Which symptom is not traditionally part of the thrombotic thrombocytopenic purpura pentad?

Which symptom is not traditionally part of the thrombotic thrombocytopenic purpura pentad?

• A. Fever
• B. Anemia
• C. Thrombocytopenia
• D. Liver failure

Answer: (D)

In thrombotic thrombocytopenic purpura, the classic five features reflect a microangiopathic process: fever, microangiopathic hemolytic anemia, thrombocytopenia, renal dysfunction, and neurologic symptoms. Liver failure is not part of this traditional set. The underlying issue is severe deficiency of the enzyme ADAMTS13, which leads to accumulation of ultra-large von Willebrand factor multimers and formation of small-vessel platelet-rich thrombi. This explains the anemia from mechanical destruction of red cells, the low platelets from consumption, and the potential kidney and brain problems due to ischemia. Fever can occur as part of the systemic response. Since liver failure is not a typical manifestation of the microthrombotic pattern, it isn’t included in the pentad.

In thrombotic thrombocytopenic purpura, the classic five features reflect a microangiopathic process: fever, microangiopathic hemolytic anemia, thrombocytopenia, renal dysfunction, and neurologic symptoms. Liver failure is not part of this traditional set. The underlying issue is severe deficiency of the enzyme ADAMTS13, which leads to accumulation of ultra-large von Willebrand factor multimers and formation of small-vessel platelet-rich thrombi. This explains the anemia from mechanical destruction of red cells, the low platelets from consumption, and the potential kidney and brain problems due to ischemia. Fever can occur as part of the systemic response. Since liver failure is not a typical manifestation of the microthrombotic pattern, it isn’t included in the pentad.