From the Research
TTP (thrombotic thrombocytopenic purpura) is more likely to cause fever than ITP (immune thrombocytopenia). TTP typically presents with a pentad of symptoms that includes fever, thrombocytopenia, microangiopathic hemolytic anemia, neurological abnormalities, and renal dysfunction. Fever occurs in approximately 59-98% of TTP patients and is thought to result from widespread microvascular thrombi formation, tissue ischemia, and the subsequent inflammatory response 1. In contrast, ITP rarely causes fever as it is primarily characterized by isolated thrombocytopenia due to immune-mediated platelet destruction without systemic inflammation.
Some key points to consider in the diagnosis and management of TTP and ITP include:
- TTP is a medical emergency requiring prompt plasma exchange therapy, while ITP management typically involves immunosuppressive treatments like corticosteroids, IVIG, or rituximab 2, 3.
- The use of caplacizumab, an anti-von Willebrand factor nanobody, has been shown to be effective in treating aTTP episodes, and may be used without plasma exchange in selected patients 4, 5.
- The diagnosis of TTP and ITP can be challenging, and requires careful consideration of the patient's clinical presentation, laboratory results, and medical history 1.
When a patient with thrombocytopenia presents with fever, TTP should be considered higher on the differential diagnosis than ITP, due to the higher likelihood of fever in TTP patients. This distinction is clinically important, as prompt and effective treatment of TTP is critical to preventing morbidity and mortality.