How is TTP managed/treated?
- Stop potential medications that may have precipitated TTP and investigate for and treat underlying conditions associated with TTP.
- Daily plasma exchange is the most effective treatment for TTP and can significantly reduce mortality in these patients. (This treatment is generally continued for a further 2 days after platelet counts have improved to >150 x 109/L).
- Large volume plasma infusions are an alternative if there is a delay in initiating plasma exchange.
- If TTP is associated with HIV, HAART therapy should be instituted.
- High dose IV methylprednisolone or oral prednisolone should be considered for 3 days after completion of plasma exchange.
- When platelets are >50 x 109/L can start chemical thromboprophylaxis +/- low dose aspirin to reduce further thrombosis.
- Folic acid supplementation should be given while active haemolysis is ongoing.
- Rituximab can also be considered in refractory cases or those with neurological or cardiac involvement.
- Avoid platelet transfusions in TTP unless there is life-threatening haemorrhage3