Cancer-related TTP and considerations of plasma exchange.

The diagnosis and therapy of thrombotic thrombocytopenic purpura (TTP) have advanced dramatically in the past 25 years, with increasing diagnostic awareness spurred on by the discovery of plasma exchange as an effective therapy. Rarely is the pentad of thrombocytopenia, anemia, renal dysfunction, neurologic dysfunction, and fever present before the diagnosis is made, and now any time that thrombocytopenia is accompanied by an elevated lactate dehydrogenase (LDH) level, TTP is high on the list of possible etiologies. Although reviews find neurologic signs to be common,[1] the question of whether the diagnosis is TTP is often raised in the setting of just thrombocytopenia and elevated LDH. Dr. George emphasizes an important group presenting with overlapping signs and symptoms: patients with new or recurrent malignancy.[2]