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Platelet Count and Prothrombin Time Help Distinguish Thrombotic Thrombocytopenic Purpura–Hemolytic Uremic Syndrome From Disseminated Intravascular Coagulation in Adults

Yara A. Park MD, Michael R. Waldrum MD, Marisa B. Marques MD
DOI: http://dx.doi.org/10.1309/AJCPPNF63FLIORCI 460-465 First published online: 1 March 2010


Thrombotic thrombocytopenic purpura–hemolytic uremic syndrome (TTP-HUS) and disseminated intravascular coagulation (DIC) may have identical manifestations in adults. Because TTP-HUS is 90% fatal without plasma exchange, prompt diagnosis is essential. To test the hypothesis that routine laboratory assays can discriminate between the 2 entities, we retrospectively identified adult patients with TTP-HUS and matched each with 2 patients with DIC. Although the platelet count, prothrombin time (PT), and partial thromboplastin time were different (P < .05) between the 2 patient groups, after regression analysis, only PT and profound thrombocytopenia remained associated with TTP-HUS (P = .001 and P = .003, respectively). A platelet count of less than 20 × 103/μL (20 × 109/L) and a PT within 5 seconds of the upper limit of the reference interval had a specificity of 92% for TTP-HUS. Our data confirm that readily available laboratory assays in the proper clinical scenario can increase the likelihood of TTP-HUS over DIC.

Key Words:
  • Thrombotic thrombocytopenic purpura
  • Hemolytic uremic syndrome
  • Disseminated intravascular coagulation
  • Prothrombin time
  • Thrombocytopenia
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