New developments in treatment modalities of thrombotic thrombocytopenic purpura

Although thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease, appropriate diagnosis and treatment result in the higher survival rate of >80%. TTP is usually suspected with thrombocytopenia and hemolytic anemia and is confirmed by a reduced activity of a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13) <10%. TTP is classified as acquired if a patient tests positive for anti-ADAMTS13 autoantibodies, and as congenital if ADAMTS13 gene abnormalities are identified. In patients with congenital TTP, fresh frozen plasma (FFP) transfusion for the supplementation of ADAMTS13 is performed. On the other hand, in patients with acquired TTP, plasma exchange therapy using FFP is conducted to supplement ADAMTS13 and remove anti-ADAMTS13 autoantibodies. Besides, corticosteroid therapy is often administered in conjunction with plasma exchange to suppress autoantibody production. In 2017, we aim to provide "diagnostic and treatment guidelines for TTP 2017 in Japan". In this review, we describe new developments in diagnosis and management of TTP, which are not discussed in the guidelines.