Thrombotic Thrombocytopenic Purpura: A Review of the Disease Entity, its Clinical and Laboratory Features, and Management Strategies

Abstract

The patient is a 47-year-old female with a history of coronary artery disease, hypertension, asthma, diabetes and obstructive sleep apnea who presented to an outside hospital with shortness of breath and lethargy. The patient was found to be in diabetic ketoacidosis, which was treated with an insulin drip. She also had a platelet count of 8 x 10 9 /L on initial laboratory studies. She was presumed to have immune thrombocytopenic purpura (ITP) and treated with five days of intravenous immunoglobulin (IVIG) without improvement. She was transferred to Thomas Jefferson University Hospital for further management. Initial vital signs included a temperature of 100.1 degrees Fahrenheit, pulse of 101 beats per minute, respiratory rate of 20 breaths per minute, blood pressure of 107/45 mmHg and oxygen saturation of 100% on room air. On physical exam, she was lethargic and not oriented. She had pupils that were equally round and reactive to light; her extraoccular muscles were intact. She had no lymphadenopathy. Her cardiac exam revealed a regular rate and rhythm with no murmurs. She had no crackles in her lung fields. Her abdomen was soft, non-tender, non-distended, with normal bowel sounds. Her extremities demonstrated purpuric lesions throughout, but were non-edematous. Laboratory studies showed a hemoglobin of 6.5 g/dl, white blood cell count of 13.3 x10 9