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Updated: Aug 5, 2026
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Platelet Transfusion in Patients With Low ADAMTS13-Confirmed Thrombotic Thrombocytopenic Purpura Is Associated With
Joseph O'Brien1, Alvin H Schmaier2, Mayher J Patel3
1Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA.
Background:
Thrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathy caused by severe ADAMTS13 deficiency. Platelet transfusions are generally contraindicated but are often administered before TTP is recognized.
Objectives:
To evaluate the association between platelet transfusion in the emergency department (ED) and outcomes in laboratory-confirmed TTP.
Methods:
We conducted a retrospective multicenter cohort study using the TriNetX Research Network (2014-2025). Adults presenting to the ED with ADAMTS13 activity < 10% who received plasma exchange within 48 h were included. The exposure was platelet transfusion within 24 h. The primary outcome was 30-day all-cause mortality; secondary outcomes included myocardial infarction (MI), stroke, intracranial hemorrhage, thrombosis, and ICU-level care. Propensity score matching (1:1) and Cox modeling were performed.
Results:
Among 693 patients, 99 (13.9%) received platelet transfusion. After matching, platelet transfusion was associated with higher 30-day mortality (30.0% vs. 13.3%; OR 2.79, 95% CI 1.31-5.93; p = 0.008) and increased MI. In Cox analysis, platelet transfusion remained independently associated with mortality (adjusted HR 2.45, 95% CI 1.24-4.85).
Conclusions:
In confirmed TTP, early platelet transfusion was independently associated with increased short-term mortality, supporting recommendations to avoid platelet transfusion and emphasizing early recognition.
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