Which of the following is NOT listed as a finding associated with thrombotic thrombocytopenic purpura (TTP)?

• A. Viral infections
• B. Chronic renal failure
• C. Hyperglycemia
• D. Bone marrow hypoplasia

Answer: (C)

Thrombotic thrombocytopenic purpura stems from a deficiency or inhibition of the enzyme ADAMTS13, which leads to accumulation of ultra-large von Willebrand factor multimers. Those multimers promote widespread platelet-rich microthrombi, causing microangiopathic hemolytic anemia and low platelets. The disease can present with fever, neurologic symptoms, and renal involvement because these microthrombi can form in multiple organ beds.

Viral infections can act as triggers that precipitate TTP, tipping the balance toward uncontrolled microthrombosis. The kidneys are often affected due to microthrombi in the renal microcirculation, so renal impairment is a recognized associated finding. Bone marrow in TTP is typically not described as hypoplastic; the marrow response is more reactive to hemolysis and thrombocytopenia rather than a primary hypoplasia. Hyperglycemia, on the other hand, is not a characteristic finding of TTP and does not arise from its pathophysiology, so it is not listed among typical associated findings.