Case history
Case history
A 40-year-old overweight black woman presents with a 1- to 2-week prodrome of fatigue and malaise with diarrhoea and vomiting. Examination is normal except for slight confusion and petechiae on her lower extremities. Laboratory studies show a haematocrit of 25% and a platelet count of 10 x 10⁹/L (10,000/microlitre). Lactate dehydrogenase is raised. Serum creatinine is 97.2 micromol/L (1.1 mg/dL). Peripheral smear shows fragmented red blood cells (schistocytes) and an raised reticulocyte count.
Other presentations
Atypical presentations include schistocyte-less TTP, where schistocytes may be absent from the blood film in the first 24 to 48 hours (however, they are usually found on evaluation of the blood film at presentation); peripheral digit ischaemia, which occurs when microthrombi disrupt blood flow to the digits; or sudden cardiac death, which is diagnosed by postmortem examination of the heart showing microthrombi in the vasculature.[11][12]
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