THROMBOTIC THROMBOCYTOPENIC PURPURA: A CASE REPORT AND REVIEW OF LITERATURE

Introduction :  Thrombotic thrombocytopenic purpura (TTP) is a syndrome that consists of the pentad of thrombocytopenia, microangiopathic hemolytic anemia, neurologic abnormalities, fever and renal disease.  Moskowitz was the first who described this syndrome in 1925, finding hyaline thrombi in many organs. The micro thrombi cause tissue ischemia, platelet consumption, and microangiopathic hemolytic anemia. Brain involvement is common and leads to stroke, seizure, confusion, and headache. Renal injury occurs in a minority of patients and it is usually modest. Case report :  We present a 57-year old male who came to our hospital because of weakness, prostration and darkening of his urine, occurring several days before admission. On physical examination we found icteric coloring of his skin and conjunctiva, big hematoma on his right lower leg and he had neurological abnormalities presented as mild headache, disorientation and aphasia. Laboratory tests revealed anemia and thrombocytopenia and the examination of peripheral blood smear showed presence of schistocytes.  Direct and indirect antiglobulin test (Coombs) was negative. Emergency treatment was started with plasmapheresis on daily basis, immunosuppressive treatment with high-dose methyl prednisolone and transfusions of red blood cells. The laboratory results and the clinical condition improved within two weeks. Conclusion : TTP is a medical condition that can be fatal if emergency treatment with plasma pheresis is not initiated presently after suspected diagnosis.