What is thrombotic thrombocytopenic purpura (TTP)?

Updated: May 25, 2021
  • Author: Theodore Wun, MD, FACP; Chief Editor: Srikanth Nagalla, MD, MS, FACP  more...
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Answer

Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder characterized by clotting in small blood vessels (thromboses), resulting in a low platelet count. [1] In its full-blown form, the disease consists of the following pentad:

  • Microangiopathic hemolytic anemia
  • Thrombocytopenic purpura
  • Neurologic abnormalities
  • Fever
  • Kidney disease

To make an accurate diagnosis, the clinician must recognize the similarity between TTP and hemolytic-uremic syndrome (HUS). [2] In addition to HUS, the differential diagnosis also includes immune thrombocytopenia (ITP) and disseminated intravascular coagulation (DIC), two entities with very different modes of therapy (see the image below).

Differential diagnosis of immune thrombocytopenia (ITP), thrombotic thrombocytopenic purpura (TTP), and disseminated intravascular coagulation (DIC).

Differential diagnosis of immune thrombocytopenia Differential diagnosis of immune thrombocytopenia (ITP), thrombotic thrombocytopenic purpura (TTP), and disseminated intravascular coagulation (DIC).

Secondary TTP has been associated with the use of certain drugs, including chemotherapy drugs such as gemcitabine and mitomycin and antiplatelet agents such as clopidogrel and ticlopidine. If secondary TTP is suspected, the offending drug should be discontinued.

See Cancer Chemotherapy: Keys to Diagnosing Common Toxicities, a Critical Images slideshow, to help recognize some of the more common complications of chemotherapy.


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