Thrombotic Thrombocytopenic Purpura: An Extended Editorial

Abstract

Mystery and perplexity have burdened the history of TTP. The etiology of this disease remains unknown. The pathogenesis has been an enigma. No specific diagnostic test has yet been devised. The diagnosis is made tentatively and with imprecision. The tissue pathologic features are not at all pathognomonic. The laboratory findings are interchangeable with numerous other entities. The treatment is in perpetual debate. This regrettable catalogue of flawless failure also records that a strong clue for life-saving treatment in this deadly disease has been overlooked for half a century, until recent times.We propose new discriminatory, diagnostic standards for the identification of thrombotic thrombocytopenic purpura (TTP). Only by the use of a stringently defined paradigm applied prospectively to TTP will it be possible to understand the pathogenesis, to improve diagnostic accuracy, and especially to evaluate reliably the efficacy of a growing list of therapies. The diagnosis of TTP is in confusion and must be put right.The bleak record of progress in TTP is best regarded as bristling with opportunities for discovery. Continuing investigations by Kwaan [93,96, this issue, and recent discoveries by Byrnes and co-workers [35-37,101, this issue, pages 199-215] have given us invaluable insights into pathogenesis and treatment respectively. Suddenly, we are hopeful that some of our ignorance about TTP will soon vanish.The Byrnes' group has reported that plasma transfusions constitute effective, life-saving treatment in TTP [this issue pages [204][205][206]. This boon, however, is coupled with a hazard. Since TTP is rare, no single group may acquire any substantial clinical experience with the disease. Furthermore, diagnostic criteria for TTP are so non-specific, that more than TTP is so labeled. Thus, a proposed therapy for authentic cases of TTP will appear to be ineffective when inappropriately applied also to cases simulating