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Thrombocytopenia is encountered commonly in the emergency department (ED). A wide array of conditions and disorders can cause thrombocytopenia. In most instances, the emergency physician will not be able to determine the definitive diagnosis, but it is important that the initial evaluation be started in a timely manner and that appropriate specialists be consulted from the ED.
This article will review four emergent hematologic conditions associated with thrombocytopenia: thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), disseminated intravascular coagulation (DIC), and immune thrombocytopenia (ITP). During the last 20 years, there has been advancement in our understanding of the pathophysiology of these conditions and some improvement in the treatment. It has been determined that TTP and HUS are two separate disease entities, and not a spectrum of one condition. DIC usually is found in hospitalized patients with serious infections, although some patients may have manifestations during time in the ED. While many novel therapies have been proposed to treat DIC, none have proven beneficial. The classification of ITP has been changed extensively over the past few years, and there are many new therapies that are challenging the standard treatment of steroids and splenectomy. This article will discuss the general approach to identification and initial treatment for each of these conditions.
— The Editor
Thrombotic Thrombocytopenic Purpura Introduction
TTP is a rare, life-threatening hematologic disorder. It was described first in 1924 as a set of clinical criteria including fever, thrombocytopenia, microangiopathic hemolytic anemia, acute kidney injury, and neurologic symptoms. TTP historically has a mortality nearing 90% if left untreated. 1,2 Given the high mortality and unknown etiology, it became an area of increasing study in hematology.
Current understanding of this disorder has evolved beyond the five features noted above. The pathophysiology of TTP now is understood to involve a deficiency in activity of...