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CME: Congenital Thrombotic Thrombocytopenic Purpura (cTTP) (Upshaw-Schulman syndrome): Therapeutic Updates, Best Practices, and Emerging Therapies

Activity Description / Statement of Need:

In this online, self-learning activity:

Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder that impacts three in a million adults per year, with congenital or hereditary TTP (cTTP, also known as Upshaw-Schulman syndrome) accounting for a third of the overall incidence. The incidence of TTP rises with increasing age and the mortality rate of untreated TTP may be as high as 90%.

In recent years molecular mechanisms contributing to TTP have been identified: patients diagnosed with TTP have larger von Willebrand factor molecules (vWF) and a defective protease enzyme of A Disintegrinlike And Metalloprotease with ThromboSpondin type 1 motif 13 (ADAMTS13), which cleaves larger vWF molecules and inhibits platelet adhesion. In congenital or hereditary TTP (cTTP, also known as Upshaw-Schulman syndrome), the gene that codes of ADAMTS13 is defective and cannot properly produce the enzyme, whereas in acquired TTP, antibody production leads to downstream enzymatic deactivation.

Target Audience:

The following healthcare professionals: hematologists; physician assistants, nurse practitioners, nurses, and pharmacists who practice in hematology; and any other healthcare professionals with an interest in or who clinically encounter patients with cTTP.


This program is supported by an educational grant from Shire.


Release Date: October 02, 2018 -- Expiration Date: October 02, 2020

Faculty: Ilene Weitz, MD

Agenda

Cursory refresher and review on congenital (cTTP) epidemiology and diagnosis

  • Epidemiology: statistics on prevalence
  • Pathogenesis and etiology: the genetics of cTTP [Learning Objective #1]
  • Symptomology and clinical presentation
  • cTTP: often in newborns, pregnant patients
  • Thrombosis, thrombocytopenia, purpura
  • Neurological, cardiac, renal complications
  • ADAMTS13 gene deficiency
  • Diagnostic criteria [Learning Objective #2]
    • Thrombocytopenia
    • Microangiopathic hemolytic anemia
    • Blood film test
  • Patient case(s)

Treatment of cTTP [Learning Objectives #3-5]

  • Treatment overview and goals of therapy for cTTP
  • cTTP: current practice guidelines and standard care options
  • Acute episodes [Learning Objective #3]
    • Plasma infusion for ADAMTS13 repletion, goal platelet count ≥ 150 x 103/mcL, usually within 1-2 days
    • Lack of immediate response suggestive of acquired TTP
    • Factor VIII for patients intolerant of plasma infusion
    • Emerging therapy and the evidence so far behind it: recombinant ADAMTS13 [Learning Objectives #4]
    • Routine monitoring: microvascular thromboses [Learning Objective #3]
  • Consequences of failure to achieve normal platelet counts
  • Special populations (e.g., pregnancy)
  • Role of family genetic testing
  • Barriers to care [Learning Objective #5]
  • Patient case(s) [Learning Objectives #3 & 5]

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Describe the pathophysiology of cTTP such that it might inform treatment mechanisms.
  • Identify diagnostic criteria and differential diagnoses for cTTP
  • Describe current treatment standards for the management of cTTP and apply them to patient cases
  • Describe new and emerging therapies for the treatment of cTTP and the existing literature support its use in practice
  • Evaluate the likelihood cTTP in a patient case and develop a treatment plan

Accreditation

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of  1.00 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Physicians: For applicable courses, to attain maintenance of certification (MOC) credit, you must enter your board certification ID # and birth date correctly.  It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC credit for this activity. Please note: not all activities on this site provide MOC credit. If this activity does not specify that it provides MOC credit in the "Accreditation" section on this page, then it does NOT provide MOC credit.

Pharmacists

ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmaceutical education. This program is approved for 1.00 hours (0.1 CEUs) of continuing education.  Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test.   Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit.  ACPE # 0574-0000-18-035-H01-P.  ACPE Accreditation effective 10/04/2018, expires 10/04/2020. This is a Knowledge (K)-type activity.

 

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.  ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.

Faculty Disclosure: Ilene C. Weitz, M.D. Professor, University of Southern California, Los Angeles, CA has no relevent financial disclosures

Disclosures of Educational Planners: Charles Turck, PharmD has no relevent financial disclosures.

Commercial Support Disclosure: This program is supported by an educational grant from Shire.

Instructions

  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Take the post-test
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

System Requirements

PC
Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
MAC
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version


Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.