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Conclusion 10. Tsai H. Advances in the pathogenesis, diagnosis, and treat-
ment of thrombotic thrombocytopenic purpura. J Am Soc
TMA syndromes represent a group of disorders defined Nephrol. 2003;14:1072–1081.
by shared characteristics of microangiopathic hemo- 11. Veyradier A, Obert B, Houllier A, et al. Specific von Will-
lytic anemia, thrombocytopenia, and organ injury from ebrand factor cleaving protease in thrombotic microangio-
pathies: a study of 111 cases. Blood 2001;98:1765–1772.
pathologic small-vessel thrombosis. Evaluation and 12. Vesely SK, George JN, Lämmle B, et al. ADAMTS13 activity
management in the field require astute clinical judg- in thrombotic thrombocytopenic purpura-hemolytic uremic
ment and empiric supportive treatment until evacuation syndrome: relation to presenting features and clinical out-
occurs. In the hospital setting, empiric treatment with comes in a prospective cohort of 142 patients. Blood. 2003;
plasma exchange is critical because of the significant 102:60–68.
reduction in morbidity and mortality in treatment of 13. Cataland S, Wu H. How I treat: the clinical differentiation
and initial treatment of adult patients with atypical hemolytic
TTP. Laboratory testing is then pursued to differentiate uremic syndrome. Blood. 2014;123:2478–2484.
the TMA syndromes. TTP is often associated with an 14. Legendre CM, Licht C, Muus P, et al. Terminal complement
ADAMTS13 deficiency. HUS usually occurs in the pres- inhibitor eculizumab in atypical hemolytic-uremic syndrome.
ence of Shiga toxin. In the absence of these syndromes, N Engl J Med. 2013;368:2169–2181.
advanced laboratory testing must be pursued to define
a specific TMA syndrome, which may have a different
treatment, prognosis, and long-term management. LT Croom, MC, USN, is currently an Undersea Medical Of-
ficer assigned to the Naval Special Warfare Center, San Diego,
California. He previously was stationed at Naval Medical
Acknowledgment
Center San Diego, where he completed internship in internal
medicine. He is a graduate of the Uniformed Services Univer-
This case was presented in a poster at the Navy chapter sity of the Health Sciences. E-mail: daniel.croom@socom.mil.
of the American College of Physicians annual confer-
ence at the Walter Reed National Military Medical Cen- CDR Tracy, MC, USN, is with the Department of Hematol-
ter, Bethesda, Maryland, on 4 December 2015. ogy Oncology, Naval Medical Center San Diego, California.

Disclosures
The authors have indicated they have no financial rela-
tionship relevant to this article to disclose. Association of Police Officer
Paramedics of the United States

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325:393:397. career opportunities of our members in the United
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