Today’s case was a middle-aged man with a history of stage 4 pancreatic adenocarcinoma who presented with somnolence and severe thrombocytopenia.

Diagnosis:

TTP should be suspected in any patient with thrombocytopenia and microangiopathic hemolytic anemia (MAHA) with schistocytes on peripheral blood smear. The classic pentad of fever, anemia, thrombocytopenia, renal failure, and neurological findings only occurs in 5% of TTP patients so a high index of suspicion is required for prompt treatment. GI symptoms, which are not included in the classic pentad of TTP, are relatively common so we suggest the following mnemonic.

Fever (10% of patients)

Anemia 

Renal involvement

Thrombocytopenia

Involvement of skin (purpura)

Neurological symptoms

GI distress