SHM Converge Scientific Abstract ePoster Gallery-Acquired Thrombotic Thrombocytopenic Purpura: A Bloodless Approach to Plasma Exchange

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This case report describes a 29-year-old Jehovah’s Witness woman who presented with three weeks of easy bruising, heavy prolonged menstrual bleeding, fatigue, and dizziness. Laboratory findings showed normocytic anemia, severe thrombocytopenia, elevated LDH, low haptoglobin, unconjugated hyperbilirubinemia, schistocytes, and undetectable ADAMTS13 with inhibitor activity, confirming acquired thrombotic thrombocytopenic purpura (aTTP).<br /><br />aTTP is a life-threatening hematologic emergency caused by autoimmune ADAMTS13 deficiency, leading to microthrombi, ischemia, and organ dysfunction. Without treatment, mortality is extremely high. Standard therapy is daily therapeutic plasma exchange (TPE) using fresh frozen plasma (FFP) or cryosupernatant plasma (CSP) to replace ADAMTS13 and remove autoantibodies.<br /><br />Because the patient’s religious beliefs prohibited FFP, and she developed a severe hypersensitivity reaction to CSP, the team used 5% human albumin solution as the sole replacement fluid for TPE. She also received high-dose corticosteroids and caplacizumab. After eight daily plasma exchanges with albumin, her platelet count stabilized above 150,000/µL by day six, bruising stopped, and her anemia improved with hematinic support. She was discharged on medical therapy and followed by hematology.<br /><br />Over 12 months of surveillance, her blood counts and other laboratory abnormalities normalized and she had no relapse. The report highlights that human albumin solution can be a safe and effective alternative plasma exchange fluid for inducing remission in aTTP when FFP or CSP cannot be used due to religious restrictions, hypersensitivity, contraindications, or shortages.

Asset Subtitle

Yu-Han Chen

Meta Tag

Author List Chadane Thompson, Devon Scott, Margit Kaufman, Maxwell Janosky, Tanganyika Barnes, Yu-Han Chen

Category Clinical Vignettes

Concept Immune-mediated Thrombotic Thrombocytopenic Purpura

Concept ADAMTS13

Concept Thrombocytopenia

Concept Hemolytic Anemia

Concept Total Plasma Exchange

Distinguished Non-Finalist

Presenter Organization Department of Internal Medicine, Englewood Hospital and Medical Center

Presenting Author Yu-Han Chen

Track Adult

Keywords

acquired thrombotic thrombocytopenic purpura

ADAMTS13 deficiency

plasma exchange

human albumin solution

Jehovah’s Witness

severe thrombocytopenia

caplacizumab

corticosteroids

hemolytic anemia

hypersensitivity reaction

Immune-mediated Thrombotic Thrombocytopenic Purpura

ADAMTS13

Thrombocytopenia

Hemolytic Anemia

Total Plasma Exchange