Case of the Month #19 - TTP

Published 01/02/2022

How is TTP managed/treated?

  • Stop potential medications that may have precipitated TTP and investigate for and treat underlying conditions associated with TTP.
  • Daily plasma exchange is the most effective treatment for TTP and can significantly reduce mortality in these patients.  (This treatment is generally continued for a further 2 days after platelet counts have improved to >150 x 109/L).
  • Large volume plasma infusions are an alternative if there is a delay in initiating plasma exchange.
  • If TTP is associated with HIV, HAART therapy should be instituted.
  • High dose IV methylprednisolone or oral prednisolone should be considered for 3 days after completion of plasma exchange.
  • When platelets are >50 x 109/L can start chemical thromboprophylaxis +/- low dose aspirin to reduce further thrombosis.
  • Folic acid supplementation should be given while active haemolysis is ongoing.
  • Rituximab can also be considered in refractory cases or those with neurological or cardiac involvement.
  • Avoid platelet transfusions in TTP unless there is life-threatening haemorrhage3