Plasma exchange with solvent/detergent‐treated plasma of resistant thrombotic thrombocytopenic purpura

Abstract

A patient with unremitting thrombotic thrombocytopenic purpura (TTP), with circulating von Willebrand factor (VWF) multimers of unusually high molecular weight, and refractory to standard plasma exchange therapy, was treated with solvent detergent (S/D) plasma. The patient achieved a sustained clinical and haematological remission, with normal VWF multimeric profile. Spontaneous remission of this patient's condition could not be excluded but would appear unlikely. S/D plasma was efficacious and potentially safe for repeated large-volume plasma exchange with respect to viral safety and reduction of anaphylactoid reactions. We have assayed coagulation factors and physiological inhibitors of haemostasis in S/D plasma, which were comparable to normal plasma except in the distribution of VWF multimers. The use of S/D plasma, previously reported in paediatric chronic relapsing TTP, should be assessed in further cases of adult TTP in the context of a clinical trial.

Efficacy and Safety Profile of Solvent/Detergent Plasma in the Treatment of Acute Thrombotic Thrombocytopenic Purpura: A Single-Center Experience

“…The occurrence of plasma-related allergic reactions due to the use of CPP and FFP are reported [23,24]. However, recent studies indicated a reduced risk of complications if SDP was used, even in patients who developed allergic reactions after the use of FFP [19][20][21].…”

“…In common use are cryosupernatant (CPP) and fresh frozen plasma (FFP), but recently solvent/detergent-treated plasma (SDP) has increasingly been used [2,[18][19][20][21][22][23]. The occurrence of plasma-related allergic reactions due to the use of CPP and FFP are reported [23,24].…”

“…Transfus Med Hemother 2010;37: [13][14][15][16][17][18][19] Efficacy and Safety of Solvent/Detergent Plasma in the Treatment of Thrombotic Thrombocytopenic Purpura 15 an increased creatinine level of 177 mmol/l. The ADAMTS-13 activity was 4%, and anti-ADAMTS-13 antibodies were detected in his serum.…”

“…We therefore used SDP as replacement fluid in TPE in order to verify its effectiveness in the treatment of TTP and its beneficial effect in reducing the number of allergic reactions and adverse events [29,30].…”

IgA Anaphylactic Transfusion Reactions

“…If there is an urgent need for plasma before such IgA-deficient plasma units can be collected, it may be more reasonable to transfuse SD-treated plasma slowly and under controlled conditions than to withhold treatment. SD-treated plasma is associated with fewer acute reactions than conventional plasma and has been used in selected patients who have not tolerated transfusions of conventional plasma without acute reactions [28]. SD-treated plasma has been transfused without complication in a patient with a history of anaphylactoid reactions to plasma-containing products who had IgA deficiency and antiIgA2 [6].…”