Author: Lindsey Lamphear, D.O.
Co Author #1: Vanessa Lalley-DeMong D.O.
Senior Editor: Margaret Gibson, MD, FAMSSM
Editor: Andrea Kussman, MD

Patient Presentation:
19 year old male Division I Football player with known history of Hereditary Thrombotic Thrombocytopenic Purpura (TTP) presented for a regularly scheduled transfusion of fresh frozen plasma with complaint of 1 day history of fever, vomiting and diarrhea. Platelet count 3 days before at a weekly CBC check was 198,000.

History:
The patient is a 19 year old male who was diagnosed with hereditary TTP at the age of 2. This patient desired to participate in competitive athletics, in the contact sport of football, which made his condition much more dangerous and in paramount need of more careful and regimented monitoring. His care plan involved weekly blood draws to monitor platelet counts and a plasma transfusion every 3 weeks. Participation limits were set up so that if his platelet count was under 100,000 he could not participate in contact activities but may continue with cardiovascular workouts, but if the platelet count dropped below 50,000 he was not allowed to participate in activity at all. Complicating factors further, the patient demonstrated a history of anaphylactic reaction to plasma transfusions, so his regular transfusions were required to be performed over 12 hours. The athlete continued participating in athletics and was recruited to play Division I football. Management of his condition involved his own participation, the coaching staff and athletic training staff, as well as supervising physicians. At the start of the football season, the athlete's platelet counts were consistently above 100,000 and permissible for participation in contact activity. He continued his management plan as directed and was monitored by training staff and supervising physicians. He continued to have his weekly blood draws as scheduled.

Physical Exam:
Temp 101.5
Gen-tired
CV-RRR
PULM-CTA bilaterally
ABD-+BS, soft, tender throughout, no rebound or guarding
EXT-no edema
SKIN-no rash or bruising

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.