Treatment of thrombotic thrombocytopenic purpura by exchange transfusion

Abstract

Three successive patients with thrombotic thrombocytopenic purpura (TTP) were treated by exchange transfusion on a total of 5 occasions in addition to receiving more conventional therapy such as corticosteroids, platelet inhibitors, heparin, and splenectomy. Dramatic relief of symptoms and objective improvement in hematologic values occurred within 24 hours of each exchange. One patient subsequently died of complications resulting from a massive hemorrhage, but in hematologic remission. The remaining 2 are now apparently well. These observations appear to confirm recent reports of a beneficial effect of exchange transfusion in TTP. Although the reason for its effectiveness is not yet known, exchange transfusion may be a highly useful adjunct in the treatment of this disorder and further evaluation of this form of therapy appears warranted.

Treatment of thrombotic thrombocytopenic purpura: A role for early vincristine administration

“…Patients were classified according to their response to PE alone, and to the need for subsequent therapy with vincristine or splenectomy, or both. Although frequently administered to patients with TTP, antiplatelet drugs and corticosteroids have failed to demonstrate therapeutic efficacy in this setting and were not considered as variables for the purpose of this study [9][10][11]. Long-term follow-up ranged from 3 years to 8 years and 3 months.…”

Journey in reverse: TTP from bedside to blood bank to bench

“…More than 50 years passed, nevertheless, before Bukowski, Hewlett, and their colleagues reported in 1976 in Seminars in Hematology [9a], along with Pisciotta, Garthwaite, Darin, and Aster in 1977 in the American Journal of Hematology [10] that whole blood exchange transfusions were associated with remission in some TTP patients. In the same year, Byrnes and Khurana described in the New England Journal of Medicine [11] successes in controlling repeated TTP episodes in a young woman with chronic relapsing TTP using infusions of only a few units of fresh-frozen plasma, stored plasma, or cryoprecipitatepoor plasma.…”

Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome in 2014—Current Knowledge and Outcomes with Plasma Exchange

“…[40][41][42][43] In the same year, Byrnes described a young woman with pregnancy-associated TTP whom he treated sequentially with selective blood product replacement. He showed the plasma fraction of blood was the main blood component in achieving a response.…”