A 35-year-old woman with neurologic symptoms presents with a markedly decreased platelet count. She has moderate anemia with many red cell fragments on the blood film, as well as polychromasia and nucleated red blood cells (RBCs). The prothrombin time (PT) and partial thromboplastin time (PTT) are both normal. Which of the following is most likely diagnosis?

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Quizplus · Accepted Answer

The combination of neurologic symptoms, significantly decreased platelet count, moderate anemia with red cell fragments on the blood film, polychromasia and nucleated RBCs point towards the diagnosis of thrombotic thrombocytopenic purpura (TTP). The normal PT and PTT rule out DIC. Hemolytic uremic syndrome (HUS) should also be considered in the differential diagnosis, but typically presents with more severe renal dysfunction and GI symptoms. Immune thrombocytopenic purpura (ITP) may present with a decreased platelet count, but typically without the presence of red cell fragments, polychromasia, or nucleated RBCs on the blood film.

A 35-Year-Old Woman with Neurologic Symptoms Presents with a Markedly