EM7 Thrombotic thrombocytopenic purpura (TTP) presenting as gastroenteritis. (Emergency Medicine).
EM7 THROMBOTIC THROMBOCYTOPENIC PURPURA thrombotic thrombocytopenic purpura
A disease of unknown origin, characterized by abnormally low levels of platelets in the blood, the formation of blood clots in the arterioles and capillaries of many organs, and neurological damage. (TTP) PRESENTING AS GASTROENTERITIS. Antonio E. Muniz, MD. Department of Emergency Medicine and Pediatrics, Medical College of Virginia of VCU, Richmond.
Thrombotic thrombocytopenic purpura is an uncommon cause of change in mental status in adults presenting to the emergency department. Change in mental status has a wide differential. Initial management should be directed at establishing an adequate airway and ensuring good oxygenation and ventilation. Assessment of vital signs and a thorough examination should be done. A detailed history should include the search for a possible ingestion or trauma. Finally, a comprehensive laboratory evaluation is done if the cause of the mental status change remains unknown. A 20-year-old man presented a 2-day history of epigastric epigastric adjective Referring to the body region between the costal margins and the subcostal plane abdominal pain, nausea, and vomiting. He denied fever, chills, urinary symptoms, and diarrhea. His medical history was unremarkable. His review of symptoms revealed intermittent gum bleeding for 2 weeks. He had a temperature of 38.2[degrees]C, blood pressure 107/79 mm Hg, heart rate 138/mm, and respiratory rate 20/min. His physical examination was remarkable for periods of confusion and lethargy. His skin was diaphoretic diaphoretic /di·a·pho·ret·ic/ (-fo-ret´ik)
1. pertaining to, characterized by, or promoting sweating.
2. an agent that promotes sweating.
adj. . Oral mucosa had dried dark blood. His WBC was 7,600/[mm.sup.3] with 30% neutrophils and 8% band forms. His hemoglobin was 10.1 g/dL antI platelets 26,000/[mm.sup.3]. His electrolytes were normal. His lactate dehydrogenase was 2,011 U/L with the remainder of the liver function tests Liver Function Tests Definition
Liver function tests, or LFTs, include tests for bilirubin, a breakdown product of hemoglobin, and ammonia, a protein byproduct that is normally converted into urea by the liver before being excreted by the kidneys. normal. His PT was 10.3 sec and PTT 34 sec. His lipase was 780 U/L and amylase 288 U/L. His chest radiograph was normal. The patient had plasmapheresis plasmapheresis, see apheresis. and was hospitalized. He slowly improved and was discharged in stable condition. TTP is a disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, diffuse and nonfocal neurologic symptoms, decreased renal function, and fever. Tissue hypoxia resulting from vessel occlusion most frequently manifest in the kidneys and CNS. Severity of disease correlates with the level of anemia, thrombocytopenia, and lactate dehydrogenase elevation. TTP has a high mortality if untreated. Treatment consists of plasmapheresis with plasma exchange, corticost eroids, and platelet-active agents (dipyridamole dipyridamole /di·py·rid·a·mole/ (di?pi-rid´ah-mol) a platelet inhibitor and coronary vasodilator used to prevent thromboembolism associated with mechanical heart valves, to treat transient ischemic attacks, and as an adjunct in , sulfapyrazone, dextran, aspirin). Refractory patients may require splenectomy Splenectomy Definition
Splenectomy is the surgical removal of the spleen, which is an organ that is part of the lymphatic system. The spleen is a dark-purple, bean-shaped organ located in the upper left side of the abdomen, just behind the bottom of the , or immunosuppression with vincristine or cyclophosphamide.