Question

1. Which of the following test can the nurse request the provider to order if tissue damage is suspected in a patient with thromboembolic thrombocytopenic purpura?

   1. Lactable dehydrogenase

   2. Bone marrow biposy

   3. Serum electrolytes

   4. CPK

Answer 1

Ans) Lactable dehydrogenase

Explaination:

Thrombotic thrombocytopenic purpura is suspected in patients with suggestive symptoms, thrombocytopenia, and anemia. If the disorder is suspected, urinalysis, peripheral blood smear, reticulocyte count, serum LDH, haptoglobin, renal function tests, ADAMTS13 assay, serum bilirubin (direct and indirect), and direct antiglobulin test are done. Early recognition is important in order to initiate treatment as quickly as possible. Therapy may need to be initiated in suspected cases before the confirmatory ADAMTS13 testing is completed if other manifestations of TTP (clinical symptoms, thrombocytopenia, elevated LDH, peripheral blood smear examination) are consistent with this diagnosis.

- Elevated serum lactate dehydrogenase (LDH) is a characteristic finding in patients with thrombotic thrombocytopenic purpura (TTP). It is widely accepted that total serum LDH principally rises due to the release of red blood cell LDH as a consequence of intravascular hemolysis.