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Thrombotic thrombocytopenic purpura — RCPSC IM MCQ

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HardHematologyThrombotic thrombocytopenic purpuraRCPSC IM

A 47-year-old has confusion, platelets 18 ×10⁹/L, microangiopathic hemolytic anemia, schistocytes and normal coagulation tests. ADAMTS13 results will take two days. What is the immediate treatment approach?

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Correct answer: C — Begin urgent plasma exchange and corticosteroids

The best answer is “Begin urgent plasma exchange and corticosteroids”. The clinical syndrome is suspected immune TTP, a treatment emergency in which plasma exchange and immunosuppression begin before ADAMTS13 confirmation. Routine platelets can worsen thrombosis, corticosteroid monotherapy is inadequate, anticoagulation does not treat the mechanism and eculizumab targets complement-mediated TMA rather than first-line immune TTP.

Reference: Canadian Blood Services, therapeutic apheresis clinical guide: https://professionaleducation.blood.ca/en/transfusion/clinical-guide/therapeutic-apheresis