Thrombotic thrombocytopenic purpura history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [3]

Overview

The majority of patients with TTP are asymptomatic. However, the classic pentad of signs/symptoms includes microangiopathic hemolytic anemia, renal failure, thrombocytopenia, neurologic dysfunction, and fever.

History and Symptoms

History

Patients with TTP may have a positive history of:^[1]


Clinical history of TTP
Thrombocytopenia	Epistaxis, bruising, petechiae, gingival bleeding, haematuria, menorrhagia, gastrointestinal bleeding, retinal haemorrhage and haemoptysis
Central neurological	Confusion, headache, paresis, aphasia, dysarthria, visual problems, encephalopathy, stroke-like symptom, coma (10%)
Renal Impairment	Proteinuria, microhaematuria
Non-specific symptoms	Pallor, jaundice, fatigue, arthralgia or myalgia
Jaundice	Resulting from microangiopathic haemolytic anaemia
Cardiac	Chest pain, heart failure, hypotension
Gastro-intestinal tract(GI)	Abdominal pain, nausea and vomiting
Skin	Skin bleeding – purpura and petechiae

Common Symptoms

Common symptoms of TTP include:^[2]^[3]
- History of autoimmune disease like SLE
- History of surgery or transplant
- Drug history
- Initial symptoms: Fatigue, pale and/or red skin, shortness of breath, bruises, bleeding
- Headache
- Numbness
- Weakness
- Dizziness
- Palpitation
- Abdominal pain
- Easy bruising
- Nausea and vomiting
- Fever
- Changes in the urine

Less Common Symptoms

Less common symptoms of TTP include:
- Chills
- Chest pain
- Cough

References

↑ Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, Cheung B, Machin SJ (August 2012). “Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies”. Br. J. Haematol. 158 (3): 323–35. doi:10.1111/j.1365-2141.2012.09167.x. PMID 22624596.
↑ Griffin D, Al-Nouri ZL, Muthurajah D, Ross JR, Ballard RB, Terrell DR; et al. (2013). “First symptoms in patients with thrombotic thrombocytopenic purpura: what are they and when do they occur?”. Transfusion. 53 (1): 235–7. doi:10.1111/j.1537-2995.2012.03934.x. PMC 3541531. PMID 23294213.
↑ Medina PJ, Sipols JM, George JN (September 2001). “Drug-associated thrombotic thrombocytopenic purpura-hemolytic uremic syndrome”. Curr. Opin. Hematol. 8 (5): 286–93. PMID 11604563.

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[pmid22624596-1] Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, Cheung B, Machin SJ (August 2012). “Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies”. Br. J. Haematol. 158 (3): 323–35. doi:10.1111/j.1365-2141.2012.09167.x. PMID 22624596.

[pmid23294213-2] Griffin D, Al-Nouri ZL, Muthurajah D, Ross JR, Ballard RB, Terrell DR; et al. (2013). “First symptoms in patients with thrombotic thrombocytopenic purpura: what are they and when do they occur?”. Transfusion. 53 (1): 235–7. doi:10.1111/j.1537-2995.2012.03934.x. PMC 3541531. PMID 23294213.

[pmid11604563-3] Medina PJ, Sipols JM, George JN (September 2001). “Drug-associated thrombotic thrombocytopenic purpura-hemolytic uremic syndrome”. Curr. Opin. Hematol. 8 (5): 286–93. PMID 11604563.

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