血栓性血小板减少性紫癜(TTP)的典型特征是发热的症状性五组,血小板减少症,微血管病性溶血性贫血,神经系统异常,和肾衰竭。非典型TTP是用于描述TTP患者的子集的诊断,这些患者的症状偏离了经典的五肽。我们报告了一例86岁的妇女,她到急诊科就诊,抱怨胸痛一天。据报道,她正在使用抗生素治疗鼻窦感染。体格检查发现双侧多处浅表血肿,主要在她的四肢。一入场,她的实验室值如下:血小板计数为6,000/立方毫米,血红蛋白10.4克/分升,白细胞计数5100细胞/立方毫米,总胆红素2.3毫克/分升,肌钙蛋白I为5.190纳克/毫升。外周血涂片正常,未发现任何分裂细胞。该患者因使用抗生素而被诊断为非ST段抬高型心肌梗死和免疫性血小板减少性紫癜,因此被送入重症监护病房。她接受了静脉注射solumedrol和高强度他汀类药物治疗。在她入院的第三天,患者的精神功能恶化,并插管以保护她的气道。第二次外周涂片显示分裂细胞,随后的实验室研究支持TTP的诊断.计划进行血浆置换治疗。然而,患者在开始心脏骤停之前就死于心脏骤停。后来用ADAMTS13(一种具有血小板反应蛋白1型基序的整合素和金属蛋白酶,成员13)测定。这种情况是TTP可以呈现的多种方式之一的示例,并强调将TTP作为鉴别诊断的重要性。
Thrombotic thrombocytopenic purpura (TTP) is typically characterized by the symptomatic pentad of fever, thrombocytopenia, microangiopathic hemolytic anemia, neurologic abnormalities, and renal failure. Atypical TTP is the diagnosis used to describe the subset of patients with TTP who present with symptoms that deviate from the classic pentad. We report a case an 86-year-old woman who presented to the emergency department complaining of chest pain for one day. She was reportedly on antibiotics for sinus infection. Physical examination revealed multiple bilateral superficial hematomas, predominantly on her extremities. On admission, her lab values were as follows: platelet count of 6,000/cubic millimeter, hemoglobin of 10.4 grams/deciliter, leukocyte count of 5100 cells/cubic millimeter, total bilirubin of 2.3 milligrams/deciliter, and troponin-I of 5.190 nanograms/milliliter. Peripheral blood smear was normal and did not reveal any schistocytes. The patient was admitted to the intensive care unit with a diagnosis of a non-ST-elevation myocardial infarction and a presumed diagnosis of immune thrombocytopenic purpura from antibiotic use. She was treated with intravenous solumedrol and a high-intensity statin. On the third day of her admission, the patient\'s mental functioning deteriorated and was intubated to protect her airway. A second peripheral smear revealed schistocytes, and subsequent laboratory studies supported the diagnosis of TTP. Plasma exchange therapy was planned. However, the patient succumbed to cardiac arrest before it could be initiated. The diagnosis was later confirmed with an ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) assay. This case serves as an example of one of the many ways in which TTP can present, and emphasizes the importance of considering TTP as a differential diagnosis.