Methylene blue-treated plasma, versus quarantine fresh frozen plasma, for acute thrombotic thrombocytopenic purpura treatment: Comparison between centres and critical review on longitudinal data

Abstract

Introduction: Therapeutic plasma exchange (TPE) is the first-line treatment for acute thrombotic thrombocytopenic purpura (TTP). Methylene blue-plasma (MBP) has been used for over 20 years, but its efficacy in this setting remains controversial.Patients and methods: this is a comparative analysis of the experience of two Centres, with different plasma products, to evaluate their efficacy in TTP. One centre used quarantine plasma (QP), and MBP the other. We performed a retrospective longitudinal study, analysing the clinical files of TTP patients of a 13-year data evaluation period. Duration of treatment and transfusion parameters, medical record, laboratory testing, concomitant medication, and survival rate, were assessed for every episode. Results: During the study period, 12 (55.5 %) and 10 (45.5 %) new cases were treated with QP and MBP, respectively. There were no significant differences between the mean numbers of TPE processes, days elapsed from diagnosis to TPE, and plasma volume transfused. The QP TPE episodes of treatment were significantly associated with an increased time to recovery compared with MBP episodes of treatment (p = 0.004). Conclusion: MBP was as effective as QP in the treatment of TTP patients. Since recovery was more favourable when MBP was used, we consider MBP remains a suitable alternative to treat TTP patients.

Anti-Viral Photodynamic Inactivation of T4-like Bacteriophage as a Mammalian Virus Model in Blood

“…Conventional disinfection techniques approved for plasma (e.g., wet and dry heat treatments) [ 7 , 10 , 28 ] proved to be efficient in the inactivation of human immunodeficiency virus (HIV) or hepatitis B virus (HBV) but are not effective against non-enveloped viruses and can cause damage to the plasma proteins [ 7 ]. Also, the solvent/detergent method (SD method) approved in some European countries and in the USA for plasma or protein concentrates disinfection [ 7 , 10 ], and effective against non-envelope viruses, has some limitations; the chemicals used promote negative effects in the erythrocyte membranes and platelets and need to be removed after treatment [ 1 , 36 ].…”

“…Regarding non-enveloped viruses, the effectiveness is slightly lower, and although it is not effective against Hepatitis A virus, it was efficient in the photoinactivation of the non-enveloped Parvovirus B19 [ 24 , 27 ]. The adverse effects of MB have been evaluated over the last years and some doubts have arisen about MB efficacy in the treatment of plasma in patients suffering from thrombotic thrombocytopenic purpura [ 23 , 28 , 29 ]. Although it is approved for plasma disinfection in several European countries, in France it was removed from the market [ 24 , 25 ] due to allergic reactions detected in a few patients who received plasma treated with MB [ 23 ].…”

Egészségügyi szakmai irányelv – A thrombotikus thrombocytopeniás purpura (TTP) és a haemolytikus uraemiás syndroma (HUS) kezeléséről

“…Az SD plazma protein S és alpha2-antiplasmin tartalma alacsonyabb, ennek ellenére klinikai vizsgálatban az FFP-vel egyenértékűnek bizonyult [48]. Hasonlóan jól szerepelt az amotosalen-UVA-FFP is [49], míg a metilénkék-UVA-FFP hatékonysága változó volt [50]. A riboflavin-UV-FFP alkalmazásáról TTP-ben még nincs adat.…”