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Diagnosis and clinical management of thrombotic thrombocytopenic purpura (TTP): a consensus statement from the TTP Catalan group

Publicated to:Blood Transfusion. 22 (2): 176-184 - 2024-04-01 22(2), DOI: 10.2450/bloodtransfus.522

Authors: Munoz, Nadia Garcia; Ortega, Sandra; Solanich, Xavier; Cid, Joan; Diaz, Maribel; Moreno, Ana B; Ancochea, Agueda; Santos, Mireia; Hernandez, Ines; Sanchez, Juan M; Luana, Armando; Garcia, Jose; Escoda, Lourdes; Medina, Laura; Ferrer, Gonzalo J; Lopez, Jordi; Cespedes, Roberto; Diaz, Johana A; Pons, Veronica; Valcarcel, David; Grifols, Joan R

Affiliations

Catedra UAB Med Transfus & Terapia Cellular & Tiss, Med Direct, Banc Sang & Teixits, Barcelona, Catalonia, Spain - Author
Hosp Arnau Vilanova, Catedra UAB Med Transfus & Terapia Cellular & Tiss, Banc Sang & Teixits, Hemotherapy, Barcelona, Spain - Author
Hosp Arnau Vilanova, Hemathol, Lleida, Catalonia, Spain - Author
Hosp Doctor Josep Trueta, Catalan Inst Oncol, Hemathol, Girona, Catalonia, Spain - Author
Hosp Doctor Josep Trueta, Catedra UAB Med Transfus & Terapia Cellular & Tiss, Banc Sang & Teixits, Hemotherapy, Girona, Catalonia, Spain - Author
Hosp Germans Trias I Pujol, Banc Sang & Teixits, Hemotherapy, Catedra UAB Med Transfus & Terapia Cellular & Tiss, Badalona, Catalonia, Spain - Author
Hosp Germans Trias i Pujol, Catalan Inst Oncol, Hemathol, Badalona, Catalonia, Spain - Author
Hosp Santa Creu & Sant Pau, Catedra UAB Med Transfus & Terapia Cellular & Tiss, Banc Sang & Teixits, Hemotherapy, Barcelona, Catalonia, Spain - Author
Hosp Santa Creu & Sant Pau, Hemathol, Barcelona, Catalonia, Spain - Author
Hosp Univ Bellvitge, Hemotherapy, Banc Sang & Teixits, Catedra UAB Med Transfus & Terapia Cellular & Tiss, Lhospitalet de Llobregat, Catalonia, Spain - Author
Hosp Univ Bellvitge, Internal Med, Lhospitalet de Llobregat, Catalonia, Spain - Author
Hosp Univ Vall Dhebron, Banc Sang & Teixits, Catedra UAB Med Transfus & Terapia Cellular & Tiss, Hemotherapy, Barcelona, Catalonia, Spain - Author
Hosp Univ Vall Dhebron, VHIO, Hemathol, Barcelona, Catalonia, Spain - Author
Univ Barcelona, IDIBAPS, Clin Barcelona, Hemostasis & Erythropathol Pathol Dept,CDB, Barcelona, Catalonia, Spain - Author
Univ Barcelona, IDIBAPS, Clin Barcelona, Hemotherapy & Hemostasis,ICMHO, Barcelona, Catalonia, Spain - Author
Univ Rovira i Virgili, Catalan Inst Oncol, Hemathol, Hosp Univ Tarragona Joan 13, Tarragona, Catalonia, Spain - Author
Univ Rovira i Virgili, Hosp Univ Tarragona Joan 13, Catedra UAB Med Transfus & Terapia Cellular & Tiss, Banc Sang & Teixits,Hemotherapy, Tarragona, Catalonia, Spain - Author
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Abstract

Thrombotic thrombocytopenic purpura (TTP) is a low prevalence disease characterized by severe deficiency of the enzyme ADAMTS13, leading to the development of thrombotic microangiopathy (TMA) and often resulting in severe organ disfunction. TTP is an extremely serious condition and, therefore, timely and appropriate treatment is critical to prevent life -threatening complications. Over the past 25 years, significant advances in the understanding of the pathophysiology of immune TTP have led to the development of readily available techniques for measuring ADAMTS13 levels, as well as new drugs that are particularly effective in the acute phase and in preventing relapses. These developments have improved the course of the disease. Given the complexity of the disease and its various clinical and laboratory manifestations, early diagnosis and treatment can be challenging. To address this challenge, a group of experienced professionals from the Catalan TTP group have developed this consensus statement to standardize terminology, diagnosis, treatment and follow up for immune TTP, based on currently available scientific evidence in the field. This guidance document aims to provide healthcare professionals with a comprehensive tool to make more accurate and timely diagnosis of TTP and improve patient outcomes.

Keywords

AcetylcysteineAdamts13Adamts13 proteinAmotosalenAnti human immunodeficiency virus agentAntinuclear antibodyBevacizumabBilirubinBortezomibCaplacizumabCarfilzomibClinical assessmentClinical practiceClinical trial (topic)ClopidogrelConsensusCoombs testCorticosteroidCreatinineCryoprecipitateCyclophosphamideCyclosporineDaratumumabDeficiencyDiagnostic testDisease exacerbationElectrocardiographyElectrolyteEmergency careEstrogenEverolimusExchangFeces cultureFibrinogenFollow upFresh frozen plasmaGemcitabineHemolysisHepatitis b core antibodyHepatitis b surface antigenHumanHumansIdiopathic thrombocytopenic purpuraImmunoglobulinImmunosuppressive treatmentInterferonIxazomibKidney functionLactate dehydrogenaseLiver functionManaged careMethylprednisoloneMicroangiopathic hemolytic anemiaMicroangiopathiesMitomycinMycophenolate mofetilOutpatient carePalbociclibPhase 2 clinical trial (topic)Phase 3 clinical trial (topic)Plasma exchangePlasma transfusionPlasmic scorePlatelet countProgesteronePurpura, thrombocytopenic, idiopathicPurpura, thrombotic thrombocytopenicQuinineRecurrenceRecurrent diseaseRelapseRemissionReticulocyte countRituximabSchistocyteSmearStandardizationThrombocytopeniaThrombotic microangiopathiesThrombotic microangiopathyThrombotic thrombocytopenic purpurThrombotic thrombocytopenic purpuraTreatment indicationTreatment outcomeUrine sedimentValidationVon willebrand factor

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Blood Transfusion due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2024 there are still no calculated indicators, but in 2023, it was in position 46/97, thus managing to position itself as a Q2 (Segundo Cuartil), in the category Hematology. Notably, the journal is positioned en el Cuartil Q2 para la agencia Scopus (SJR) en la categoría Medicine (Miscellaneous).

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 2.47, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-26, the following number of citations:

  • WoS: 2
  • Scopus: 3
  • Europe PMC: 2

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-26:

  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 9 (PlumX).