10(1):p 25-27, January-March 2024. | DOI: https://doi.org/10.21088/ijem.2395.311X.10124.5

How Cite This Article:

Gokul B, Shishodia S, Shegal P, Nair DB. Thrombotic thrombocytopenic purpura: atypical presentation in ER/an approach to be considered by ER physicians. Indian J Emerg Med. 2024;10(1):25-7.

Timeline

Received : December 16, 2023         Accepted : February 02, 2024          Published : March 30, 2024

Abstract

To Consider the Diagnosis of TTP in cases of Thrombocytopenia Presenting to Er with altered mental status. A 28 year young male known case of seizure Disorder Juvenile Myoclonic Epilepsy Presenting to Er with complaints of sudden onset of altered mental status since 1 day with history of fever for 1 day Documented 3 days back and his labs revealed thrombocytopenia with Aki. Patient was initially managed conservatively with Antiepileptics, IV fluids, Antibiotics and supportive therapy. In course of hospital stay, patient developed Hemolysis with generalised tonic clonic seizures and was later diagnosed as TTP (Sepsis Induced) with Neurological Involvement with AKI with status epilepticus. A case of thrombocytopenia with altered mental status presenting in Er, A Differential Diagnossis of TTP must be considered in Initial Period.


References

  • 1.   Tanner L, Müller MM. [Blood Transfusion: a Guide to Clinical Decision Making]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2019 Mar; 54(3):194-205. [pubmed]
  • 2.   Coppo P, Cuker A, George JN. Thrombotic thrombocytopenic purpura: Toward targeted therapy and precision medicine. Res Pract Thromb Haemost. 2019 Jan; 3(1):26-37. [PMC free article] [pubmed]
  • 3.   Wiernek SL, Jiang B, Gustafson GM, Dai X. Cardiac implications of thrombotic thrombocytopenic purpura. World J Cardiol. 2018 Dec 26;10(12):254-266. [PMC free article] [pubmed]
  • 4.   Cox EC. Thrombotic thrombocytopenic purpura: report of three additional cases and a short review of the literature. J S C Med Assoc.1966 Dec; 62(12) : 465-70. [pubmed]
  • 5.   Bell WR, Braine HG, Ness PM, Kickler TS. Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 patients. N Engl J Med. 1991 Aug 08; 325(6):398-403. [PubMed]
  • 6.   Gavriilaki E, Anagnostopoulos A, Mastellos DC. Complement in Thrombotic Microangiopathies: Unraveling Ariadne's Thread Into the Labyrinth of Complement Therapeutics. Front Immunol. 2019;10:337. [PMC free article] [PubMed]
  • 7.   Amin Asnafi A, Jalali MT, Pezeshki SMS, Jaseb K, Saki N. The Association Between Human Leukocyte Antigens and ITP, TTP, and HIT. J Pediatr Hematol Oncol. 2019 Mar; 41(2):81-86. [PubMed]
  • 8.   van Dorland HA, Taleghani MM, Sakai K, Friedman KD, George JN, Hrachovinova I, Knöbl PN, von Krogh AS, Schneppenheim R, Aebi-Huber I, Bütikofer L, Largiadèr CR, Cermakova Z, Kokame K, Miyata T, Yagi H, Terrell DR, Vesely SK, Matsumoto M, Lämmle B, Fujimura Y, Kremer Hovinga JA., Hereditary TTP Registry. The International Hereditary Thrombotic Thrombocytopenic Purpura Registry: key findings at enrollment until 2017. Haematologica. 2019 Oct; 104(10):2107-2115. [PMC free article] [PubMed]
  • 9.   Swart L, Schapkaitz E, Mahlangu JN. Thrombotic thrombocytopenic purpura: A 5-year tertiary care centre experience. J Clin Apher. 2019 Feb; 34(1):44-50. [PubMed]
  • 10.   Terrell DR, Vesely SK, Kremer Hovinga JA, Lämmle B, George JN. Different disparities of gender and race among the thrombotic thrombocytopenic purpura and hemolyticuremic syndromes. Am J Hematol. 2010 Nov; 85(11):844-7. [PMC free article] [PubMed]
  • 11.   Zhu H, Liu JY. Thrombotic thrombocytopenic purpura with neurological impairment: A Review. Medicine (Baltimore). 2022 Dec 9;101(49):e31851. Doi: 10.1097/ MD.0000000000031851. PMID: 36626546; PMCID: PMC9750575.

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This research received no funding.

Author Contributions

All authors contributed significantly to the work and approve its publication.

Acknowledgements

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Conflicts of Interest

The authors report no conflicts of interest in this work.


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Cite this article

Gokul B, Shishodia S, Shegal P, Nair DB. Thrombotic thrombocytopenic purpura: atypical presentation in ER/an approach to be considered by ER physicians. Indian J Emerg Med. 2024;10(1):25-7.


Licence:

Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)

This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.


Received Accepted Published
December 16, 2023 February 02, 2024 March 30, 2024

DOI: https://doi.org/10.21088/ijem.2395.311X.10124.5

Keywords

Sepsis induced thrombotic thrombocytopenic purpuraEmergency departmentNeurological involvementAtypical

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Received December 16, 2023
Accepted February 02, 2024
Published March 30, 2024

licence


Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)

This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.


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