What is included in long-term monitoring of thrombotic thrombocytopenic purpura (TTP)?

Updated: Feb 18, 2019
  • Author: Theodore Wun, MD, FACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

The necessary outpatient follow-up for patients with thrombotic thrombocytopenic purpura (TTP)  and hemolytic-uremic syndrome (HUS) who have entered a complete or partial response is not well defined. Anecdotal reports of increased relapse rates upon abrupt cessation of plasma exchange have resulted in many apheresis services tapering off plasma exchange over the course of 2-3 weeks. However, this practice has not been validated in any prospective or retrospective analysis.

Recommendations are that the patient be seen every week for 2 weeks and, if stable, every 2 weeks for a month. During this time, weekly measurement of a complete blood count and lactate dehydrogenase (LDH) are performed. If the platelet count drops or the LDH level starts to rise, another course of five plasma exchanges is reinstituted. If the patient remains stable for a month, the frequency of the follow-up is decreased.The relapse rate is 13-36%, and recurrences as many as 9 years later have been reported.


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