Recognising TTP
TTP should be suspected when low platelets are accompanied by microangiopathic haemolytic anaemia — anaemia with fragmented red cells, raised LDH and low haptoglobin. Fever, neurological symptoms, kidney injury and abdominal pain may also occur, but the classic five-feature picture is often incomplete.
TTP is a medical emergency. Untreated, it can cause stroke, heart injury, kidney failure and death. Urgent assessment and plasma exchange are often needed.
Related: Haematology → · Dr. Sachita Baniya profile → · All conditions →
Diagnosis and urgent coordination
Blood tests include a full count, blood film, LDH, haptoglobin, creatinine, liver tests and coagulation studies. ADAMTS13 activity and inhibitor testing confirm the diagnosis, but treatment should not wait for the result when the picture is typical.
Other causes of thrombotic microangiopathy — pregnancy, infection, drugs, transplantation, cancer and atypical haemolytic uraemic syndrome — are reviewed in parallel. Coordination with emergency, ICU, apheresis and nephrology teams is essential.
- Low platelets with anaemia and fragmented red cells
- Raised LDH and low haptoglobin
- Neurological or renal symptoms
- Pregnancy, drug or transplant history
Treatment and follow-up
Plasma exchange is the cornerstone of urgent treatment, together with corticosteroids and careful supportive care. Caplacizumab or other therapies may be used in selected cases according to local availability and protocol.
After recovery, patients need monitoring for relapse, because TTP can recur. Pregnancy, surgery and certain medicines require advance discussion with the haematology team.
Access and booking
Dr. Baniya consults at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, and also practises at Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital, Kathmandu, and Advanced Care Hospital. Appointments are arranged at the Durbar Marg clinic or through the respective hospital or cancer centre. Bring all blood counts, marrow, flow cytometry and molecular reports.