title: What's new in the diagnosis and pathophysiology of thrombotic thrombocytopenic purpura.
abstract: Severe ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) deficiency causes thrombotic thrombocytopenic purpura (TTP), which is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and the absence of oliguric or anuric renal failure. However, some patients with this constellation of findings do not have ADAMTS13 deficiency, and some patients with ADAMTS13 deficiency have renal failure or relatively normal blood counts. Consequently, many investigators and clinicians have incorporated severe ADAMTS13 deficiency into the case definition of TTP. This change has facilitated the timely initiation of treatment for patients with atypical clinical features who otherwise would not be recognized as having TTP. Conversely, excluding severe ADAMTS13 deficiency focuses attention on the diagnosis and treatment of other causes of thrombotic microangiopathy that require different treatment. The rapid return of ADAMTS13 data is important to make the best use of this information.
authors.affiliation: Departments of Medicine and Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO.
authors.forename: J Evan
authors.initials: JE
authors.lastname: Sadler
mesh_terms: D051722:ADAM Proteins / Q000097:blood* / Q000172:deficiency; D000071120:ADAMTS13 Protein; D001158:Arteries / Q000473:pathology; D006405:Hematology / Q000379:methods* / Q000639:trends; D006461:Hemolysis; D006801:Humans; D009422:Nervous System Diseases / Q000150:complications; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis* / Q000503:physiopathology*; D051437:Renal Insufficiency / Q000150:complications; D013927:Thrombosis / Q000150:complications; D020246:Venous Thrombosis / Q000150:complications; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D014841:von Willebrand Factor; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human