Early Recognition of Atypical Thrombotic Thrombocytopenic Purpura (TTP) in Severe Asymptomatic Thrombocytopenia Using the PLASMIC Score and Peripheral Blood Smear.

Thrombotic thrombocytopenic purpura (TTP) is the clinical syndrome of cluster symptoms of thrombotic microangiopathy, which rarely manifests with all classic symptoms of fever, neurological changes, acute kidney failure, hemolytic anemia, and thrombocytopenia. This case describes a patient who was admitted for acute abdominal pain, initially suspected to be pancreatitis, and found to have severe, asymptomatic thrombocytopenia. The diagnostic challenge was compounded by overlapping factors, including chronic alcohol use and vitamin B12 deficiency. A comprehensive workup, including PLASMIC score (platelet count, hemolysis, absence of active cancer, absence of solid organ or stem cell transplant, mean corpuscular volume, international normalized ratio, and creatinine) assessment and peripheral blood smear, ultimately led to the diagnosis of acquired immune TTP (iTTP). Early recognition enabled timely treatment and likely prevented severe complications.