Thrombotic Thrombocytopenic Purpura in a 33-Year-Old Female Presenting to a Rural Emergency Department: A Case Report.

INTRODUCTION

Thrombotic thrombocytopenic purpura is a rare, life-threatening hematologic emergency characterized by thrombocytopenia, microangiopathic hemolytic anemia, renal dysfunction, neurologic symptoms, and fever. Prompt recognition and treatment are crucial for improving outcomes.

CASE PRESENTATION: A 33-year-old female presented to a rural emergency department with fever, malaise, cognitive changes, and pancytopenia. Initial evaluation revealed severe thrombocytopenia and anemia, raising suspicion for thrombotic thrombocytopenic purpura.

MANAGEMENT: The patient was stabilized with intravenous fluids and transferred to a tertiary hospital, where she was confirmed to have thrombotic thrombocytopenic purpura based on ADAMTS13 deficiency. She received plasma exchange and corticosteroid therapy, followed by outpatient hematology follow-up.

DISCUSSION: This case underscores the importance of early recognition of thrombotic thrombocytopenic purpura, particularly in rural and resource-limited settings, where delays in transfer and specialized care can significantly increase mortality risk. Emergency nurses play a pivotal role in identifying clinical red flags, initiating stabilization, and coordinating timely transfer.