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Sialic acids rather than glycosaminoglycans affect normal and sickle red blood cell rheology by binding to four major sites on fibrinogen

and corticosteroids would not have been considered without our patient's requests, and would not have been possible without our patient's intelligence, understanding and agreement. We could confidently manage her as an outpatient because she was reliable, she lived near to the medical center, and her family could help with her management and guarantee her safety. Also, we would not have considered this treatment if her thrombocytopenia had been severe or if she had any neurologic symptoms. But with all of these supportive circumstances, we were able to manage our patient successfully. Our experience illustrates the ability of caplacizumab and rituximab, without hospitalization, to achieve a remission in patients with TTP. More importantly, our experience illustrates the value of integrating shared decision-making into clinical practice and exemplifies how shared decision-making can facilitate changes of medical practice, including utilization of new treatments.