An Overview of the Laboratory’s Role in the Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura

Billie Ketelsen

doi:10.29074/ascls.2020002253

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Table 1.

Original patient laboratory values for a 40-year-old female who was seen in the emergency department with abdominal pain over 3 days

Hematology	Reference Interval	Original Patient Values
WBC, bil/L	3.3–10.7	4.7
RBC, tril/L	3.87–5.08	3.3
Hemoglobin, g/dl	12.1–15	9.0
Hematocrit, %	34.4–44.2	27.8
MCV, fL	80–100	84
MCH, pg	28–32	27
MCHC, %	32–36	32
RDW, %	11.5–15.5	20
Platelet, bil/L	150–400	32
MPV, fL	8.5–12.5	14
IPF, %	1–11	15
Neutrophils, bil/L	1.6–7.2	3.2
Lymphocytes, bil/L	1.1–4.0	1
Monocytes, bil/L	0.0–0.8	0.4
Eosinophils, bil/L	0.0–0.5	0.0
Basophils, bil/L	0.0–0.1	0.0
Immature granulocytes, bil/L	0.00–0.03	0.01
RBC morphology	<1/hpf	schistocytes 3–5; polychromasia 1–3
Coagulation
PT, s	9.5–12.3	11.8
aPTT, s	24.3–32.2	29.7
Fibrinogen, mg/dl	180–400	319
ADAMTS13 activity, %	50–160	<5
ADAMTS13 inhibitor, BU	<0.4	2
Chemistry
LDH, U/L	140–280	362
Creatinine	0.5–1.0	1.2
Bilirubin, mg/dl	0.2–1.2	3.6
Urinalysis—completed day prior to above results
Test strip results
Color	Yellow	Dark Yellow
Clarity	Clear	Cloudy
Glucose	Negative	Negative
Bilirubin	Negative	Negative
Ketones	Negative	Negative
Specific gravity	1.003–1.035	1.017
Blood	Negative	3+
pH	5.0–8.0	7.0
Protein, mg/dl	Negative	100
Urobilinogen, mg/dl	0.2–1	2
Nitrates	Negative	Negative
Leukocyte esterase	Negative	Negative
Urinary sediment
RBC	0–2 (negative)	0–2 (negative)
WBC	0–2 (negative)	3–10
Epithelial, squamous	0–5 (negative)	>50
Casts, hyaline	0–2 (negative)	0–2 negative
Bacteria	0–1+ (negative)	1+

Abbreviations: ADAMTS13, a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13; aPTT, activated partial thromboplastin time; BU, blood unit; IPF, immature platelet fraction; LDH, lactic acid dehydrogenase; MCH, mean cell hemoglobin; MCHC, mean cell hemoglobin concentration; MCV, mean cell volume; MPV, mean platelet volume; PT, prothrombin time; RBC, red blood cell; RDW, red cell distribution width; WBC, white blood cell.