Additional/alternative diagnoses in patients presenting with clinically suspected TTP-HUS
| Additional diagnoses (apparent at the time of initiation of plasma exchange treatment): |
| Preeclampsia/eclampsia/HELLP syndrome |
| Autoimmune disorders (examples: systemic lupus erythematosus,44 scleroderma,9antiphospholipid antibody syndrome45) |
| Alternative diagnoses (only apparent or appreciated after plasma exchange is initiated) |
| Sepsis (examples: Rocky Mountain spotted fever, cytomegaloviral sepsis, disseminated aspergillosis, β-streptococcal sepsis) |
| Disseminated malignancy (examples: metastatic pancreatic or lung carcinoma,46 acute lymphocytic leukemia) |
| Malignant hypertension47 |
| Heparin-induced thrombocytopenia/thrombosis |
| Additional diagnoses (apparent at the time of initiation of plasma exchange treatment): |
| Preeclampsia/eclampsia/HELLP syndrome |
| Autoimmune disorders (examples: systemic lupus erythematosus,44 scleroderma,9antiphospholipid antibody syndrome45) |
| Alternative diagnoses (only apparent or appreciated after plasma exchange is initiated) |
| Sepsis (examples: Rocky Mountain spotted fever, cytomegaloviral sepsis, disseminated aspergillosis, β-streptococcal sepsis) |
| Disseminated malignancy (examples: metastatic pancreatic or lung carcinoma,46 acute lymphocytic leukemia) |
| Malignant hypertension47 |
| Heparin-induced thrombocytopenia/thrombosis |
In patients with established diagnoses of preeclampsia, TTP-HUS may be suspected because of the severity of neurologic and renal abnormalities and their persistence for longer than several days after delivery. Patients with an autoimmune disorder in whom hematologic, neurologic, and renal manifestations are severe and refractory to immunosuppressive treatment may be treated with plasma exchange for a possible additional diagnosis of TTP-HUS. In some patients, an alternative explanation for the signs and symptoms of TTP-HUS only becomes apparent or appreciated after plasma exchange is initiated; some examples from The Oklahoma TTP-HUS Registry are listed. Selected references are provided.