Púrpura trombocitopénica trombótica inmune: sospecha y manejo básico en los servicios de urgencias. Revisión y consenso de un grupo de expertos de las sociedades científicas SEHH y SEMES.

Autores de IIS La Fe

• 

  Javier De La Rubia Comos

  Autor

Participantes ajenos a IIS La Fe

• Pascual-Izquierdo, Cristina
• Piñera Salmerón P
• Temboury Ruiz, Francisco
• Valcarcel Ferreiras, David
• Jimenez Hernandez, Sonia
• Salinas Argente, Ramon
• del Arco Galan, Carmen

Grupos

• Hematología y Hemoterapia

Abstract

Acquired or immune thrombotic thrombocytopenic purpura (TTP) are thrombotic microangiopathies associated with high mortality if treatment is not started early. Onset is usually sudden, meaning that the condition is often diagnosed in hospital emergency departments, where TTP must be suspected as early as possible. These guidelines were drafted by specialists in emergency medicine and hematology to cover the diagnosis, referral, and treatment of patients suspected of immune-mediated TTP who require emergency care. Immune TTP should be suspected whenever a patient presents with hemolytic microangiopathy and has a negative Coombs test, and thrombocytopenia, possibly in conjunction with fever and neurologic and cardiac alterations. If one of the existing diagnostic algorithms indicates there is a high probability that the patient has immune TTP, plasma exchange therapy should be started along with immunosuppressants. Treatment with caplacizumab should also be considered. The patient should be referred immediately to the hematology department within the same hospital or a referral hospital.

Keywords

• Diagnosis.; Diagnóstico.; Emergency department.; Microangiopatía trombótica.; Plasma exchange therapy.; Púrpura trombótica trombocitopénica.; Recambio plasmático.; Renal insufficiency.; Thrombotic microangiopathy.; Thrombotic thrombocytopenic purpura.; Tratamiento.; Treatment.; Urgencias.