Nawsherwan Mohammad: Recognizing TTP Before the ADAMTS13 Result Arrives
Nawsherwan Mohammad, Consultant Hematopathologist at Nanakaly Hospital, shared a post on LinkedIn about a recent article by Stephen MacDonald et al., published in BJHaem, adding:
“Suspected TTP is a medical emergency – don’t wait for ADAMTS13 to treat when clinical suspicion is high.
A practical summary of the 2026 BSH laboratory guidance on thrombotic thrombocytopenic purpura:
- Think TTP when thrombocytopenia plus microangiopathic haemolytic anaemia occur together.
- Look for marked thrombocytopenia, schistocytes, reticulocytosis, elevated LDH, low haptoglobin, and usually normal coagulation.
- Send a pre-treatment ADAMTS13 sample – ideally 3.2% sodium citrate, not EDTA – but never delay treatment.
- ADAMTS13 activity less than 10 IU/dL strongly supports TTP.
- 10–20 IU/dL is a grey zone, not an automatic negative.
- If less than 10 IU/dL, test anti-ADAMTS13 antibodies within 72 hours.
- Antibody-negative does not prove congenital TTP – genetic testing is required.
- For monitoring, use the same assay platform whenever possible.
Key message: rapid recognition, early sampling, and urgent treatment save lives.”
Title: Diagnosis and monitoring of thrombotic thrombocytopenic purpura: Guidance for laboratories from the British Society for Haematology
Authors: Stephen MacDonald, Thomas Pitchford, Deepak Singh, Rebekah Fretwell, P. Vince Jenkins, Caroline Lawrence, Richard Gooding, Sean Platton
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