SHM Converge Scientific Abstract ePoster Gallery-Thrombotic Thrombocytopenic Purpura: Ambiguity Calls for the Plasmic Score

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This case report highlights the diagnostic challenge of thrombotic thrombocytopenic purpura (TTP), a rare but life-threatening emergency that usually requires urgent plasma exchange. Because ADAMTS13 testing is not always immediately available, the PLASMIC score can help estimate the likelihood of severe ADAMTS13 deficiency and guide early treatment.<br /><br />A 54-year-old man presented with resolving epigastric pain and severe thrombocytopenia (platelets 21K/uL) but had no bleeding symptoms or other classic signs of TTP. Initial labs showed evidence of hemolysis, including elevated LDH, low haptoglobin, and indirect hyperbilirubinemia. The peripheral smear showed only a few schistocytes, so the team initially suspected immune thrombocytopenic purpura (ITP) and started dexamethasone.<br /><br />His PLASMIC score, based on day 1 labs, was 7/7, indicating high risk for severe ADAMTS13 deficiency and strongly suggesting TTP. However, because he was asymptomatic, plasma exchange was not started. The patient left the hospital against medical advice before the diagnosis was confirmed.<br /><br />ADAMTS13 results later returned at 3% with an inhibitor present, confirming immune-mediated TTP. When he returned, his platelet count had normalized, but hemolysis was still ongoing. He was then treated with rituximab and prophylactic entecavir due to hepatitis B serology. After four weeks, his platelet count and hemolysis markers normalized, and hemoglobin improved.<br /><br />The authors emphasize that TTP can present atypically, even without obvious symptoms. This case shows how the PLASMIC score can be especially useful when ADAMTS13 results are delayed, helping clinicians recognize high-risk TTP early and avoid missed opportunities for lifesaving plasma exchange.

Asset Subtitle

Klevi Golloshi

Meta Tag

Author List Blake Anderson, Klevi Golloshi

Category Clinical Vignettes

Concept Thrombotic Thrombocytopenic Purpura

Concept Total Plasma Exchange

Concept ADAMTS13 Deficiency

Concept PLASMIC Score

Concept Time to Treatment

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Klevi Golloshi

Track Adult

Keywords

thrombotic thrombocytopenic purpura

TTP

PLASMIC score

ADAMTS13 deficiency

thrombocytopenia

hemolysis

plasma exchange

immune-mediated TTP

rituximab

schistocytes

Thrombotic Thrombocytopenic Purpura

Total Plasma Exchange

ADAMTS13 Deficiency

PLASMIC Score

Time to Treatment