In thrombotic thrombocytopenic purpura, which practice is contraindicated because it may worsen thrombosis?

In thrombotic thrombocytopenic purpura, which practice is contraindicated because it may worsen thrombosis?

• A. Plasma exchange is contraindicated
• B. Platelet transfusions are never used in TTP
• C. Platelet transfusions may cause thrombi formation
• D. Corticosteroids are never used

Answer: (C)

In thrombotic thrombocytopenic purpura, a severe deficiency of ADAMTS13 allows ultra-large von Willebrand factor multimers to drive widespread formation of platelet-rich microthrombi in small vessels. Because the problem is already driven by platelets sticking to these abnormal vWF strings, adding more platelets through transfusion can feed these microthrombi and worsen thrombosis, potentially increasing organ ischemia. That’s why platelet transfusions are generally avoided in TTP unless there is life-threatening bleeding or a high-risk invasive procedure where bleeding risk outweighs thrombotic risk. Plasma exchange remains the main treatment because it removes anti-ADAMTS13 antibodies and replenishes the enzyme, helping to halt the microthrombus formation. Corticosteroids may be used as adjunct therapy in immune-mediated cases.

In thrombotic thrombocytopenic purpura, a severe deficiency of ADAMTS13 allows ultra-large von Willebrand factor multimers to drive widespread formation of platelet-rich microthrombi in small vessels. Because the problem is already driven by platelets sticking to these abnormal vWF strings, adding more platelets through transfusion can feed these microthrombi and worsen thrombosis, potentially increasing organ ischemia. That’s why platelet transfusions are generally avoided in TTP unless there is life-threatening bleeding or a high-risk invasive procedure where bleeding risk outweighs thrombotic risk.

Plasma exchange remains the main treatment because it removes anti-ADAMTS13 antibodies and replenishes the enzyme, helping to halt the microthrombus formation. Corticosteroids may be used as adjunct therapy in immune-mediated cases.