Bone marrow transplantation (in most patients, the etiology of the acute disorder diagnosed as TTP is actually sepsis and/or acute GVHD) Pregnancy (75% occur peripartum/postpartum; distinction from preeclampsia, eclampsia, and HELLP syndromes may be impossible) Drug-associated Acute, immune-mediated toxicity (quinine most common; also ticlopidine, clopidogrel) Insidious, dose-related toxicity (mitomycin C, alpha-interferon, cyclosporine, tacrolimus, other chemotherapeutic and immunosuppressive agents)
Bloody diarrhea prodrome (as in typical HUS of children, usually caused by enterohemorrhagic E. coli; however in adults, may or may not be associated with renal failure) Autoimmune disorders (patients with systemic lupus erythematosus, anti-phospholipid antibody syndrome, scleroderma, and polyarteritis nodosa can have signs suggesting consideration of TTP. In some patients, pathologic lesions and response to plasma exchange treatment are consistent with TTP as an additional diagnosis) Alternative disorders that may mimic TTP (sepsis [e.g., meningococcus, cytomegalovirus, aspergillosis, rocky mountain spotted fever], disseminated malignancy, malignant hypertension) Idiopathic, “typical” TTP (may have a prolonged clinical course with multiple exacerbations and subsequent relapses)
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