What is the efficacy of plasma exchange for thrombotic thrombocytopenic purpura (TTP) treatment?

Updated: Feb 18, 2019
  • Author: Theodore Wun, MD, FACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Marn Pernat et al reported their 11-year experience with membrane plasma exchange for the treatment of TTP. [19] Therapy was immediately initiated in 56 patients, then administered once or twice daily until platelet counts normalized, with an average number of 19 ± 17 plasma exchanges per patient. Nearly 1100 plasma exchange procedures were performed, in which 1-1.5 plasma volumes (3606 ± 991 mL) were replaced with fresh frozen plasma, with an average duration of 23 ± 17 days. [19] Although renal impairment was found in 36% of patients, 93% (52/56) had an excellent response to the therapy, of whom 86% (48 patients) reached complete remission (platelet count > 100 × 109/L). [19]

There were four deaths soon after plasma exchange therapy was initiated (post one to three procedures), and in the follow-up period, of six patients who had achieved complete remission and subsequently had one to five relapses each year, one died of acute hemolytic reaction during tapering of the therapy. Splenectomy was performed on three patients. [19] Overall, Marn Pernat et al did not find serious side effects with plasma exchange therapy in their cohort of 1066 patients.


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