Date: [Date of encounter]
Patient: [Patient Name]
Chief Complaint:
Document the patient’s main concerns, such as fatigue, easy bruising, bleeding (e.g., petechiae, epistaxis, menorrhagia), neurological symptoms (headache, confusion, seizures, coma), or signs of organ dysfunction (abdominal pain, shortness of breath).
History of Present Illness:
Onset and duration of symptoms.
Progression of symptoms over time.
Severity of bleeding symptoms.
Any recent illness, infections, vaccinations, or drug exposures.
History of prior thrombotic events (e.g., deep vein thrombosis, pulmonary embolism).
Past Medical History:
Underlying medical conditions (e.g., HIV, autoimmune diseases, pregnancy).
History of similar episodes suggestive of TTP.
Surgical history (including splenectomy).
Medication history (focusing on medications that can trigger TTP, e.g., ticlopidine, quinine).
Family History:
Family history of TTP or autoimmune diseases.
Social History:
Tobacco use (may increase risk of thrombosis).
Physical Exam:
Vital signs (may be normal or show signs of infection or organ dysfunction).
General examination (assess for fever, pallor, jaundice, petechiae, or signs of organomegaly).
Neurological examination (assess for mental status, focal deficits, or signs of increased intracranial pressure).
Laboratory Tests:
Complete blood count (CBC) with confirmation of thrombocytopenia (platelet count less than 150,000/mcL) and microangiopathic hemolytic anemia (fragmented red blood cells on peripheral smear).
Peripheral blood smear for morphology.
Coagulation studies (PT, PTT) – may be prolonged despite low platelet count.
LDH (lactate dehydrogenase) – typically elevated in TTP.
Reticulocyte count – may be low despite anemia.
ADAMTS13 activity – a specific test to diagnose TTP, measures a plasma protein crucial for preventing platelet aggregation.
Depending on suspected cause, additional tests may be ordered:
Viral serologies (HIV, hepatitis)
Autoimmune workup (if suspicion of secondary TTP)
Assessment:
Clinical suspicion of TTP based on pentad of symptoms (thrombocytopenia, microangiopathic hemolytic anemia, neurological symptoms, fever, renal dysfunction) – not all features may be present initially.
Confirmation with laboratory findings, including low platelet count, microangiopathic hemolytic anemia, and typically, a severely low ADAMTS13 activity.
Severity of TTP based on clinical presentation and laboratory abnormalities.
Identification of potential triggers (e.g., infection, medications).
Plan:
Urgent Management: This is a medical emergency requiring prompt initiation of plasma exchange (PLEX) with fresh frozen plasma (FFP) to replace ADAMTS13 activity and remove inhibitory factors.
Adjunctive Therapy: Depending on the suspected cause:
Corticosteroids for cases with underlying autoimmune conditions.
Rituximab for recurrent TTP.
Supportive Care:
Management of bleeding and anemia with blood transfusions if needed.
Management of organ dysfunction (e.g., dialysis for renal failure).
Neurological supportive care (seizure prophylaxis, management of increased intracranial pressure).
Monitoring: Close monitoring of platelet count, LDH, ADAMTS13 activity, and organ function tests.
Consultation: Consider referral to a hematologist for co-management and treatment optimization.
Patient Education:
Educate the patient about TTP, the importance of early diagnosis and treatment, and potential complications.
Discuss the need for adherence to treatment plan and follow-up care.
Provide information on avoiding potential triggers if identified.
Follow-up:
Frequent monitoring is necessary until remission is achieved (normalization of platelet count and ADAMTS13 activity).
Long-term follow-up to monitor for recurrence and manage potential complications.
Disclaimer: This template is for informational purposes only and should be adapted to fit the specific needs of each patient. The diagnosis and management of TTP require prompt action and close collaboration with a hematologist