Department of Pathology and Laboratory Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514, USA.
Am J Clin Pathol. 2010 Mar;133(3):460-5. doi: 10.1309/AJCPPNF63FLIORCI.
Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) and disseminated intravascular coagulation (DIC) may have identical manifestations in adults. Because TTP-HUS is 90% fatal without plasma exchange, prompt diagnosis is essential. To test the hypothesis that routine laboratory assays can discriminate between the 2 entities, we retrospectively identified adult patients with TTP-HUS and matched each with 2 patients with DIC. Although the platelet count, prothrombin time (PT), and partial thromboplastin time were different (P < .05) between the 2 patient groups, after regression analysis, only PT and profound thrombocytopenia remained associated with TTP-HUS (P = .001 and P = .003, respectively). A platelet count of less than 20 x 10(3)/microL (20 x 10(9)/L) and a PT within 5 seconds of the upper limit of the reference interval had a specificity of 92% for TTP-HUS. Our data confirm that readily available laboratory assays in the proper clinical scenario can increase the likelihood of TTP-HUS over DIC.
血栓性血小板减少性紫癜-溶血尿毒症综合征（TTP-HUS）和弥散性血管内凝血（DIC）在成人中可能具有相同的表现。由于 TTP-HUS 未经血浆置换治疗的病死率高达 90%，因此早期诊断至关重要。为了验证常规实验室检测能否区分这两种病症的假说，我们回顾性地确定了患有 TTP-HUS 的成年患者，并将每位患者与 2 位患有 DIC 的患者相匹配。尽管血小板计数、凝血酶原时间（PT）和部分凝血活酶时间在两组患者之间存在差异（P＜0.05），但经回归分析后，仅 PT 和严重血小板减少与 TTP-HUS 相关（P=0.001 和 P=0.003）。血小板计数＜20×10^3/μL（20×10^9/L）和 PT 接近参考区间上限的 5 秒内，对 TTP-HUS 的特异性为 92%。我们的数据证实，在适当的临床情况下，易于获得的实验室检测可提高 TTP-HUS 而非 DIC 的可能性。
