TTP: The PLASMIC Code

NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications. This will also allow you to see how the algorithm was created, the population studied and any limitations to the study.

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1. A simpler score without the incorporation of the MCV, can be used to identify TTP in Chinese patients.

2. In pregnant women with suspected TTP, combining the PLASMIC Score [6-7] with the LDH: AST ratio [≥5.5] showed a higher positive predictive value for TTP compared to the PLASMIC score alone.

See Reference 2.

1. Bendapudi PK, et al. Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microan-giopathies: a cohort study. The Lancet Haematology. 2017; 4(4):p.e157-e164.

2. Jamme M and Rondeau E. The PLASMIC score for thrombotic thrombocytopenic purpura. Lancet Haematol. 2017; 4: e148-1499.

3. Tang N, Wang X, et al. Validation of the PLASMIC score, a clinical prediction tool for thrombotic thrombocytopenic purpura diagnosis, in Chinese patients. Thromb Res. 2018; 172: 9-13.

4. Bendapudi PK and Makar RS. An Algorithmic Approach to the Diagnosis and Management of the Thrombotic Microangiopathies. American Journal of Clinical Pathology. 2016; 145: 152-4.

5. Bendapudi PK, Upadhyay V, et al. Clinical Scoring Systems in Thrombotic Microangiopathies. Semin Thromb Hemost. 2017; 43: 540-8.

6. Upadhyay VA, Geisler BP, et al. Utilizing a PLASMIC score-based approach in the management of suspected immune thrombotic thrombocytopenic purpura: a cost minimization analysis within the Harvard TMA Research Collaborative. Br J Haematol. 2019.

7. Saha M, McDaniel JK, et al. Thrombotic thrombocytopenic purpura: pathogenesis, diagnosis and potential novel therapeutics. J Thromb Haemost. 2017; 15: 1889-900.

[P] Platelet Count <30 x 10⁹/L
	Yes: 1 Point
	No: 0 points
[L] Haemolysis: Elevated reticulocyte count [>2.5%]; undetectable Haptoglobin or indirect [unconjugated] Bilirubin >2.0 mg/dL [34µmol/L]
	Yes: 1 Point
	No: 0 Points
[A] Active Cancer: Treatment within the previous 12 months
	Yes: 0 Points
	No: 1 Point
[S] History of Solid Organ or Stem Cell transplant
	Yes: 0 Points
	No: 1 Point
[M] MCV <90fL
	Yes: 1 Point
	No: 0 Points
[I] INR <1.5
	Yes: 1 Point
	No: 0 Points
[C] Creatinine <2.0mg/dL [<177µmol/L]
	Yes: 1 Point
	No: 0 Points

Interpretation
0-4	Risk Group: Low Risk of severe ADAMTS13 Deficiency [<15% normal activity] 0%
5-6	Risk Group: Intermediate Risk of severe ADAMTS13 Deficiency [<15% normal activity] 6%
7	Risk Group: High Risk of severe ADAMTS13 Deficiency [<15% normal activity] 72%

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