Thrombotic Thrombocytopenic Purpura (TTP) / Hemolytic Uremic Syndrome vs Disseminated Intravascular Coagulation
Thrombotic Thrombocytopenic Purpura (TTP) / Hemolytic Uremic Syndrome and Disseminated Intravascular Coagulation are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Thrombotic Thrombocytopenic Purpura (TTP) / Hemolytic Uremic Syndrome vs Disseminated Intravascular Coagulation at a glance
- Thrombotic Thrombocytopenic Purpura (TTP) / Hemolytic Uremic Syndrome: Thrombotic microangiopathies — TTP from ADAMTS13 deficiency, HUS classically from Shiga toxin; both produce microangiopathic hemolysis with thrombocytopenia.
- Disseminated Intravascular Coagulation: Systemic activation of coagulation with simultaneous thrombosis and bleeding — always secondary to an underlying trigger.
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Side-by-side comparison
| Feature | Thrombotic Thrombocytopenic Purpura (TTP) / Hemolytic Uremic Syndrome | Disseminated Intravascular Coagulation |
|---|---|---|
| At a glance | Thrombotic microangiopathies — TTP from ADAMTS13 deficiency, HUS classically from Shiga toxin; both produce microangiopathic hemolysis with thrombocytopenia. | Systemic activation of coagulation with simultaneous thrombosis and bleeding — always secondary to an underlying trigger. |
| Classic presentation | Microangiopathic hemolytic anemia + thrombocytopenia + schistocytes on smear + normal coagulation studies — assume TTP/HUS until proven otherwise.; Classic TTP pentad (rarely all 5; even 2 of 5 in correct context warrants treatment): microangiopathic hemolytic anemia, thrombocytopenia, neurologic symptoms (confusion, headache, focal… | Septic patient with widespread oozing from IV sites plus thrombocytopenia, prolonged PT/PTT, low fibrinogen, and elevated D-dimer.; Bleeding: oozing from IV sites, mucosal bleeding, hematuria, GI bleeding, intracranial hemorrhage; Thrombosis: purpura fulminans (especially meningococcemia, post-infectious), digital ischemia, gangrene of… |
| Workup / key labs | Microangiopathic hemolytic anemia + thrombocytopenia + schistocytes ± end-organ dysfunction. TTP confirmed by ADAMTS13 activity <10%; STEC-HUS by positive stool studies; aHUS by exclusion + complement workup.; CBC — anemia, thrombocytopenia (often <50K in TTP, <100K in HUS); Peripheral smear — schistocytes (helmet cells, fragmented… | Clinical setting consistent with DIC + thrombocytopenia + prolonged PT/PTT + low or falling fibrinogen + elevated D-dimer. Formal scoring by ISTH overt DIC score.; CBC — thrombocytopenia; Peripheral smear — schistocytes (microangiopathic hemolysis); PT prolonged, PTT prolonged (factor consumption); Fibrinogen LOW (or falling from a high… |
| Imaging | Head CT/MRI if neurologic symptoms (exclude hemorrhage before plasma exchange line placement); Renal ultrasound if persistent AKI | Directed by suspected underlying cause (CT abdomen/pelvis for trauma or sepsis source, head CT for hemorrhage, obstetric ultrasound) |
| First-line treatment | TTP (acquired): EMERGENCY plasma exchange (PLEX) — initiate as soon as TTP suspected; do not wait for ADAMTS13 result. Replaces deficient ADAMTS13 and removes autoantibody. Daily until platelet count >150K for ≥2 days; TTP: high-dose glucocorticoids (methylprednisolone 1 g IV × 3 days or prednisone 1 mg/kg) to suppress autoantibody;… | TREAT THE UNDERLYING CAUSE — most important and definitive intervention (source control, empiric antibiotics, deliver fetus, treat APL with ATRA + arsenic, etc.); Supportive care: hemodynamic resuscitation, ventilation, renal replacement as needed; Bleeding patient: fresh frozen plasma (FFP) for prolonged PT/PTT, cryoprecipitate if… |
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