Currently, prophylaxis with plasma transfusions is recommended in patients with hTTP and most frequently, although inconsistently, is initiated only after complications from the disease have arisen (upper panel). Given the high frequency of stroke and neurologic impairment reported by patients in Borogovac et al, the authors make a strong case for prophylaxis from the time of diagnosis. Complications of hTTP (lower panel) include hTTP relapses during the neonatal period associated with neonatal jaundice, infections (particularly childhood illness), and pregnancy along with stroke and chronic kidney disease. The authors highlight the fact that stroke often preceded the hTTP diagnosis, which suggests an important need to make this diagnosis early to prevent major neurologic morbidity. Illustration created using Biorender.