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Thrombotic thrombocytopenic purpura — SCE Acute Medicine MCQ

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HardHaematological EmergenciesThrombotic thrombocytopenic purpuraSCE Acute Medicine

A 39-year-old woman has confusion, petechiae, haemoglobin 78 g/L, platelets 9 × 10⁹/L, schistocytes, high LDH and normal coagulation tests. Creatinine is 150 micromol/L. TTP is strongly suspected and the ADAMTS13 result will not be available today. What is the most appropriate next step?

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Correct answer: E — Start plasma exchange, corticosteroids and caplacizumab

Thrombocytopenia with microangiopathic haemolytic anaemia, neurological features and normal coagulation strongly suggests immune TTP. Treatment must not wait for ADAMTS13 confirmation: urgent plasma exchange and immunosuppression are required, with early caplacizumab according to the specialist pathway. Platelet transfusion is avoided unless there is life-threatening bleeding.

Reference: https://b-s-h.org.uk/guidelines/guidelines/diagnosis-and-management-of-thrombotic-thrombocytopenic-purpura-and-thrombotic-microangiopathies