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Patient: 28-year-old female, married, nulligravida. Setting: Preconception counseling visit. Referral Reason: History of TTP in her last pregnancy 9 months ago with family history of thrombotic thrombocytopenic purpura (TTP) in multiple siblings; seeking risk assessment and pregnancy planning guidance. Given the strong family history, female clustering, and pregnancy-specific onset, there is a high clinical suspicion of congenital TTP (Upshaw-Schulman syndrome), an autosomal recessive deficiency of ADAMTS13. She was sent for ADAMTS 13 it was borderline 52% (reference > 61). Positive pathogenic variant gene. Platelet count, RFT, LDH, peripheral blood smear were all normal. Question here: Does she need FFP prior to conception?

#ITP 4 y/o female pt

Idiopathic thrombocytopenic purpura. 5 year old female, comes to the ER for presenting petechiae, mother says she got bit by a spider prior to presenting the petechiae.

Thrombotic thrombocytopenic purpura (TTP) is a potentially fatal condition that can be challenging for clinicians to identify in the setting of autoimmune diseases such as systemic lupus erythematosus (SLE). This difficulty is compounded when a patient presents with all of the clinical signs of a TTP-like microangiopathy; however, with near normal ADAMTS13. This case report describes a 44-year-old female with a history of SLE who was hospitalized with acute on chronic anemia, thrombocytopenia, and altered mental status. The patient’s ADAMTS13 was mildly low; hence, she was initially treated for SLE-associated immune thrombocytopenic purpura without any clinical response. The patient then underwent plasmapheresis (plasma exchange [PLEX]) for treatment of a suspected TTP-like microangiopathy. She responded to PLEX with improvement in her platelet count and mental status. This case illustrates the importance of considering TTP-like microangiopathic hemolytic anemia in the differential for patients with a history of SLE presenting with clinical signs of TTP even in the setting of near-normal ADAMTS13, thus warranting prompt treatment with PLEX.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family; are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?