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Thrombotic thrombocytopenic purpura — SCE Acute Medicine MCQ

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HardHaematological EmergenciesThrombotic thrombocytopenic purpuraSCE Acute Medicine

A 38-year-old woman presents with confusion and petechiae. Hb is 78 g/L, platelets 14 x 10^9/L, creatinine 158 micromol/L, bilirubin 44 micromol/L and blood film shows schistocytes. Coagulation screen is normal. What is the most appropriate next step in management?

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Correct answer: A — Urgent plasma exchange with haematology input for suspected TTP

Thrombocytopenia, microangiopathic haemolysis, neurological features and renal injury with normal coagulation suggest TTP, a haematological emergency requiring urgent plasma exchange and immunosuppression. ADAMTS13 confirms the diagnosis but treatment should not wait. Platelet transfusion is generally avoided unless life-threatening bleeding occurs. The key distinction from DIC is the normal coagulation screen.

Reference: BSH TTP guideline, BNF