The Clinical Challenges of Thrombotic

Thrombotic thrombocytopenic purpura (TTP) describes syndromes with multiple etiologies, some of which are rapidly fatal without plasma exchange treatment. Although there have been advances in understanding the pathogene-sis of TTP, evaluation and management remain difficult because there are no specific diagnostic criteria, as TTP can be clinically similar to other acute disorders, such as sepsis, disseminated malignancy, malignant hypertension, and preeclampsia, and because urgent treatment is required. An unexpected observation of anemia and thrombocytopenia should trigger consideration of TTP; evidence that the ane-mia is due to microangiopathic hemolysis, suggested by the presence of red cell fragmentation on the blood smear, supports the diagnosis. When the diagnostic criteria of microangiopathic hemolytic anemia and thrombocytopenia without an apparent alternative etiology are fulfilled, plasma exchange treatment is appropriate. However, plasma exchange has risks for severe complications and death; therefore, this management decision must be bal-anced against the confidence in the diagnosis. With plasma exchange treatment, approximately 80 % of patients sur-vive, in contrast to only 10 % in the era prior to the avail-ability of plasma exchange. The continuing mortality from TTP, the risks of plasma exchange treatment, and the poten-tial for recurrent episodes of TTP are clinical challenges that remain to be solved