Diagnostic Challenges in Immune-Mediated Thrombotic Thrombocytopenic Purpura: A Case Report of Initial Misdiagnosis

Clinical Question BoxHow should immune-mediated thrombotic thrombocytopenic purpura (iTTP) be identified and managed in patients with atypical presentations and multiple comorbidities?iTTP should be suspected in patients with unexplained thrombocytopenia and hemolytic anemia, even without the classic pentad or schistocytes on initial peripheral smear, particularly in those with underlying autoimmune disease.Prompt initiation of therapeutic plasma exchange is warranted while awaiting confirmatory ADAMTS13 testing, with adjunctive therapies such as corticosteroids and caplacizumab to reduce immune-mediated activity and thrombotic risk.Early recognition and timely treatment are crucial to minimizing morbidity and mortality, especially in patients with complex or confounding comorbidities.