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One hundred years ago, in 1924, the first description of a patient with a disease, now known as thrombotic thrombocytopenic purpura (TTP) was published by Dr. Eli Moschcowitz. In honor of this report, this article, written by distinguished specialists in TTP, reviews the increase in scientific knowledge on this disease during the last 100 years. It covers the scientific progress from plasma therapy, the first beneficial treatment for TTP, to the elucidation of the pathophysiology, the discovery of ADAMTS13, the development of assays and targeted therapies up to the modern treatment concepts, that improved the outcome of TTP from an incurable disease to a well understood and treatable disorder., Competing Interests: PK: Grants or contracts from any entity: Sanofi/Ablynx, Novo Nordisk, Takeda, Roche. Consulting fees: Sanofi/Ablynx, Novo Nordisk, Takeda, Roche. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Sanofi/Ablynx, Novo Nordisk, Takeda, Roche, Technoclone. Support for attending meetings and/or travel: Sanofi/Ablynx, Novo Nordisk, Takeda, Roche. Participation on a Data Safety Monitoring Board or Advisory Board: Sanofi/Ablynx, Novo Nordisk, Takeda.BL: Consulting fees: Hämatologie Praxis Bern, Monthly consultation and case discussions. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Lecture fee, Long-term burden of TTP, Virtual meeting Takeda 18.05.2021; Lecture fee, History of ADAMTS13 and TTP, Educational meeting Alexion, Liverpool, 20.09.2023. Participation on a Data Safety Monitoring Board or Advisory Board: Chairman of DMCs for studies of recombinant ADAMTS13 in hereditary and acquired TTP, run by Takeda; Chairman of DMC of Mayari study, treatment of acquired TTP using caplacizumab and immunosuppression without plasma exchange, run by Sanofi., (Thieme. All rights reserved.)

Three selected casuistic studies of individual patient problems from my long-standing professional experience are presented. I intend to highlight the potential contribution of case studies, including new approaches of laboratory investigation, for the advancement of pathophysiological knowledge and would encourage to "rehabilitate" the low academic profile generally attributed to "case reports.", Competing Interests: B.L. is chairman of the Data Safety Monitoring Committees for the Shire 281102 study (rADAMTS13 in cTTP) and for the Shire SHP 655–201 study (rADAMTS13 in iTTP) (now both sponsored by Takeda); over the past 6 years, B.L. received congress travel support by Baxter, Ablynx, Alexion, Siemens, and Bayer, and lecture fees from Siemens, Bayer, Alexion, Roche, and Sanofi., (Thieme. All rights reserved.)

Immunoglobulin light chain (AL) amyloidosis is a systemic disease caused by a plasma cell clone synthesizing an unstable light chain, which forms amyloid fibrils. Deposition of amyloid fibrils affects primarily kidney, heart, nervous system, spleen, liver, gastrointestinal tract and the skin. Skin bleeding in these patients is called amyloid purpura. Classically, it occurs spontaneously and bilaterally in the periorbital region. Vessel wall fragility and damage by amyloid are the principal causes of periorbital and gastrointestinal bleeding. Additionally, coagulation factor inhibitory circulating paraprotein, hyperfibrinolysis, platelet dysfunction or isolated acquired factor X deficiency may contribute to even more severe, diffuse bleedings. Early diagnosis remains essential for improving prognosis of patients with AL amyloidosis. Although pictures of amyloid purpura have been often reported in the literature, the clinical diagnosis may be delayed. We report a case of cutaneous manifestation of AL amyloidosis diagnosed not until one year after the appearance of the first symptoms. Diagnostic work-up revealed that the patient suffered from multiple myeloma with secondary AL amyloidosis. Atraumatic ecchymoses at the face, particularly the eyelids as well as in the neck should raise the suspicion of AL amyloidosis.

Hereditary thrombotic thrombocytopenic purpura, Upshaw-Schulman syndrome, ADAMTS13 Hereditary thrombotic thrombocytopenic purpura (TTP), also known as Upshaw-Schulman syndrome, is a rare recessively inherited disease. Underlying is a severe constitutional deficiency of the von Willebrand factor-cleaving protease, ADAMTS13, due to compound heterozygous or homozygous mutations in the ADAMTS13 gene. The clinical picture is variable and more and more patients with an adult-onset are diagnosed. In the majority of countries the only available treatment is plasma, which when administered regularly can efficiently prevent acute disease bouts. The decision to initiate regular prophylaxis is often not easy, as evidence based guidelines and long term outcome data are lacking. Through the hereditary TTP registry (www.ttpregistry.net, ClinicalTrials.gov identifier: NCT01257269), which was initiated in 2006 and is open to all patients diagnosed with Upshaw-Schulman syndrome and their family members, we aim to gain further information and insights into this rare disease, which eventually will help to improve clinical management of affected patients.

We present a woman (age: 57 years) with an excessive bleeding episode under acetylsalicylic acid after bone marrow puncture due to an acquired von Willebrand syndrome (avWS) in the context of a myeloproliferative disorder. The laboratory features showed a high platelet concentration and a qualitative defect of von Willebrand factor (vWF) with a low normal vWF ristocetin cofactor activity, a normal vWF antigen and a decrease of the larger vWF multimers in plasma. The exact mechanism of avWS is still incompletely resolved. Myeloproliferative diseases are one of several underlying disorders that may cause avWS. The diagnosis of the underlying disease is important because its treatment may lead to an improvement of the vWF abnormality. For symptomatic treatment of bleeding, desmopressin, vWF concentrate infusion, intravenous immunoglobulin and/or fibrinolysis inhibitors can be tried.