Expert statement on the ICU management of patients with thrombotic thrombocytopenic purpura

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

“…No empirical evidence is available for the tapering regimen, which is generally based on the platelet count and ADAMTS13 level. Except under special circumstances, the patient may be switched to prednisone 1 mg/kg/day, followed by tapering once the patient's condition has stabilized [142]. Dexamethasone 40 mg/day for 4 days may be used to treat relapsed or refractory ITP or as an alternative to first-line treatment [143].…”

Rituximab Twice Weekly for Refractory Thrombotic Thrombocytopenic Purpura in a Critically Ill Patient with Acute Respiratory Distress Syndrome

“…Experts suggest that ICU discharge be allowed when plasma exchange can be tapered or stopped, when signs of hemolysis disappear, and platelet count increases over 150,000/mL, which usually correlates with cardiac and neurological improvements [6]. Experts suggest that rituximab should be used in patients with relapsing autoimmune TTP and should also probably be used as a first-line therapy in severe TTP [6]. Our patient had an improvement initially and then deteriorated.…”

“…A recent expert statement on the ICU management of patients with TTP suggested the following: The lack of platelet normalization by day 5 associated with persistent signs of hemolysis (high LDH level) and/or severe cardiac or neurological manifestations defines unresponsive or refractory TTP [6]. Older age, cerebral involvement, and persistently high LDH may help identify TTP patients at increased risk of early death [6]. All patients diagnosed with TTP must be initially admitted to an ICU to monitor and manage organ dysfunctions and to provide urgent plasma exchange therapy [6].…”

“…Older age, cerebral involvement, and persistently high LDH may help identify TTP patients at increased risk of early death [6]. All patients diagnosed with TTP must be initially admitted to an ICU to monitor and manage organ dysfunctions and to provide urgent plasma exchange therapy [6]. Experts suggest that ICU discharge be allowed when plasma exchange can be tapered or stopped, when signs of hemolysis disappear, and platelet count increases over 150,000/mL, which usually correlates with cardiac and neurological improvements [6].…”

“…All patients diagnosed with TTP must be initially admitted to an ICU to monitor and manage organ dysfunctions and to provide urgent plasma exchange therapy [6]. Experts suggest that ICU discharge be allowed when plasma exchange can be tapered or stopped, when signs of hemolysis disappear, and platelet count increases over 150,000/mL, which usually correlates with cardiac and neurological improvements [6]. Experts suggest that rituximab should be used in patients with relapsing autoimmune TTP and should also probably be used as a first-line therapy in severe TTP [6].…”