Thrombotic Thrombocytopenia Purpura

Patients with Thrombotic Thrombocytopenia Purpura, or TTP, are often times seen in the emergency department and subsequently admitted to the inpatient or the critical care unit. The problems that TTP patients can present with vary greatly and astute nursing assessment plus knowledge of the pathophysiology behind the diagnosis is vital to deliver excellent nursing care. Thrombotic Thrombocytopenia Purpura or TTP is a rare but potentially fatal condition that occurs as result of decreased levels of ADAMTS-13, a cleaving protease for von Willebrand factor (vWF), which causes platelet aggregation and microvascular thrombi and subsequent end-organ damage, along with thrombocytopenia, hemolytic anemia, and possible neurologic and renal impairment (Kappler, Ronan-Bentle, & Graham, 2014). TTP belongs to a group of disorders called thrombotic microangiopathies. Also included in this group are Hemolytic Uremic Syndrome (HUS), and pregnancy-induced hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome (Kappler et al., 2014). The decreases in ADAMTS-13, causing TTP, can either be congenital, idiopathic, or acquired as a result of autoantibodies, drugs, or malignancies (Trachtman, 2013). TTP can occur spontaneously or be triggered by an infection, pregnancy, or other stimulus of autoantibodies and as many as 30% of those affected relapse after a remission (Rosove, 2014). Most commonly occurring in adults, primarily women, patients typically present with thrombocytopenia (with or without signs of bleeding), hemolytic anemia, fever, altered mental status or headaches, renal impairment, and abdominal or chest pain (Kappler et al, 2014). Treatment for TTP is plasma exchange therapy, with the goal of replacing the missing ADAMTS-13 and removing the contributing antibody (Kappler et al., 2014). Patients presenting with these symptoms may be cared for in many areas of practice and because correct diagnosis and prompt treatment are crucial in TTP, clinicians must be informed on signs, symptoms, and proper treatment. Without prompt recognition and treatment, mortality rates from TTP can be as high as 90% (Kappler et al., 201