Thrombotic Thrombocytopenic Purpura

LORENCE A. GUTTERMAN, MD; Thomas D. Stevenson, MD
Arch Intern Med. 1984;144(4):869. doi:10.1001/archinte.1984.00350160239053.
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To the Editor.  —The patient described by Martinez et al1 in the September 1983 Archives could be considered as having disseminated intravascular coagulation (DIC) with "the roentgenographic and clinical appearance of pulmonary hemorrhage"1(p1818) and not thrombotic thrombocytopenic purpura (TTP). The data the authors present indicate consumptive coagulopathy (prolonged prothrombin time and partial thromboplastin time [PTT], elevated fibrinogen degradation products, and moderate thrombocytopenia). Except for thrombocytopenia, the abnormal coagulation tests distinguish DIC from TTP. In addition, the histologic changes described in the renal biopsy specimen may be found in DIC as well as in TTP. For these reasons, we believe the severe pulmonary hemorrhage in this patient resulted from DIC or a primary disorder and not from TTP. The authors have not clearly established, at least to our satisfaction, the diagnosis of TTP. Presented with these findings, we would be disappointed in any physician who did not consider Goodpasture's


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