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Thrombotic thrombocytopenic purpura — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesThrombotic thrombocytopenic purpuraSCE Acute Medicine

A 38-year-old woman is assessed on the acute medical unit. She has confusion, bruising, AKI and platelets 14 x10^9/L. Blood film shows schistocytes and Coombs test is negative. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: C — Arrange urgent plasma exchange via haematology

Arrange urgent plasma exchange via haematology is the best answer because TTP is a haematological emergency requiring urgent plasma exchange. Give intravenous calcium gluconate immediately is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Do not wait for ADAMTS13 result before initiating specialist management when suspicion is high.

Reference: BSH TTP guideline