A local ambulance company brings you a 25-year-old woman; her husband tells you “she's confused.” Temperature 38.9°C (102°F); blood pressure 130/100 mm Hg. She has a diffuse petechial rash and generalized edema. She is oriented only to self and is delirious. Laboratory studies show: BUN, 29 mg/dL; creatinine, 2.7 mg/dL; platelet count, 27,000/mm3; and hematocrit, 30% with numerous schistocytes seen on the peripheral smear. WBC count is normal with no left shift. Which of the following statements is TRUE?
The patient requires urgent heparinization.
A PT and PTT would probably be prolonged in this patient.
Antibiotic coverage is indicated.
Plasmaphoresis and treatment with fresh frozen plasma is needed.
Intravenous steroids are not recommended.
This patient has classic signs of thrombotic thrombocytopenic purpura (TTP) including anemia, thrombocytopenia, fever, neurologic, and renal dysfunction. Patients may present in coma. The PT and PTT are not prolonged in TTP. Heparinization is not routinely indicated for the initial treatment of TTP. Large doses of intravenous steroids are used if the diagnosis is suspected. Plasmaphoresis and transfusion with fresh frozen plasma may reverse the clinical and laboratory abnormalities.