{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:05:03Z","timestamp":1784005503198,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to analyze the clinical characteristics and causes of misdiagnosis in patients with thrombotic thrombocytopenic purpura (TTP) presenting with initial neurological symptoms, so as to provide reference for reducing misdiagnosis; to explore the feasibility and efficacy of albumin combined with plasma exchange in the treatment of TTP patients when plasma inventory is insufficient; and to put forward key precautions for TTP diagnosis and treatment, so as to provide strategic support for the treatment of similar cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical data of the patient (medical history, examination results, diagnosis and treatment records, etc.) were collected retrospectively; albumin combined with plasma exchange was adopted when plasma inventory was insufficient; laboratory indicators and symptom recovery were dynamically monitored to evaluate the effectiveness and safety of the treatment; misdiagnosis risks and the current status of alternative treatment were analyzed combined with literature review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Thrombotic thrombocytopenic purpura with initial neurological symptoms is easily confused with cerebral infarction, and thrombocytopenia of unknown origin is a key clue for differential screening. TTP should be excluded before platelet transfusion; when plasma inventory is insufficient, albumin combined with plasma exchange is feasible and effective for the treatment of AB-blood-type TTP, which can provide an alternative strategy for clinical practice; early diagnosis, timely targeted treatment and multidisciplinary collaboration are the keys to improving the prognosis of TTP patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1843101","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:21:40Z","timestamp":1784002900000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Albumin combined with plasma exchange in the treatment of refractory thrombotic thrombocytopenic purpura"],"prefix":"10.3389","volume":"13","author":[{"given":"Yi","family":"Zhao","sequence":"first","affiliation":[{"name":"Graduate School, Hebei North University, Zhangjiakou","place":["Hebei, China"]},{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linman","family":"Cao","sequence":"additional","affiliation":[{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]},{"name":"Graduate School, Hebei Medical University, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongrong","family":"Wang","sequence":"additional","affiliation":[{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]},{"name":"Graduate School, Hebei Medical University, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linzheng","family":"Luo","sequence":"additional","affiliation":[{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijing","family":"Liu","sequence":"additional","affiliation":[{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]},{"name":"Graduate School, North China University of Science and Technology, Tangshan","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyu","family":"Li","sequence":"additional","affiliation":[{"name":"Graduate School, Hebei North University, Zhangjiakou","place":["Hebei, China"]},{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boci","family":"Li","sequence":"additional","affiliation":[{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]},{"name":"Graduate School, Hebei Medical University, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bowen","family":"Ren","sequence":"additional","affiliation":[{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun","family":"Zuo","sequence":"additional","affiliation":[{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao","family":"Chu","sequence":"additional","affiliation":[{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingmin","family":"Zhao","sequence":"additional","affiliation":[{"name":"Cangzhou People\u2019s Hospital, Cangzhou","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Xing","sequence":"additional","affiliation":[{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Li","sequence":"additional","affiliation":[{"name":"Graduate School, Hebei North University, Zhangjiakou","place":["Hebei, China"]},{"name":"Hebei Provincial People\u2019s Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"64","DOI":"10.4274\/tjh.galenos.2020.2020.0348","article-title":"Comparison of clinical scoring systems in the management of patients with microangiopathic hemolytic anemia and thrombocytopenia.","volume":"38","author":"Baysal","year":"2021","journal-title":"Turk J Haematol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1177\/1753495X251338163","article-title":"Thrombotic thrombocytopenic purpura in pregnancy: a case report and literature review.","volume":"19","author":"Andreatidis","year":"2025","journal-title":"Obstet Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1182\/blood.2025028416","article-title":"Rapid ADAMTS13 activity assays for thrombotic thrombocytopenic purpura: a systematic review and meta-analysis.","volume":"146","author":"Deshpande","year":"2025","journal-title":"Blood"},{"key":"B4","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1055\/s-0037-1603100","article-title":"Clinical scoring systems in thrombotic microangiopathies.","volume":"43","author":"Bendapudi","year":"2017","journal-title":"Semin Thromb Hemost"},{"key":"B5","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/j.thromres.2020.09.012","article-title":"Validation of the PLASMIC score for predicting ADAMTS13 activity < 10% in patients with suspected thrombotic thrombocytopenic purpura in Alberta, Canada.","volume":"196","author":"Wynick","year":"2020","journal-title":"Thromb Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2486","DOI":"10.1111\/jth.15006","article-title":"ISTH guidelines for the diagnosis of thrombotic thrombocytopenic purpura.","volume":"18","author":"Zheng","year":"2020","journal-title":"J Thromb Haemost"},{"key":"B7","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1111\/imj.12935","article-title":"Diagnosis and management of thrombotic thrombocytopenic purpura (TTP) in Australia: findings from the first 5 years of the Australian TTP\/thrombotic microangiopathy registry.","volume":"46","author":"Blombery","year":"2016","journal-title":"Intern Med J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1080\/10408363.2023.2232039","article-title":"Laboratory investigation and diagnosis of thrombotic thrombocytopenic purpura.","volume":"60","author":"Dimopoulos","year":"2023","journal-title":"Crit Rev Clin Lab Sci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1158\/1055-9965.EPI-18-0702","article-title":"Aspirin, NSAIDs, and glioma risk: original data from the glioma international case-control study and a meta-analysis.","volume":"28","author":"Amirian","year":"2019","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"B10","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1002\/jca.21760","article-title":"A modified PLASMIC score including the lactate dehydrogenase\/the upper limit of normal ratio more accurately identifies Chinese thrombotic thrombocytopenic purpura patients than the original PLASMIC score.","volume":"35","author":"Zhao","year":"2020","journal-title":"J Clin Apher"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e157","DOI":"10.1016\/S2352-3026(17)30026-1","article-title":"Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microangiopathies: a cohort study.","volume":"4","author":"Bendapudi","year":"2017","journal-title":"Lancet Haematol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1182\/blood.2019000795","article-title":"Adjuvant low-dose rituximab and plasma exchange for acquired TTP.","volume":"134","author":"Zwicker","year":"2019","journal-title":"Blood"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2496","DOI":"10.1111\/jth.15010","article-title":"ISTH guidelines for treatment of thrombotic thrombocytopenic purpura.","volume":"18","author":"Zheng","year":"2020","journal-title":"J Thromb Haemost"},{"key":"B14","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1002\/jca.21288","article-title":"The use of 50% albumin\/plasma replacement fluid in therapeutic plasma exchange for thrombotic thrombocytopenic purpura.","volume":"28","author":"O\u2019Brien","year":"2013","journal-title":"J Clin Apher"},{"key":"B15","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1002\/jca.21771","article-title":"Efficacy of albumin and compounded plasma for plasma exchange in acquired thrombotic thrombocytopenic purpura.","volume":"35","author":"Hou","year":"2020","journal-title":"J Clin Apher"},{"key":"B16","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1182\/bloodadvances.2019000827","article-title":"Cost savings to hospital of rituximab use in severe autoimmune acquired thrombotic thrombocytopenic purpura.","volume":"4","author":"Goshua","year":"2020","journal-title":"Blood Adv"},{"key":"B17","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1056\/NEJMc1905426","article-title":"Caplacizumab Therapy without plasma exchange for acquired thrombotic thrombocytopenic purpura.","volume":"381","author":"Chander","year":"2019","journal-title":"N Engl J Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"303","DOI":"10.3233\/CH-231784","article-title":"A case of infection-induced thrombotic thrombocytopenic purpura.","volume":"84","author":"Cui","year":"2023","journal-title":"Clin Hemorheol Microcirc"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1843101\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:21:43Z","timestamp":1784002903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1843101\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":18,"alternative-id":["10.3389\/fmed.2026.1843101"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1843101","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]},"article-number":"1843101"}}