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HIV-Associated TTP — SCE Infectious Diseases MCQ

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ModerateHIV MedicineHIV-Associated TTPSCE Infectious Diseases

A 42-year-old man with HIV on ART develops immune-mediated thrombotic thrombocytopenic purpura (TTP). His blood film shows schistocytes. ADAMTS13 activity is <5%. He is haemodynamically stable. What is the immediate treatment?

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Correct answer: D — Urgent plasma exchange (plasmapheresis) plus corticosteroids — TTP is a haematological emergency regardless of HIV status

TTP (ADAMTS13 <10%) is a haematological emergency requiring urgent plasma exchange to remove anti-ADAMTS13 autoantibodies and replenish functional ADAMTS13. Corticosteroids are given concurrently. Rituximab is added for refractory or relapsing disease. Platelet transfusion is generally avoided in TTP as it may worsen thrombotic microangiopathy (though this is debated and may be given if life-threatening haemorrhage occurs). TTP occurs with increased frequency in HIV, though the mechanism is not fully elucidated. ART should be continued.

Reference: BSH 2024 – TTP guidelines; BHIVA 2022 – Haematological complications of HIV