Atypical Presentation of Thrombotic Thrombocytopenic Purpura in a Patient with Elevated Troponin Level in an Emergency Room and Critical Care Unit Setting

Division

East Florida

Hospital

Aventura Hospital and Medical Center

Document Type

Case Report

Publication Date

10-31-2019

Keywords

ADAMTS13, Thrombotic Microangiopathy, Plasmapheresis, Schistocytes, Thrombotic Thrombocytopenic Purpura, Troponin

Disciplines

Critical Care | Medicine and Health Sciences | Pulmonology

Abstract

The following case report follows a 56-year-old male who presented to the emergency room complaining of chest pain, sweating, headache, and nausea. Initially, the patient was given a working diagnosis of non-ST-elevation myocardial infarction. However, further observation, lab studies, and specialty consultations contributed to a final diagnosis of thrombotic thrombocytopenic purpura. This report discusses the atypical presentation of thrombotic thrombocytopenic purpura, its differential diagnosis, and the critical management thereof, in order to promptly recognize and treat this life-threatening condition. In particular, this report highlights the following: 1) an elevated troponin level is not always indicative of myocardial infarction; 2) the ADAMTS-13 test cannot be relied upon immediately as it takes time (days or longer) to receive this lab result; 3) TMA is an umbrella term including TTP, HUS, and DIC, and must be differentially diagnosed; and 4) a peripheral smear exposing the presence of schistocytes can be decisive in confirming the diagnosis of thrombotic thrombocytopenic purpura

Publisher or Conference

EC Emergency Medicine and Critical Care

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