This ASH spotlight session will feature a debate discussing whether caplacizumab should be a component of the routine treatment of all patients with acute thrombotic thrombocytopenic purpura. Recently introduced, caplacizumab had a modest impact on disease in large clinical trials. Despite this, various guidelines and recommendation documents have suggested its routine use. However, persuasive arguments can be made both for and against its use, in light of its cost/ benefit analysis and its impact on long-term outcomes, particularly in light of other therapeutic advances in this area, including the widespread use of anti CD 20 monoclonal antibodies for patients presenting with TTP.