Understanding a patient’s diagnosis

In this section you can find an infographic providing an overview of the diagnostic pathway in aTTP, and expert interviews discussing the challenges in diagnosing TTP.

TTP Diagnostic pathway

The diagnosis of TTP should be treated as a medical emergency.1 Thrombocytopaenia & MAHA in the absence of any other identifiable cause => suspect TTP.1

Presenting clinical features and signs include1:

Thrombocytopenia

Central neurological symptoms

Non-specific symptoms: pallor, jaundice, fatigue, arthralgia or myalgia

Jaundice

Renal impairment

Gastrointestinal tract symptoms

Cardiac symptoms

Potential triggers of interest in clinical history2:

Bacterial or viral infections

Drug ingestion (quinine, ticlopidine, clopidogrel, mitomycin C, alpha-interferon, cyclosporin, tacrolimus and other immunosuppressive and chemotherapeutic agents)

Pregnancy

Autoimmune disorders [mainly systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APL)]

Bone marrow transplantation

Disseminated malignancy

Tests and expected results may include1:

Blood samples should be sent for investigation before first PEX1

Full blood count and blood film.
Anaemia, thrombocytopenia, fragments on film.

Reticulocyte count
raised

Haptoglobin reduced

Lactate dehydrogenase raised due to haemolysis or organ damage

Direct antiglobulin test Negative

Clotting screen including fibrinogen normal

Urea and electrolytes Renal impairment

Blood must be taken prior to treatment to assess baseline ADAMTS13 activity.
Severely reduced ADAMTS13 activity helps to confirm the diagnosis of TTP1

TTP is an acute life threatening disorder that affects primarily young people and primarily females but it can occur at any age…

Dr. Marie Scully

The signs & symptoms of TTP

That was one week or 5 days that this girl was going around with the signs and symptoms but everybody thought that it is flu…

Dr. Flora Peyvandi

Patient case study

It can be very difficult to diagnose an acute TTP episode and in many patients there are no specific, definitive clinical signs.

Dr. Marie Scully

Diagnosing TTP

References

  1. Scully M et al. Br J Haematol 2012;158:323–335.
  2. Veyradier A, Meyer D. J Thromb Haemost 2005;3:2420–7.