Rose et al developed a simple score for evaluating a patient with thrombotic thrombocytopenic purpura (TTP). The authors are from Hadassah University in Jerusalem.
Patient selection: TTP
Parameters:
(1) neurological findings
(2) renal impairment (based on serum urea, serum creatinine, urinalysis, dialysis)
(3) platelet count in 10^9/L
(4) hemoglobin in g/dL
|
Parameter |
Finding |
Points |
|
neurological findings |
none (normal) |
0 |
|
|
confusion, lethargy, behavioral change |
1 |
|
|
focal neurological deficits, convulsions, stupor and coma |
2 |
|
renal impairment |
none |
0 |
|
|
(hematuria) OR (proteinuria > 2 g/24h) OR (urea > 10.7 and < 25 mmol/L) OR (creatinine > 132 and <221 µmol/L) |
1 |
|
|
(urea >= 25 mmol/L) OR (creatinine >= 221 µmol/L) OR (dialysis) |
2 |
|
platelet count |
> 100 * 10^9/L |
0 |
|
|
20 to 100 |
1 |
|
|
< 20 * 10^9/L |
2 |
|
hemoglobin |
> 12 g/dL |
0 |
|
|
9 to 12 g/dL |
1 |
|
|
< 9 g/dL |
2 |
total score =
= SUM(points for all 4 parameters)
A modified version was developed for situations where neurological findings are not recorded.
|
Parameter |
Finding |
Points |
|
neurological findings |
absent |
0 |
|
|
present |
1 |
|
hemoglobin |
> 12 g/dL |
0 |
|
|
9 to 12 g/dL |
1 |
|
|
< 9 g/dL |
2 |
|
platelet count |
> 100 * 10^9/L |
0 |
|
|
20 to 100 |
1 |
|
|
< 20 * 10^9/L |
2 |
|
renal impairment |
creatinine <= 132 µmol/L |
0 |
|
|
creatinine > 132 and < 221 |
1 |
|
|
creatinine >= 221 µmol/L |
2 |
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8 for original, 7 for modified
• The higher the score the more severe the syndrome
Limitations:
• ADAMTS13 activity is not incorporated.
• The development was based on expert opinion rather than a statistical model.
• The score is not a marker of 6-month mortality.
Specialty: Hematology Oncology, Clinical Laboratory
