Thrombotic Thrombocytopenic Purpura in Pediatric Patients

Thrombotic thrombocytopenia purpura is a serious disease that can involve complex symptomatology, prolonged hospitalization, and a high risk of mortality if treatment is delayed. This disease is rare, but it is even rarer among pediatric patients. Even though it was first described 100 years ago, th...

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Main Authors: Niki Shrestha, Ebruphiyo Okpako, Robert W. Maitta
Format: Article
Language:English
Published: MDPI AG 2025-04-01
Series:Biomedicines
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Online Access:https://www.mdpi.com/2227-9059/13/5/1038
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author Niki Shrestha
Ebruphiyo Okpako
Robert W. Maitta
author_facet Niki Shrestha
Ebruphiyo Okpako
Robert W. Maitta
author_sort Niki Shrestha
collection DOAJ
description Thrombotic thrombocytopenia purpura is a serious disease that can involve complex symptomatology, prolonged hospitalization, and a high risk of mortality if treatment is delayed. This disease is rare, but it is even rarer among pediatric patients. Even though it was first described 100 years ago, the earliest documented case was a pediatric patient. The last three decades have seen the discovery of the pathological mechanisms responsible for its clinical presentation. Symptoms/signs characteristic of microangiopathic hemolytic anemia with significant thrombocytopenia characterize the vast majority of patients. Its pathology centers on the accumulation of ultra-large von Willebrand factor multimers due to an enzyme deficiency that prevents their breakdown. Currently, in pediatric patients, two forms of the disease are known: congenital due to a mutation in the enzyme’s gene and immune-mediated due to enzyme depletion or neutralization secondary to autoantibody formation. With the advent of therapeutic plasma exchanges, immunosuppression, and, more recently, a TTP-specific nanobody, there is reason for optimism that the disease does not necessarily equate to a bad outcome. Thus, the aim of this review is to contrast the congenital and immune-mediated forms of the disease in pediatric patients while presenting them in the context of their pathologic mechanisms, diagnosis, and treatment.
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spelling doaj-art-c42c0e504ee9432bb536cfacab6c2b1b2025-08-20T03:14:32ZengMDPI AGBiomedicines2227-90592025-04-01135103810.3390/biomedicines13051038Thrombotic Thrombocytopenic Purpura in Pediatric PatientsNiki Shrestha0Ebruphiyo Okpako1Robert W. Maitta2Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USADepartment of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USADepartment of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USAThrombotic thrombocytopenia purpura is a serious disease that can involve complex symptomatology, prolonged hospitalization, and a high risk of mortality if treatment is delayed. This disease is rare, but it is even rarer among pediatric patients. Even though it was first described 100 years ago, the earliest documented case was a pediatric patient. The last three decades have seen the discovery of the pathological mechanisms responsible for its clinical presentation. Symptoms/signs characteristic of microangiopathic hemolytic anemia with significant thrombocytopenia characterize the vast majority of patients. Its pathology centers on the accumulation of ultra-large von Willebrand factor multimers due to an enzyme deficiency that prevents their breakdown. Currently, in pediatric patients, two forms of the disease are known: congenital due to a mutation in the enzyme’s gene and immune-mediated due to enzyme depletion or neutralization secondary to autoantibody formation. With the advent of therapeutic plasma exchanges, immunosuppression, and, more recently, a TTP-specific nanobody, there is reason for optimism that the disease does not necessarily equate to a bad outcome. Thus, the aim of this review is to contrast the congenital and immune-mediated forms of the disease in pediatric patients while presenting them in the context of their pathologic mechanisms, diagnosis, and treatment.https://www.mdpi.com/2227-9059/13/5/1038thrombotic thrombocytopenic purpuracongenitalimmune-mediatedTTPsteroidstherapeutic plasma exchange
spellingShingle Niki Shrestha
Ebruphiyo Okpako
Robert W. Maitta
Thrombotic Thrombocytopenic Purpura in Pediatric Patients
Biomedicines
thrombotic thrombocytopenic purpura
congenital
immune-mediated
TTP
steroids
therapeutic plasma exchange
title Thrombotic Thrombocytopenic Purpura in Pediatric Patients
title_full Thrombotic Thrombocytopenic Purpura in Pediatric Patients
title_fullStr Thrombotic Thrombocytopenic Purpura in Pediatric Patients
title_full_unstemmed Thrombotic Thrombocytopenic Purpura in Pediatric Patients
title_short Thrombotic Thrombocytopenic Purpura in Pediatric Patients
title_sort thrombotic thrombocytopenic purpura in pediatric patients
topic thrombotic thrombocytopenic purpura
congenital
immune-mediated
TTP
steroids
therapeutic plasma exchange
url https://www.mdpi.com/2227-9059/13/5/1038
work_keys_str_mv AT nikishrestha thromboticthrombocytopenicpurpurainpediatricpatients
AT ebruphiyookpako thromboticthrombocytopenicpurpurainpediatricpatients
AT robertwmaitta thromboticthrombocytopenicpurpurainpediatricpatients