title: [Unusual cause of macrohematuria in a 29-year-old woman].
abstract: METHODS
  We report on the case of a young women presenting with macrohaematuria, petechiae and strong headaches.
  
  
  METHODS
  Laboratory showed a thrombotic microangiopathy with helmet cells, increased LDH levels (>600 U/l), and thrombocytopenia (<40,000/μl).
  
  
  METHODS
  Due to strong haemolytic activity and headache with blurred vision, immediate plasma separation with fresh frozen plasma was commenced. Markedly decreased ADAMTS13 activity and detection of anti-ADAMTS13 antibodies were consistent with the diagnosis of idiopathic thrombotic thrombocytopenic purpura. In total, 11 plasma separations were required to stop disease activity. In parallel, immunosuppressive therapy using glucocorticoids was initiated. The patient was discharged from the hospital in a good general condition and with normalized laboratory findings 26 days after hospitalization.
  
  
  CONCLUSIONS
  All patients with anemia and thrombocytopenia should be tested for haemolysis and helmet cells. An early diagnosis and initiation of necessary therapy are determining for the clinical outcome.
authors.affiliation: Medizinische Klinik, Abt. Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmologie, Universitätsklinikum Tübingen.
authors.forename: Sebastian-Jonas
authors.initials: SJ
authors.lastname: Saur
authors.forename: Maik
authors.initials: M
authors.lastname: Häntschel
authors.forename: Ferruh
authors.initials: F
authors.lastname: Artunc
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Rittig
authors.forename: Ulrike
authors.initials: U
authors.lastname: Janssen
authors.forename: Lothar
authors.initials: L
authors.lastname: Kanz
authors.forename: Karl
authors.initials: K
authors.lastname: Jaschonek
authors.forename: Wichard
authors.initials: W
authors.lastname: Vogel
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Kopp
mesh_terms: D051722:ADAM Proteins / Q000276:immunology; D000071120:ADAMTS13 Protein; D000328:Adult; D004910:Erythrocyte Membrane / Q000473:pathology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006417:Hematuria / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D006461:Hemolysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D010949:Plasma; D010956:Plasmapheresis; D011693:Purpura / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D013921:Thrombocytopenia / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D057049:Thrombotic Microangiopathies / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D014653:Vascular Headaches / Q000209:etiology* / Q000276:immunology / Q000628:therapy
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D007770:L-Lactate Dehydrogenase; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human