Rituximab Information Leaflet for
Thrombotic Thrombocytopenia Purpura
(TTP) patients
You have been prescribed Rituximab to treat your TTP.
Rituximab is a monoclonal antibody. It works by recognising the protein (CD20) on the
surface of one of the main types of normal white blood cells (B-cell lymphocytes) and then
binding onto it (like a key in a lock) and remove the cells producing the antibodies causing
TTP.
Rituximab is given during the acute TTP episode when you are in hospital, and can also be
given in the out-patient setting if your enzyme level: ADAMTS13 is lowered from previous
stable readings.
Before Rituximab is administered, we will check your Hepatitis status. Depending on the
results, you may be started on a drug called Lamivudine.
How is it given?
Rituximab is clear colourless fluid after being diluted. It is given as a drip (infusion) through
a fine tube (cannula) inserted into a vein. The first infusion is usually given slowly eg over
8-12 hours when you are an in-patient. This is because it is not uncommon to get a reaction
with the first infusion, associated with shivering, temperature, shaking. This is an allergic
reaction. The nurses looking after you are very familiar with Rituximab and will slow/stop
the infusion temporarily and give you further medication to reduce the symptoms. One of
these medications, Piriton, is anti-histamine and can make you very sleepy. Subsequent
infusions (depending on degree of reaction experienced) will be administered over 2-4
hours. Timing of administration will be determined by your consultant.
You may have anything between 4 and 8 Rituximab infusions when you present with TTP.
Longer term we monitor you in the outpatients ‘clinic and if your ADAMTS 13 drops to low
levels, even though you are well, we will give you further Rituximab to prevent you having a
TTP relapse.
Possible reactions / side effects
Everyone reacts differently to Rituximab. Some people have very few side effects, while
others may experience more. Side effects are generally mild and can be reduced with
medicines.
Listed below are the most common side effects:

Flu-like symptoms: these can include a high temperature, chills, weakness,
muscle aches, tiredness, dizziness and headaches. They can occur while the
Rituximab is being given, but do not usually last long.

Low blood pressure: this may happen during the infusion, so your blood pressure
readings will be checked regularly during the infusion.

Feeling sick and occasional vomiting: you will be given anti-sickness tablets. If
you find the sick feeling persists, please inform the nurse who will get a stronger
anti-sickness medication prescribed for you.

Allergic reactions: you may have a slight allergic reaction to the Rituximab. Signs
of this include skin rashes and itching, a feeling of swelling in the tongue, irritation
of the nasal passages, wheezing, a cough and breathlessness. You are
monitored closely throughout the infusion, but if you experience any of these
symptoms, please let the nurses know.

Lowered resistance to infection: Rituximab can reduce the production of
antibodies making you more prone to infection.

Lowered White Blood Cells: occasionally neutropenia can be seen post
administration of Rituximab.

Flushing: you may experience sudden warmth in your face as well as some
redness or darkening. This can happen for a short time during the infusion.

Joint pains: very occasionally patients can complain of joint pains, especially in the
knees.

PML: Progressive multifocal leukoencephalopathy is a rare viral disease of the
brain. It is associated with certain immunosuppressive or immunomodulatory
therapies.
What conditions is Rituximab used in as a treatment
If you look up Rituximab on the internet, you will see it is primarily used in a type of blood
cancer called lymphoma. But it is also licensed for use in an autoimmune condition called
rheumatoid arthritis. Rituximab is not licensed in TTP, but is shown to be very effective in
getting patients into remission and preventing relapse. It is also used in other
haematological conditions that are not blood cancers that are due to the immune system
being unregulated.
Contact Names / Numbers for the TTP Team
TTP Lead Consultant: Dr Marie Scully
TTP Consultant: Dr John –Paul Westwood
TTP Data Manager: Debra Elllis
TTP Clinical Nurse Specialist: Siobhan Mc Guckin: 07908 175363
Out of Hours / Urgent Medical Advice Number: 07852 220900
Approved By: Dr Marie Scully, Dr JP Westwood and Siobhan Mc Guckin