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PLASMIC Score for TTP

Predicts severe ADAMTS13 deficiency in thrombotic microangiopathy.

PLASMIC Score for TTP
Platelet count <30 x10^9/L
Haemolysis (reticulocytes >2.5%, undetectable haptoglobin, or indirect bilirubin >2 mg/dL)
No active cancer in past year
No history of solid-organ or stem-cell transplant
MCV <90 fL
INR <1.5
Creatinine <2.0 mg/dL
Result0 points

Low probability of severe ADAMTS13 deficiency (about 0-4%).

PLASMIC score (0-7)
0
Risk of ADAMTS13 <10%
0-4%

When to use

  • Estimating the likelihood of severe ADAMTS13 deficiency (TTP) in a patient with thrombotic microangiopathy before enzyme results return.

Formula

One point each for: platelets <30, haemolysis, no active cancer, no prior transplant, MCV <90 fL, INR <1.5, creatinine <2.0 mg/dL. Score 6-7 = high risk of severe ADAMTS13 deficiency.

Pearls and pitfalls

  • A high score (6-7) supports empirical plasma exchange while awaiting confirmatory ADAMTS13 testing.

References

  1. Bendapudi PK, et al. Derivation and external validation of the PLASMIC score. Lancet Haematol. 2017;4(4):e157-64.