Document Detail

Morphologic diagnosis of thrombotic thrombocytopenic purpura.
MedLine Citation:
PMID:  14695628     Owner:  NLM     Status:  MEDLINE    
The diagnosis of thrombotic thrombocytopenic purpura (TTP) rests on evidence of microangiopathic hemolytic anemia and thrombocytopenia in the absence of disseminated intravascular coagulation and other known causes of thrombotic microangiopathy. Highly specific diagnostic tools such as serum levels of ADAMTS13 are not routinely available for immediate clinical diagnosis. The presence of schistocytes on a blood smear is the morphologic hallmark of the disease, but no guidelines exist as to the number of schistocytes required to differentiate TTP from other thrombotic microangiopathies. We studied 6 patients with TTP and compared their schistocyte counts with those of 40 normal subjects, 28 patients with chronic renal disease, 5 with preeclampsia, and 5 with normal functioning mechanical heart valves. The mean schistocyte count for the TTP patients was 8.35% versus 0.05% for normal subjects, 0.2% for renal patients, 0.25% for preeclamptic patients, and 0.18% for patients with mechanical valves (P < 0.001). Schistocytes were found on 100% of blood films of TTP patients and ranged from 1.0% to 18.4% of red cells. Schistocytes are found on the smears of 58% of normal individuals and on 80-100% of the other patient groups studied, but always comprise less than 0.5% of the red cell population. An initial schistocyte count of greater than 1% strongly suggests a diagnosis of TTP in the absence of other known causes of thrombotic microangiopathy.
Edward R Burns; Yenmay Lou; Anjali Pathak
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of hematology     Volume:  75     ISSN:  0361-8609     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2003-12-25     Completed Date:  2004-02-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-21     Citation Subset:  IM    
Copyright Information:
Copyright 2003 Wiley-Liss, Inc.
Department of Pathology, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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MeSH Terms
Case-Control Studies
Chronic Disease
Diagnosis, Differential
Erythrocyte Count
Erythrocytes, Abnormal / pathology*
Heart Valve Prosthesis
Kidney Diseases / pathology
Pre-Eclampsia / pathology
Purpura, Thrombotic Thrombocytopenic / blood*,  pathology

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