Table 4.
TTP & TTP-like syndrome (DIT) | TTP-like syndrome (DIT) associated with HC (e.g., sepsis) equal to acute “DIC” | DIC (e.g., APL) | PF (e.g., amyloidosis) | |
---|---|---|---|---|
Thrombocytopenia | Always present | Always present | Present due to APL, but not due to consumption (?) | Not present |
MAHA/aMAHA | Always present | Always present | Do not occur | Not present |
Fibrinogen | Normal | Decreased | Always decreased | Always decreased |
Factor VIII | Normal | Normal or increased | Markedly decreased | Decreased |
Factor V | Normal | Decreased | Decreased | Normal or decreased |
Factor X | Normal | Decreased | Usually normal | Normal (?) |
Factor VII | Normal | Markedly decreased | Normal | Normal |
Factor IX | Normal | Decreased | Normal | Normal |
FDP | Normal | ? | Positive | Strongly positive |
Prothrombin time | Normal | Prolonged | Prolonged | Prolonged |
Activated partial thromboplastin time |
Normal | Prolonged | Prolonged | Prolonged |
Thrombin time | Normal | Prolonged | Prolonged | Prolonged |
Thrombosis form | Microthrombi | Microthrombi | Friable fibrin clots (meshes) | Absent |
Bleeding: Character Treatment |
Petechiae; Usually no need of treatment |
May cause serious bleeding; Controllable with FFP & rFVIIa |
Common, serious bleeding; Abrogated with ATRA & chemotherapy |
Slow & persistent bleeding; Treatable with AFA |
Hypoxic organ dysfunction (MODS) |
Present | Present | Not present | Not present |
Platelet transfusion | Contraindicated | Contraindicated | May be used for APL | Not needed |
AFA anti-fibrinolytic agent, ATRA all-trans retinoic acid, “DIC” false disseminated intravascular coagulation, DIT disseminated intravascular microthrombosis, FDP fibrin degradation products, FFP fresh frozen plasma; HC hepatic coagulopathy; MAHA/aMAHA microangiopathic hemolytic anemia/atypical MAHA, PF primary fibrinolysis, TTP thrombotic thrombocytopenic purpura