Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Thrombotic thrombocytopenic purpura differential diagnosis
Introduction
Overview
Overview
The main differential diagnosis of TTP is hemolytic-uremic syndrome. TTP should be diffrential from the other disaeses such as TMA syndromes, disseminated intravascular coagulation ,hypertension, immune thrombocytopenic purpura (ITP)
- Malignant hypertension
- Hematological abnormalities
- Ischemic manifestations linked to autoimmune diseases
Differential Diagnosis
Differential Diagnosis
The main differential diagnosis of TTP is hemolytic-uremic syndrome (HUS, which has neurosymptoms, renal failure, hypertension and fever). Note that ADAMTS13 activity is normal in HUS.[1]
The table below helps differentiate TTP from other thrombotic microangiopathies.[2]
| Diagnosisa | Hemolysisb | Platelet count, ×10^9/Lc | Creatinine level, mg/dLc | Key Featuresd | Therapies |
| Thrombotic thrombocytopenic purpura | Yes | <30 | <2 | ADAMTS13 deficiency (<10%-20%) | Immune: therapeutic plasma exchange, immune suppression, caplacizumab; Congenital: donor plasma or recombinant ADAMTS13 |
| Complement-mediated thrombotic microangiopathy | Yes | >30
<100 |
>2 | Complement dysregulation | Complement inhibitors |
| Infection | |||||
| Shiga toxin producing Escherichia coli (O157:H7) | Yes | Variable | Variable | Variable | Supportive care; Disease-specific antivirals/antimicrobials |
| Advanced HIV infection | |||||
| Sepsis | |||||
| Autoimmune | |||||
| Systemic lupus erythematosus | Yes | Variable | Variable | Variable | Corticosteroid with-without other immunosuppressant.
Anticoagulation with/without therapeutic plasma exchange. |
| Catastrophic antiphospholipid syndrome | |||||
| Pregnancy | |||||
| Preeclampsia | Yes | Variable | Variable | Variable | Delivery of fetus |
| HELLP syndrome (hemolysis, elevated liver enzyme levels, low platelet count) | |||||
| Cardiac | |||||
| Malignant hypertension | Yes | Variable | Variable | Variable | Treatment of hypertension or valvular disease |
| Malfunctioning mechanical valve | |||||
| Cancer | |||||
| Disseminated cancer | Yes | Variable | Variable | Variable | Treatment of cancer |
| Transplant | |||||
| Hematopoietic cell | Yes | Variable | Variable | Variable | Treatment of rejection or graft-vs-host disease, supportive care, stop offending drugs |
| Solid organ | |||||
| Drugs | |||||
| Quinine | Yes | Variable | Variable | Variable | Stop offending drug |
| Ticlopidine | |||||
| Tacrolimus | |||||
| Gemcitabine | |||||
| Mitomycin | |||||
Abbreviation: ADAMTS13, a disintegrin and metallopeptidase with thrombospondin type 1 motif 13.
a Common etiologies are listed, although the list is not meant to be exhaustive.
b Hemolysis: low hemoglobin level, high reticulocyte count/serum lactate dehydrogenase level/indirect bilirubin, low haptoglobin levels.
c Common laboratory values at presentation, although patients may differ.
d All thrombotic microangiopathies can have neurologic, cardiac, and abdominal features due to involvement of microvasculature.
SI conversion factor: To convert creatinine values to μmol/L, multiply by 88.4.
References
References
- ↑ Joly, Bérangère S.; Coppo, Paul; Veyradier, Agnès (2017). “Thrombotic thrombocytopenic purpura”. Blood. 129 (21): 2836–2846. doi:10.1182/blood-2016-10-709857. ISSN 0006-4971.
- ↑ Pishko AM, Li A, Cuker A (August 2025). “Immune Thrombotic Thrombocytopenic Purpura: A Review”. JAMA. 334 (6): 517–529. doi:10.1001/jama.2025.3807. PMID 40388146 Check
|pmid=value (help).
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2] Anum Ijaz M.B.B.S., M.D.[3]