PLASMIC Score

Q: All of the following are components of  PLASMIC Score for suspected thrombotic thrombocytopenic purpura (TTP) EXCEPT? - select one

A) Platelet count

B) Evidence for Hemolysis

C) History of active cancer

D) INR  less than 1.5

E) Liver enzymes twice normal

Answer: E

PLASMIC score helps to identify patients who are at high risk of TTP. It is a validated score to estimate the probability of ADAMTS13 activity ≤10 percent in patients with Microangiopathic hemolytic anemia (MAHA) and thrombocytopenia. 

It provides confidence for diagnosing TTP, as the results of ADAMTS13 activity testing may take prolonged time when decision for management plans need to be made. It has seven components:

1. Platelet count - if less than <30 x 109/L
2. Evidence of hemolysis like reticulocyte count >2.5%, haptoglobin undetectable, or indirect bilirubin >2.0 mg/dL
3. Evidence of active cancer treatment within the past year
4. History of solid-organ or stem-cell transplant
5. INR <1.5
6. Creatinine <2.0 mg/dL
7. MCV <9.0 x 10-14 L 

  

Each component gets one point if the answer is yes, except for cancer and solid-organ or stem cell transplant, which gets zero points if the answer is yes (please refer to any online calculator).      

         

Risk of severe ADAMTS13 deficiency

• 0 to 4 = Low risk
• 5 = Intermediate risk
• 6 to 7 = High risk

  

A score less than 5 generally does not require further workup, and a score ≥5 requires ADAMTS13 to be sent.

  

Oncology service should be consulted.

         

 

#hematology

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Reference:

         

1. Bendapudi PK, Hurwitz S, Fry A, et al. Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microangiopathies: a cohort study. Lancet Haematol 2017; 4:e157.