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Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are thrombotic microangiopathies (TMA) associated with hemolysis (anemia), thrombocytopenia, and renal dysfunction in adults and children.
Tests generally appear in the order most useful for common clinical situations
| Test name: CBC with Platelet Count & Automated Differential |
| ARUP #: 0040003 |
| Methodology: Automated Cell Count with Flow Cell Differential |
| Use: Confirm anemia and thrombocytopenia |
| Test name: Urea Nitrogen, Serum or Plasma |
| ARUP #: 0020023 |
| Methodology: Quantitative Spectrophotometry |
| Use: Assess for the presence of renal disease |
| Test name: Creatinine, Serum or Plasma |
| ARUP #: 0020025 |
| Methodology: Quantitative Enzymatic |
| Use: Assess for the presence of renal disease |
| Test name: Lactate Dehydrogenase, Serum or Plasma |
| ARUP #: 0020006 |
| Methodology: Quantitative Enzymatic |
| Use: Confirm hemolysis |
| Test name: Direct Coombs (Anti-Human Globulin) |
| ARUP #: 0013008 |
| Methodology: Hemagglutination |
| Use: Exclude immune hemolytic anemia |
| Test name: Antibody Detection, RBC |
| ARUP #: 0010004 |
| Methodology: Hemagglutination |
| Use: Rule out immune hemolytic anemia |
| Test name: Prothrombin Time |
| ARUP #: 0030215 |
| Methodology: Electromagnetic Mechanical Clot Detection |
| Use: Rule out DIC Usually normal in TMA patients |
| Test name: Partial Thromboplastin Time |
| ARUP #: 0030235 |
| Methodology: Electromagnetic Mechanical Clot Detection |
| Use: Rule out DIC Usually normal in TMA patients |
| Test name: Fibrinogen Panel |
| ARUP #: 0030137 |
| Methodology: Refer to individual components |
| Use: Rule out DIC |
| Test name: D-Dimer |
| ARUP #: 0030057 |
| Methodology: Immunoturbidimetric |
| Use: Confirm or rule out DIC |
| Test name: ADAMTS13 Activity |
| ARUP #: 0030056 |
| Methodology: Fluorescence Resonance Energy Transfer |
| Use: May be useful to distinguish TTP from HUS |
| Limitations: Sample must be drawn prior to beginning plasma infusion or exchange Mild to moderate ADAMST13 deficiency may be seen in a variety of medical conditions |
| Test name: Bilirubin, Direct & Total, Serum or Plasma |
| ARUP #: 0020426 |
| Methodology: Quantitative Spectrophotometry |
| Comments: Elevation of total and indirect bilirubin associated with hemolysis |
| Test name: Haptoglobin |
| ARUP #: 0050280 |
| Methodology: Quantitative Immunoturbidimetric |
| Comments: Decrease associated with hemolysis |
| Test name: Urinalysis, Complete |
| ARUP #: 0020350 |
| Methodology: Reflective Photometry/Microscopic by Yellow IRIS |
| Comments: Evaluate proteinuria and hematuria |
| Test name: Stool Culture, Routine (Includes E. coli Shiga-like Toxin by EIA 0060047) |
| ARUP #: 0060134 |
| Methodology: Standard reference procedures for Salmonella, Shigella, Campylobacter, and E. coli 0157 culture and identification. |
| Comments: Identification of Shiga-like toxin producing bacteria in patients with diarrhea indicates risk for subsequent HUS Routine Stool Culture includes culture for Salmonella, Shigella, Campylobacter, and E. coli 0157 as well as EIA for Shiga-like toxin from E. coli |