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Thrombotic thrombocytopenic purpura — SCE Acute Medicine MCQ

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HardCancer, palliative care and haematologyThrombotic thrombocytopenic purpuraSCE Acute Medicine

A 43-year-old woman presents with confusion, bruising and acute kidney injury. Platelets are 12 x 10^9/L, haemoglobin is 72 g/L, reticulocytes are raised and blood film shows schistocytes. Coagulation screen is normal and pregnancy test is negative. What is the most appropriate next step in management?

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Correct answer: E — Urgent plasma exchange and caplacizumab discussion for suspected thrombotic thrombocytopenic purpura

Thrombocytopenia, microangiopathic haemolytic anaemia, neurological symptoms and renal injury with normal coagulation suggest TTP, which is fatal without urgent plasma exchange and specialist therapy. Platelet transfusion is avoided unless life-threatening bleeding because it may worsen thrombosis. Normal coagulation helps distinguish TTP from DIC.

Reference: BSH guideline on thrombotic thrombocytopenic purpura