A 30-year-old woman has recurrent thrombocytopenia during each pregnancy. Labs show low platelets, fragmented red cells (schistocytes), elevated LDH, low haptoglobin, and normal coagulation studies. The MOST likely diagnosis is:

• A Disseminated intravascular coagulation (DIC)
• B Immune thrombocytopenic purpura (ITP)
• C Heparin-induced thrombocytopenia (HIT)
• D Thrombotic thrombocytopenic purpura (TTP) ✓

Explanation

TTP is characterized by the pentad of thrombocytopenia, microangiopathic hemolytic anemia (schistocytes, elevated LDH, low haptoglobin), fever, renal dysfunction, and neurological symptoms — caused by severely reduced ADAMTS13 activity (autoantibody-mediated in acquired TTP), leading to accumulation of ultra-large vWF multimers and platelet microthrombi. Coagulation studies (PT, aPTT, fibrinogen) are characteristically normal, distinguishing TTP from DIC.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.