Approach to the Critical Patient

Immediate priorities

Recognition and resuscitation triggers

Monitoring and targets

Hemodynamic and neurologic monitoring

Escalation triggers

Critical escalation criteria

Immediate consults

Consultation priorities

History

Presenting symptoms

Neurologic symptoms (most common: 39 to 80% of cases)

Hematologic and constitutional symptoms

Cardiopulmonary and GI symptoms

Risk factors and triggers

Demographic risk factors

Associated conditions and triggers

Drug triggers

Alarm features

High-risk historical features

Physical Exam

Vitals and general appearance

Vital sign patterns

Skin and mucosal findings

Bleeding manifestations

Hemolysis signs

Neurologic exam

Altered mental status assessment

Seizure assessment

Cardiovascular and abdominal exam

Cardiac findings

Abdominal exam

PITFALLS

Diagnostic pitfalls

Differential Diagnosis

Thrombotic microangiopathy spectrum

Primary TMA diagnoses

Mimics with overlapping hematologic features

Hematologic mimics

Pregnancy-related TMA

Other important mimics

Systemic disease-related

Laboratory Tests

Essential diagnostic labs

Peripheral blood smear

Hemolysis panel

Confirmatory and ruling-out labs

ADAMTS13 activity assay

Anti-ADAMTS13 antibody testing

Direct antiglobulin test (DAT)

Organ injury and baseline labs

Cardiac biomarkers

Renal function

Coagulation studies

Infection and immune workup

Diagnostic Tests

Scoring Systems

PLASMIC score

French Thrombotic Microangiopathies score (FTM)

MRI

Brain MRI indications

MRI brain findings in TTP

CT

CT head without contrast

CT abdomen-pelvis

Ultrasound

Echocardiography (cardiac ultrasound)

Abdominal ultrasound

Point-of-care ultrasound (POCUS)

Disposition

Admission and level of care

All suspected TTP requires hospital admission

ICU admission criteria

Discharge criteria

Criteria for hospital discharge

Outpatient follow-up plan

Treatment

Emergency initiation of TPE

Therapeutic plasma exchange (TPE)

Corticosteroids

Corticosteroid therapy

Rituximab

Rituximab (anti-CD20 monoclonal antibody)

Caplacizumab

Caplacizumab (anti-vWF Nanobody)

Contraindicated and avoided treatments

Platelet transfusion

Drug avoidance

Refractory TTP management

Salvage therapies

Special Populations

Pregnancy

Pregnancy-associated TTP

Geriatric

Older adult considerations

Pediatrics

Pediatric TTP considerations

Background

Epidemiology

Incidence and demographics

Associated conditions distribution

Pathophysiology

ADAMTS13 deficiency mechanism

Organ injury mechanisms

Therapeutic Considerations

Triple therapy paradigm

ADAMTS13-guided preemptive therapy

Congenital TTP management

Patient Discharge Instructions

copy discharge instructions

Diagnosis and why it is serious

Medications at home

Activity and diet

Warning signs: return to the emergency room immediately for

Follow-up

References

Guidelines and key sources

Primary guidelines

Key clinical trials and studies

Landmark trials and evidence

Coding and classification

ICD-10 and classification

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.