The importance of clinical judgment for the diagnosis of thrombotic thrombocytopenic purpura

George, James N.

doi:10.1111/trf.14357

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…Although documentation of a severe decrease in ADAMTS13 activity supports TTP diagnosis, early diagnosis and management doesn’t require measurement of ADAMTS13; moreover, severe deficiency of ADAMTS13 is not specific for TTP. 1 , 9 , 10 …”

Section: Discussionmentioning

confidence: 99%

“…Conditions that can mimic TTP include malignant hypertension, systemic lupus erythematosus, systemic sclerosis, catastrophic antiphospholipid syndrome, systemic malignancies, and systemic infections. 9 - 13 Infections also can trigger TTP onset. 14 , 15 One report that discussed systemic infections mimicking or triggering TTP listed many bacteria, fungi, and viruses.…”

Section: Discussionmentioning

confidence: 99%

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Acute Hepatitis Caused by Genotype 4 HCV Presenting with Microangiopathic Hemolytic Anemia

Kamal

Youssef

Mansour

2018

ACG Case Reports Journal

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Many cases have been reported about the role of chronic hepatitis C and interferon therapy in the development and recurrence of thrombotic thrombocytopenic purpura (TTP), but to our knowledge there is no previous report about the association between acute hepatitis C and any microangiopathic hemolytic anemia (MAHA) including TTP. We report a case of acute hepatitis C that presented with MAHA resembling TTP, which resolved with spontaneous clearance of viral infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Hepatitis Caused by Genotype 4 HCV Presenting with Microangiopathic Hemolytic Anemia

Kamal

Youssef

Mansour

2018

ACG Case Reports Journal

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“…However, this patient's story emphasizes the importance of clinical judgment for the diagnosis of TTP. 20 Endocarditis. Patient 4 (Table 2) was a healthy woman who came to the hospital emergency department because she had 3 days of dyspnea and right-side pleuritic chest pain.…”

Section: Diversity Of Initial Presentationsmentioning

confidence: 99%

The remarkable diversity of thrombotic thrombocytopenic purpura: a perspective

George

2018

Blood Advances

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Understanding the autoimmune etiology of acquired thrombotic thrombocytopenic purpura (TTP) has provided precision for the diagnosis and a rationale for immunosuppressive treatment. These advances have also allowed recognition of the remarkable clinical diversities of patients' initial presentations and their long-term outcomes. These diversities are illustrated by the stories of patients from the Oklahoma TTP Registry. The initial presentation of TTP may be the discovery of unexpected severe thrombocytopenia in a patient with minimal or no symptoms. The patient may remain asymptomatic throughout treatment or may die suddenly before treatment can be started. ADAMTS13 activity may be reported as normal in a patient with characteristic clinical features of TTP, or the unexpected report of ADAMTS13 deficiency in a patient with another established disorder may lead to the discovery of TTP. ADAMTS13 activity during clinical remission is unpredictable. ADAMTS13 activity may recover and remain normal, it may remain severely deficient for many years, or it may become normal only many years after recovery. Our treatment of initial episodes and management of patients after recovery and during remission continue to change. The addition of rituximab to the treatment of acute episodes and preemptive rituximab for patients with severe ADAMTS13 deficiency during remission are reported to prevent relapse. Because TTP is uncommon, there are few data to guide these changes. Therefore our patients' stories are profoundly influential. Their stories are the foundation of our experience, and our experience is the guide for our decisions.

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“…Most centers that treat TTP outsource the assay, resulting in initiation of TPE before the availability of the assay result. The usefulness or otherwise of an in‐house assay with a rapid turnaround time has been controversial . Outsourcing the assay to a reference laboratory can be problematic, as unknown preanalytical variables could interfere with the test result.…”

mentioning

confidence: 99%

Falsely low ADAMTS13 activity caused by levofloxacin

2019

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the PEG-AHG method. Antibody identification of the samples showed positive for IgG antibodies, which consist with daratumumab agent (IgG1κ). These results showed promising effect of MP method for pretransfusion test in patient with daratumumab.The main shortcoming of the MP test is its lack of adequate sensitivity in the Kell system. 3 However, this could be overcome by performing a supplementary antiglobulin reaction on the sensitized, polybrene-treated RBCs, 3 although there are still some limitations of the MP method, such as the need for further training laboratory technicians and inadequate sensitivity for Kell blood-type detection in some areas. With no interference with daratumumab, the MP method reveals its advantage in pretransfusion test in the era of targeted monoclonal therapy.

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The importance of clinical judgment for the diagnosis of thrombotic thrombocytopenic purpura

Cited by 8 publications

References 20 publications

Acute Hepatitis Caused by Genotype 4 HCV Presenting with Microangiopathic Hemolytic Anemia

Acute Hepatitis Caused by Genotype 4 HCV Presenting with Microangiopathic Hemolytic Anemia

The remarkable diversity of thrombotic thrombocytopenic purpura: a perspective

Falsely low ADAMTS13 activity caused by levofloxacin

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