Laboratory Findings in Hematology, Clinical Chemistry, and Urinalysis for Patients With Thrombotic Thrombocytopenic Purpura

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Figure 1.
Typical blood film in thrombotic thrombocytopenic purpura (TTP). This peripheral blood film from a patient with TTP demonstrates schistocytes (A), polychromasia (B), and thrombocytopenia, since no platelets are seen. Anisocytosis is reflected in the red blood cell size variation from (A) to (B) (magnification 500×).
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Figure 2.
Platelets and shistocytes in thrombotic thrombocytopenic purpura. This field demonstrates thrombocytopenia with only a single large platelet in the center of the field. Shistocytes are also seen, including several keratocytes (A) and a schizocyte (B). Anisocytosis is notable in the size variation between (B) and (C) (magnification 1000×).

Table 1.

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

Hematology:	Reference Interval	Patient Values Day 1	Patient Values Day 4*
WBC billion/L	3.3–10.7	4.7	6.1
RBC trillion/L	3.87–5.08	3.3	3.45
Hemoglobin g/dL	12.1–15	9.0	9.7
Hematocrit %	34.4–44.2	27.8	28.8
MCV fL	80–100	84
MCH pg	28–32	27
MCHC %	32–36	32
RDW %	11.5–15.5	20
Platelet billion/L	150–400	32	91
MPV fL	8.5–12.5	14
IPF%	1–11	15
Neutrophils billion/L	1.6–7.2	3.2	3.4
Lymphocytes billion/L	1.1–4.0	1	2.1
Monocytes billion/L	0.0–0.8	0.4	0.6
Eosinophils billion/L	0.0–0.5	0.0	0.0
Basophils billion/L	0.0–0.1	0.0	0.0
Immature granulocytes billion/L	0.00–0.03	0.01	0.01
RBC morphology	<1/hpf	Schistocytes 3–5; polychromasia 1–3	Bite cells 1–2
Chemistry:
LDH U/L	140–280	362	176
Creatinine mg/dL	0.5–1.0	1.2
Bilirubin mg/dL	0.2–1.2	3.6
Haptoglobin mg/dL	50–220	<8	53
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+