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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 34-year-old woman presents with purpura, fever and confusion. Platelets are 9 × 10^9/L, Hb 78 g/L, creatinine 138 micromol/L and blood film shows schistocytes. PT and APTT are normal. Pregnancy test is negative. What is the most appropriate next step in management?

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Correct answer: A — Start urgent plasma exchange pathway with haematology involvement

Thrombocytopenia, microangiopathic haemolysis, neurological features and renal involvement with normal coagulation suggest thrombotic thrombocytopenic purpura. TTP is a haematological emergency requiring urgent specialist input and plasma exchange/caplacizumab pathway. Routine platelet transfusion can worsen thrombosis unless there is life-threatening bleeding.

Reference: British Society for Haematology TTP Guideline