Platelet transfusions and bleeding complications associated with plasma exchange catheter placement in patients with presumed thrombotic thrombocytopenic purpura

Abstract

There were no major bleeding complications associated with plasma exchange catheter insertion in thrombocytopenic patients with presumed TTP. In light of the uncertain risk of platelet transfusion in patients with TTP, it may be reasonable to forgo prophylactic platelet transfusion prior to catheter placement.

Outcomes of platelet transfusion in patients with thrombotic thrombocytopenic purpura: a retrospective case series study

“…In a review of 55 patients with presumed TTP, there were no major bleeding events associated with CVC placement even in patients who had platelet counts of <20,000/μl [17]. In our study, we found no bleeding complications related to central venous catheter placement despite some patients having platelet counts of <20,000/μl.…”

“…More recent studies have shown that a platelet count of 20,000/μl for central venous catheter placement is generally safe in patients with thrombocytopenia [16,17]. In a review of 55 patients with presumed TTP, there were no major bleeding events associated with CVC placement even in patients who had platelet counts of <20,000/μl [17].…”

Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality

“…[6][7][8]12 The generally accepted practice has been to restrict platelet transfusions only to life-threatening bleeds, and in fact, some clinical recommendations institute low-dose anti-platelet agents concurrent with platelet count recovery. [30][31][32] A systematic review and analysis of data from the Oklahoma TTP-HUS Registry could neither rule in nor rule out adverse outcomes from platelet transfusions and concluded that there was "uncertain evidence of harm." 33 Our large data set suggests that platelets may be associated with 6 times higher odds of developing †Any CNS/gastrointestinal bleeding/genitourinary bleeding is reported as a "documented bleeding.…”

Implementation of a rapid assay of ADAMTS13 activity was associated with improved 30‐day survival rate in patients with acquired primary thrombotic thrombocytopenic purpura who received platelet transfusions

“…UK TTP guidelines describe that PLT transfusions are contraindicated in TTP unless there is life‐threatening hemorrhage . However, severe hemorrhage is rare in TTP patients, although profound thrombocytopenia is a typical feature . In clinical practice, PLT transfusion is often requested by a surgeon before inserting a central venous catheter for access for plasma exchange rather than the risk of severe hemorrhage occurring during or after the procedure.…”