Thrombotic Thrombocytopenic Purpura

Unparalleled expertise in rapid TTP diagnostics, then and now.

Versiti Diagnostic Labs has an incomparable history leading the field in Thrombotic Thrombocytopenic Purpura (TTP) diagnostics. BloodCenter of Wisconsin, part of Versiti, was the first lab in the United States to offer clinical testing for ADAMTS13, an enzyme whose deficiency or absence leads to the clinical manifestations of TTP including anemia, thrombosis, and/or organ damage.

Today, Versiti Diagnostic Labs maintains the largest menu of diagnostic tests available for TTP.

Our team offers referring physicians a streamlined diagnostic algorithm to quickly provide a diagnosis for more effective patient treatment.

Thrombotic Thrombocytopenic Purpura (TTP) is a rare, life-threatening disorder of the blood-coagulation system which causes microscopic clots to form in small blood vessels throughout the body. Although it’s rare, TTP affects about 4 to 6 people per million each year, most often women and African-Americans. Diagnosis of TTP is made clinically, but discerning it from other thrombotic microangiopathies is often difficult.

Versiti Blood Center of Wisconsin, pioneered the ADAMTS13 assays and is the only U.S. lab that conducts activity, inhibitor, antibody, and sequencing assays in-house. By creating a more sensitive assay, we can determine the precise level of activity of the disease, producing a more accurate diagnosis. Versiti also offers one of the fastest turn-around time of TTP diagnosis in the country, with average turnaround times under 24 hours.

Streamlined testing algorithm using tailored, evidence-based protocols.

Versiti Diagnostic Labs’ goal is to simplify and streamline the diagnostic process, with tailored, evidence-based protocols. The experience of our team—and our desire to provide you with industry-leading service—allows us to provide more than just a test result. We practice laboratory medicine to provide specific diagnostic insights for every patient. Our expert consultation when you need it, offers a comprehensive approach to diagnosing TTP.

ADAMTS13 is a plasma protein that regulates the interaction of platelets with von Willebrand factor. Severe deficiency of ADAMTS13 allows formation of platelet microthrombi, which in turn obstruct arterioles and capillaries, generating the clinical sequelae of TTP. In adults, severe ADAMTS13 deficiency is usually an acquired abnormality caused by autoantibody.

The majority of adults with idiopathic TTP have a severe deficiency of ADAMTS13 with activity levels < 10%. The low levels are often due to autoantibodies that inhibit or clear ADAMTS13. Patients with idiopathic TTP usually require therapeutic plasma exchange to achieve clinical remission. Patients with idiopathic TTP and severe ADAMTS13 deficiency are more likely to respond to plasma exchange therapy than patients without severe deficiency. Persistence of ADAMTS13 deficiency or an inhibitor/antibody during clinical remission suggests an increased risk for recurrence of symptomatic TTP.

Congenital severe ADAMTS13 deficiency is a rare autosomal recessive disorder (Upshaw-Schulman syndrome). Patients usually present as children, but adult presentations are reported, often triggered by stress events such as pregnancy. Patients are at risk for recurrent episodes of TTP. Antibody to ADAMTS13 is usually not detected, and patients generally improve with plasma transfusion therapy for ADAMTS13 replacement.

Disease-causing mutations have been identified throughout the coding sequence of the ADAMTS13 gene. No specific mutation appears to predominate. DNA sequence analysis will confirm a diagnosis of congenital ADAMTS13 deficiency. For family members of patients with known ADAMTS13 mutations, sequencing of the appropriate exons can be used for diagnosis, carrier status or prenatal testing.

1298

ADAMTS13 Activity

This assay is measured by Fluorescence Resonance Energy Transfer (FRET) with a synthetic substrate.

1299

ADAMTS13 Antibody

The antibody assay detects IgG antibody serologically by ELISA.

1295

ADAMTS13 Evaluation

ADAMTS13 Evaluation is a reflexive testing algorithm for evaluation of TTP. Activity is always performed. If result is <= 30%, the inhibitor assay (1297) is performed. If inhibitor result is <= 0.7 Inhibitor Units, the antibody assay (1299) is performed

1297

ADAMTS13 Inhibitor

The inhibitor assay measures antibodies that inhibit ADAMTS13 function by mixing study.

 
Diagnostic Laboratories
Diagnostic laboratory services including HLA testing, donor testing, immunohematology reference lab testing, hematology testing and more.
 
Hematology Testing
Versiti provides von Willebrand factor tests, aHUS diagnosis, hemophilia lab tests and other laboratory diagnosis of bleeding and clotting disorders.
 
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