Possibilities and limits of treatment in patients with thrombotic thrombocytopenic purpura

Abstract

Results of treatment of 18 patients fulfilling the criteria for TTP are presented. Thrombocytopenia was present in all patients (100%). Sixteen of the 18 patients (88.8%) had mental status changes, and seven of the 18 patients (38.8%) had renal impairment. One patient had a secondary type of TTP, caused by non-Hodgkin's lymphoma of the large intestine (that was diagnosed later) and was excluded from the study. Immunosuppresive therapy with steroids, plasma exchange and replacement of removed volume with fresh frozen plasma in a dosage of 25 ml/kg body weight resulted in a statistically significant increase of platelet count (P = 0.00222), and a significant improvement in consciousness defined by increased GCS after 2 weeks (P = 0.00222). In two patients renal function recovered, and in one of them hemodialysis was no longer needed. This improvement in a small group of patients had no statistical significance. TTP recurred in seven patients. High doses of steroids caused serious side effects in two patients: in one patient, steroid diabetes, and in the other one, intestinal perforation.

Expert statement on the ICU management of patients with thrombotic thrombocytopenic purpura

“…We identified six studies that reported on critically ill patients with TTP (Table 2). 15,16,[39][40][41][42] These populations differed in terms of severity of illness, organ support and mortality, which may be attributable to variation in admission policies across centres.…”

Thrombotic thrombocytopenic purpura in southern Turkey: a single-center experience of 29 cases

“…Currently, plasma exchange (PE) therapy has been the accepted method of treatment in patients with TTP (Bell et al, 1991;Rock et al, 1996;Gasparovic et al, 2000). The benefit of other therapeutic modalities such as steroids and antiplatelet agents in combination with PE has not been conclusively shown (George, 2000).…”

Time course of organ dysfunction in thrombotic microangiopathy patients receiving either plasma perfusion or plasma exchange*

“…These studies included small numbers of patients and were usually descriptive (17)(18)(19)(20). One retrospective multicenter study investigated factors associated with outcomes for ICU patients with severe TMA and suggested that the means of administration of plasma therapy had a significant impact on the outcome (20).…”