Thrombotic Thrombocytopenic Purpura: Experience with Whole Blood Exchange Transfusion

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

“…[6][7][8] These published reports have held credibility due to: (1) biologic basis of the hypothesis; (2) identification of a close temporal relationship between platelet transfusions and adverse outcomes; and (3) autopsy analysis revealing that platelets were the principal component of the thrombotic lesion in TTP patients. [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."…”

“…[1][2][3][4][5] It has been hypothesized that platelet transfusions may potentially provoke fatal thrombotic events, [6][7][8][9][10] particularly arterial ones, in TTP and HIT. 10,11 In TTP, the principal histologic abnormality is proposed to be a "platelet microvascular thrombus."…”

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

“…The first case reports describing neurological deterioration and death in patients with TTP following platelet transfusion were published in 1981 [2, 3]. Gottschall and colleagues described three patients who received plateletcontaining products and died, two of whom developed coma within minutes of transfusion [2]. Harkness and colleagues described a 34-year-old patient with TTP who had a sudden neurologic deterioration within 30 min of platelet transfusion and died 12 h later.…”

“…Secondary outcomes included bleeding of any severity or worsening thrombocytopenia. The period of 24 h was chosen based on the assumption that adverse events directly related to platelet products should occur immediately or within a few hours of platelet transfusion as described in prior case reports [2][3][4][5].…”

“…Current guidelines advise against the transfusion of platelets in patients with TTP except in cases of severe bleeding [1]. These recommendations are based on a small number of case reports describing worsening neurologic outcomes or mortality within hours of platelet transfusion; however, the patients in these reports did not receive plasma exchange prior to or during platelet transfusion [2][3][4][5][6]. Some recent studies, however, have described no adverse outcomes in patients with TTP who received platelet transfusion [7][8][9][10].…”