EM7 Thrombotic thrombocytopenic purpura (TTP) presenting as gastroenteritis. (Emergency Medicine).
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 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. 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 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 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, sulfapyrazone, dextran, aspirin). Refractory patients may require splenectomy, or immunosuppression with vincristine or cyclophosphamide.
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|Publication:||Southern Medical Journal|
|Article Type:||Brief Article|
|Date:||Dec 1, 2001|
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