We are now sure the patient has TTP.  Results of previously requested investigations show:

• Viral screen (HIV/Hep B/C) – negative
• Autoimmune screen – negative
• CXR – lung fields clear, heart size normal, no obvious bone or soft tissue abnormality
• ECG – no ischaemic changes
• Troponin and amylase – not elevated
• ADAMTS13 <5%
• CT Chest/abdo/pelvis – requested

The patient had had three days of plasma exchange and his FBC is as follows:

WCC 7.5 x10*9/L

Hb 99g/L

PLT 65 x10*9

Questions:

• What is the next course of management?
• How long would you continue plasma exchange?

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