Good morning sir, My father 55/male is affected by TTP with left ACA Stroke and systemic hypertension, he is under physiotherapy, speech therapy for aphasia and improving from stroke but in three months he had 4 acute reactivation of TTP , first two episodes he was treated by PEX and third episode PEX and retuximab, which delayed the fourth episode upto one month. This time he was treated with PEX alone. He is under metaprolol 12.5mg , bethanecol 25, piracetam 800, Prednisone 15 mg od, and a alpha blocker for past 3 months I'm maxillofacial surgeon I want to ask hematologist about increasing the steroids as my father responded well for steroids in the beginning just after the attack of stroke his platelets rose from 3K to 12 K. (thrombolysis was not done). I want to add that his entire antibody study was negative and Adams TS 13 level was 51 after one cycle of PEX he will develop echymosis, high LDH and schistocyste during reactivation episode. We have down around 14 PEX in 3 months of duration, Please help us to find a way to avoid further reactivation of TTP