Acquired TTP: Management following recovery from an acute episode and during remission
- James N George, MD
James N George, MD
- Professor of Medicine
- University of Oklahoma Health Sciences Center
- Adam Cuker, MD, MS
Adam Cuker, MD, MS
- Assistant Professor of Medicine, Assistant Professor of Pathology & Laboratory Medicine
- Perelman School of Medicine University of Pennsylvania
Most patients (85 to 90 percent) with acquired autoimmune thrombotic thrombocytopenic purpura (TTP) are treated effectively with plasma exchange (PEX), glucocorticoids, and, for some patients, rituximab. However, relapse following remission is an important concern. Therefore, all patients who have recovered from an episode of TTP require lifelong monitoring and rapid intervention at the first sign of a relapse. Additionally, patients require continued surveillance for a variety of important long-term health problems related to TTP.
This topic review discusses our approach to the management of a patient who has recovered from an acute episode of acquired TTP, including routine monitoring, evaluation for symptoms of relapse, care during pregnancies, and monitoring and treatment of long-term morbidities.
Separate topic reviews discuss other aspects of care for patients with acquired, autoimmune TTP (ie, TTP due to an autoantibody against ADAMTS13):
●Diagnosis – (See "Acquired TTP: Clinical manifestations and diagnosis".)
●Treatment of an acute episode – (See "Acquired TTP: Initial treatment".)
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- MONITORING AND THERAPY AFTER RESPONSE TO TREATMENT
- First week
- First month
- First year
- Subsequent years
- ADAMTS13 measurements
- Risk of relapse
- Symptoms of disease relapse
- Diagnostic evaluation for suspected relapse
- Urgency of intervention
- ROUTINE MEDICAL CARE DURING REMISSION
- Evaluation for complications of TTP
- - Hypertension and cardiovascular disease
- - Renal impairment
- - Depression
- - Minor cognitive impairment
- - Systemic lupus erythematosus
- PREGNANCY AFTER AN EPISODE OF TTP
- SUMMARY AND RECOMMENDATIONS