Prof. Marie Scully
University College Hospital, London
23rd March 2020
I’m sure everyone has heard the PMs speech this evening: stay indoors unless absolutely necessary to travel.
From the updated ‘at risk’ groups; patients with rare conditions are considered at risk.
TTP is a rare condition but not necessarily at risk.
There are 100’s of rare diseases and many are associated with an increased risk of infection or have therapies making patients more at risk to develop viral infections.
There are 2 main types of TTP:
- Congenital TTP – requiring patients have regular treatment to replace the missing enzyme. They are not at increased risk from COVID19, but any infection can result in a flare in their TTP. Therefore, it is really important patients are on regular ADAMTS 13 replacement such as plasma infusion, continue their therapy and if necessary, can receive extra treatment.
- Immune mediated TTP
- The ‘risk’ period is immediately after an acute TTP episode, as large doses of steroids are typically used.
- Patients who have had TTP in the past but their ADAMTS 13 levels are normal /near normal/stable-they are not at increased risk.
- Patients who have recently (within the last 6 months) received therapy to prevent a TTP relapse, they may be at moderate risk from the effects of COVID19.
- Steroids-recent high dose may increase the effect of COVID19. – moderate risk from the effects of COVID19.
- Mycophenolate or azathioprine or low dose long term steroids – low/moderate risk from the effects of COVID19.
- Rituximab/other anti-CD20 therapies: There remains some debate re the risk group. If received in the last 6 months-the risk is moderate. Outside of this period, patients having received rituximab are low risk. However, from years of experience and many of you can vouch for this, there does not appear to be an increase in viral infections after rituximab. But the cells needed to produce antibodies are very low and remain so for at least 6 months.
All of this risk is based on TTP and does not include other health conditions.
Please contact your local or regional nursing or medical teams if there are any queries. Do not turn up to your normal clinics/day care settings unless you have contacted your nurse specialist or doctor. Most clinics have been altered e.g. to telephone consultations and only those patients for whom their ADAMTS 13 is reducing/specific issues will be asked to attend in person. If you are symptomatic and it could be COVID19 and you have planned treatment/need a review -please contact your medical teams first. Most hospitals have specific processes in place for presumed COVID19 or patients self-isolating.
Please follow the Governments advice, but if you are concerned, contact your local team.