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
