Influence of type of exchange fluid on survival in therapeutic apheresis for thrombotic thrombocytopenic purpura

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a potentially lethal disease that may respond favorably to plasma infusion or therapeutic plasma exchange (TPE) with frozen plasma (FP) as the exchange fluid. Frozen plasma from which the cryo-precipitated fraction has been removed (cryopoor plasma, CP) has reportedly been useful in refractory cases in which a response to FP is not being observed. We report a retrospective analysis of all cases of TTP treated by TPE with either FP (1985-1989) or CP (1989-1993) as exchange fluid at a large tertiary care hospital between the years 1985 and 1993. A severity score index was compiled for each patient using the platelet count, mental status, hematocrit, and renal function at the time of diagnosis. Nineteen patients were treated with FP (group 1) and 18 patients with CP (group 2). Groups did not differ in age, gender, race, hematologic parameters, or severity scores. Patients treated with CP, however, had more plasma exchange (14 +/- 10 vs. 12 +/- 8, respectively) and more fluid exchanged than these treated with FP (50 L +/- 36 vs. 37 L +/- 40, respectively). Survival was 72% in the CP group and 47% in the FP group. Although a survival advantage for the use of CP as exchange fluid in the treatment of TTP is suggested by our observations, the retrospective nature of the study, lack of randomization, and sequential rather than concurrent use of FP and CP indicates caution in interpretation. The data do indicate, however, that use of CP is acceptable as the initial exchange fluid in TTP.

Cryoprecipitate poor plasma does not improve early response in primary adult thrombotic thrombocytopenic purpura (TTP)

“…Plasma exchange with CPP has been used when patients responded incompletely to FFP, and subsequent responses were attributed to a greater efficacy of CPP [11,12]. Other retrospective, uncontrolled studies have suggested an improved response rate and survival in newly diagnosed patients with TTP [13,14].…”

“…Cryoprecipitate poor plasma (CPP) has been suggested as a preferable exchange fluid because of the contributory role of vWF in the pathogenesis of TTP [5][6][7][8][9], the reported effectiveness of CPP as salvage therapy for refractory TTP [11,12] and the suggestion of its superiority in non-randomized studies in the treatment of TTP [13,14].…”

Plasma Exchange in the Management of Thrombotic Thrombocytopenic Purpura

“…With CSP, there was some decrease in the quantity of vWF after therapy. A retrospective analysis by Owens (Owens et al, 1995) also compared patient survival following the use of either FFP or CSP. The survival was 72% in the group that received CSP and 47% in the group which received FFP.…”

Cryoprecipitate‐reduced plasma:rationale for use and efficacy in the treatment ofthrombotic thrombocytopenic purpura

“…At this time, there are only two studies that have evaluated its use in this manner. 6,40 One study compared patient survival at a large tertiary‐care hospital using either CRP or FFP as replacement fluid in plasma exchange procedures. 40 From 1985 to 1989, 19 patients were treated with FFP.…”