Thrombotic Thrombocytopenic Purpura (TTP).
Medgeeks with Andrew Reid
Medgeeks
4.8 • 996 Ratings
🗓️ 31 January 2019
⏱️ 8 minutes
🧾️ Download transcript
Summary
Today, we have a 35 year old African American female with a past medical history of hypertension, who presents to the emergency department.
He has a two week history of a viral upper respiratory symptoms, including a low grade fever, cough, nasal congestion, rhinorrhea, sore throat, decreased oral intake - followed by a persistent nose bleed.
The nose bleed began over the last couple days and isn't stopping despite persistent pressure. And over the last 24 hours, she had a change in her mental status per her family.
Her exam was unremarkable.
Her vitals: 100.2 F, HR 90s, BP 145/82, and 98% O2 RA.
Initial labs revealed:
- WBC: 18,000
- H/H: 9/27
- Platelets: 7,000
- Creatinine: 1.4
- Total bilirubin: 3
- LDH: 1,500
- Normal fibrinogen, D-dimer, PT, INR
- Peripheral smear: moderate schistocytes
What's your diagnosis?
Well, at this point, we are thinking Thrombotic thrombocytopenic purpura (TTP).
Today, we are going to break this disease down for you.
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Transcript
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| 0:00.0 | Team Zack here from med geeks today I have a good case that I want to review with you folks |
| 0:05.3 | so a 35 year old African American female with the past medical history of |
| 0:11.2 | hypertension presents to the ER, has a two-week history of viral upper respiratory symptoms, |
| 0:18.0 | including a low-grade fever, 99 to 100 over the past couple weeks,ough, nasal congestion, rhinorrhea, |
| 0:25.4 | sore throat, decreased oral intake, |
| 0:27.5 | followed by this persistent nosebleed |
| 0:30.4 | over the past couple days that just didn't stop with any pressure. And then over the past couple of days that just didn't stop with any pressure and then over the past 24 hours had a change in her mental status. |
| 0:38.0 | Per her family, the patient wasn't really acting herself and was more confused. On exam, unremarkable, no findings whatsoever. |
| 0:48.0 | Initial vitals reveal a low-grade temp of 100.2, heart rate 90s, pressure was 1.45 over 82 and that oxygen |
| 0:56.6 | saturation is 96% on room air. Initial labs reveal the white count of |
| 1:01.6 | 18,000 H H&H 9 over 27, platelets of 7, |
| 1:09.2 | karateenine of 1.4, a total Billy Rubin of 3, L.D.H of 1,500, remember normal's less than 200, a normal |
| 1:19.8 | fibrenogen, a normal D-dimer and normal p t-nr peripheral smear showed moderate schistocytes |
| 1:29.1 | so what diagnosis do we have |
| 1:44.0 | T. T. T. T. P. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T. T, let's kind of run through TTP. |
| 1:46.0 | So epidemiology, the peak age 30 to 40, |
| 1:49.4 | it's more common in women. |
| 1:51.6 | And it's a rare blood disorder, and don't see it too often. |
| 1:55.0 | Pathophysiology, I find this actually very interesting, so it's congenital or acquired |
| 2:00.0 | and what it is it's a deficiency in the enzyme atom T.S. 13. |
| 2:05.0 | Remember this for testing purposes. |
| 2:08.0 | T. T.P. Adam. |
... |
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