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Thrombotic Thrombocytopenic Purpura: Serial Clotting Studies, Relation to the Generalized Shwartzman Reaction, and Remission After Adrenal Steroid and Dextran Therapy

ROBERT G. LERNER, M.D.; SAMUEL I. RAPAPORT, M.D., F.A.C.P.; and JAMES MELTZER, M.D.
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Los Angeles, California


Ann Intern Med. 1967;66(6):1180-1190. doi:10.7326/0003-4819-66-6-1180
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Thrombotic thrombocytopenic purpura (TTP) was first described by Moschcowitz (1) in 1925. It is an acute, fluctuating illness whose major clinical manifestations are thrombocytopenia, hemolytic anemia with characteristically fragmented red blood cells, changing neurologic findings, fever, jaundice with both direct and indirect bilirubinemia, and renal abnormalities. When a patient exhibits all six of these findings, one may make the diagnosis clinically—provided, however, that other disorders that may mimic TTP (for example, systemic lupus erythematosus or metastatic malignancy with disseminated intravascular coagulation) have been searched for carefully and eliminated. The pathologic diagnosis requires more than the demonstration of hyaline thrombi in

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