After clinical review it is clear the patient is deteriorating. He needs urgent treatment for highly likely TTP. He has HIV, hepatitis, troponin, amylase, haemolysis screen (LDH/haptoglobin/retics), TFTs, lupus anticoagulant, autoimmune screen and an ADAMTS13 assay requested. CXR and ECG are performed. The renal team are alerted in order to assist with urgent plasma exchange with 1.5 solvent/detergent treated fresh frozen plasma. A gram of IV methylprednisolone is infused. Folic acid is prescribed 5mg/day.
- If plasma exchange cannot immediately be arranged are there any alternatives?
- What if the patient continued to deteriorate despite 1.5 plasma exchange/day?
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