ICU Map
hematology / oncology

Thrombocytopenia + Hemolysis + Organ Injury

Recognize a thrombotic microangiopathy, estimate the probability of immune TTP, obtain ADAMTS13 before plasma therapy when feasible, and start time-critical TTP treatment without waiting for the result when suspicion is high.

CLINICAL ALGORITHMMedically Verified (2026-09-15)

Thrombocytopenia + microangiopathic hemolysis: treat high-probability immune TTP before confirmatory testing returns

Figure: Thrombocytopenia + microangiopathic hemolysis: treat high-probability immune TTP before confirmatory testing returns. This action-focused visual summarizes the linked Clinical Problem; the full problem text, evidence references and local policy remain the source of truth.(Action pathway — use the full evidence-linked problem and local protocol for clinical decisions)

Recognize TMA

  • Confirm microangiopathic hemolysis (schistocytes, elevated LDH/indirect bilirubin, low haptoglobin, reticulocytosis) with thrombocytopenia and ischemic organ injury. Renal, neurologic and cardiac involvement can vary; the historic pentad is neither required nor expected.

Estimate probability of immune TTP

  • Use clinical judgment plus a validated pretest tool such as PLASMIC when appropriate. Severe thrombocytopenia with MAHA and relatively preserved coagulation studies raises concern for TTP; markedly abnormal PT/aPTT/fibrinogen favors DIC, while heparin exposure/thrombosis may suggest HIT.

ADAMTS13

  • Send ADAMTS13 activity/inhibitor before plasma exposure whenever this can be done without delaying treatment. Severe ADAMTS13 deficiency (<10%) supports TTP, but the result often returns too late to guide the first lifesaving decision.

Act now if immune TTP is strongly suspected

Avoid harm

Reassess

Direct evidence for this problem

1 source
guideline•2025
2025 Focused Update of the 2020 ISTH Guidelines for Management of Thrombotic Thrombocytopenic Purpura ↗

Current ISTH guidance for acute immune TTP treatment, including plasma exchange, immunosuppression and caplacizumab.

Evidence status

Review metadata not yet recorded.

Status, review dates and guideline versions appear here once editorial metadata is authored for this content.

Actionable Clinical Workflows (3)

Step-by-step ICU Processes
Massive Hemorrhage & Hemostatic Resuscitation

From emergent massive-hemorrhage protocol activation and early balanced component resuscitation to physiologic correction, targeted factor/anticoagulant reversal, and definitive source control.

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Bleeding

From assessing hemodynamic stability to correcting reversible contributors to coagulopathy.

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Maternal Critical Illness Rapid Assessment

Urgent maternal stabilization, left uterine displacement, syndromic differentiation, and multidisciplinary escalation.

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Deep-Dive Topic Destinations (3)

Reference Knowledge
Thrombotic Thrombocytopenic Purpura (TTP)hematology

Recognition of thrombotic microangiopathy, PLASMIC risk, ADAMTS13 testing, immediate plasma exchange, steroids, caplacizumab, and ICU complications.

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Disseminated Intravascular Coagulation (DIC) & Sepsis Coagulopathyhematology

Tissue-factor-driven coagulation activation, antithrombin/protein C depletion, PAI-1-associated fibrinolytic suppression, ISTH 2025 DIC assessment, comparison with TTP/HUS/HIT, and targeted replacement.

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Heparin-Induced Thrombocytopenia (HIT)hematology

PF4-heparin antibody Fc-gamma-RIIa platelet activation, the 4Ts score, ELISA OD values vs Serotonin Release Assay (SRA), and direct thrombin inhibitor protocols.

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