Early Recognition of Atypical Thrombotic Thrombocytopenic Purpura (TTP) in Severe Asymptomatic Thrombocytopenia Using the PLASMIC Score and Peripheral Blood Smear

TL;DR

This case study shows how a rare blood disorder was diagnosed early using a scoring system and blood smear in a patient with unclear symptoms.

Contribution

The paper demonstrates the utility of the PLASMIC score and blood smear in diagnosing atypical TTP in a non-classical clinical setting.

Findings

A patient with severe thrombocytopenia and no classic TTP symptoms was diagnosed with immune TTP using the PLASMIC score and blood smear.

Early diagnosis of atypical TTP allowed timely treatment and likely prevented severe complications.

Chronic alcohol use and vitamin B12 deficiency complicated the diagnosis but were managed through comprehensive evaluation.

Abstract

Thrombotic thrombocytopenic purpura (TTP) is the clinical syndrome of cluster symptoms of thrombotic microangiopathy, which rarely manifests with all classic symptoms of fever, neurological changes, acute kidney failure, hemolytic anemia, and thrombocytopenia. This case describes a patient who was admitted for acute abdominal pain, initially suspected to be pancreatitis, and found to have severe, asymptomatic thrombocytopenia. The diagnostic challenge was compounded by overlapping factors, including chronic alcohol use and vitamin B12 deficiency. A comprehensive workup, including PLASMIC score (platelet count, hemolysis, absence of active cancer, absence of solid organ or stem cell transplant, mean corpuscular volume, international normalized ratio, and creatinine) assessment and peripheral blood smear, ultimately led to the diagnosis of acquired immune TTP (iTTP). Early recognition enabled timely treatment and likely prevented severe complications.

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