A 33-year-old woman comes to the physician because of a 3-day history of headaches, and fatigue The patient does not appear to be in acute distress. Temperature is 37.7 C (99.9 F), blood pressure is 115/65 mm Hg, and pulse is 78/min. Light touch sensation is decreased in the right upper extremity and the lower right side of the face. Evaluation reveals severe thrombocytopenia. Laboratory results are as follows: PT and PTT are normal. Peripheral blood smear shows numerous schistocytes. Urinalysis is positive for mild proteinuria. Which of the following is the most likely underlying cause of this patient's current condition?

Question

A 33-year-old woman comes to the physician because of a 3-day history of headaches, and fatigue The patient does not appear to be in acute distress.  Temperature is 37.7 C (99.9 F), blood pressure is 115/65 mm Hg, and pulse is 78/min. Light touch sensation is decreased in the right upper extremity and the lower right side of the face.  Evaluation reveals severe thrombocytopenia.  Laboratory results are as follows:  PT and PTT are normal.  Peripheral blood smear shows numerous schistocytes.  Urinalysis is positive for mild proteinuria.  Which of the following is the most likely underlying cause of this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Thrombotic thrombocytopenic purpura frequently results from impaired function of the von Willebrand factor (vWF)-cleaving protease ADAMTS-13, which causes the accumulation of uncleaved vWF multimers that are significantly more prothrombotic.  Patients develop diffuse microvascular thrombosis, which leads to thrombocytopenia and microangiopathic hemolytic anemia.

A 33-Year-Old Woman Comes to the Physician Because of a 3-Day