Effectiveness of platelet transfusions after plasma exchange in adult thrombotic thrombocytopenic purpura: A report of two cases

被引:14
作者
Coppo, P
Lassoued, K
Mariette, X
Gossot, D
Oksenhendler, E
Adrie, C
Azoulay, E
Schlemmer, B
Clauvel, JP
Bussel, A
机构
[1] Hop St Louis, Serv Immunohematol, F-75475 Paris, France
[2] CHU Hop Nord, Immunol Lab, Amiens, France
[3] Inst Mutualiste Montsouris, Paris, France
[4] Hop St Louis, Serv Reanimat Med, Paris, France
[5] Univ Paris, F-75252 Paris, France
[6] Hop St Louis, Unite Hemapherese, Paris, France
关键词
thrombotic thrombocytopenic purpura; plasma exchange; plasma infusion; platelet transfusion;
D O I
10.1002/ajh.1179
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Plasma infusion (PI) and plasma exchange (PE) are the most efficient treatment of thrombotic thrombocytopenic purpura (TTP), allowing achievement of complete remission in 60 to 90% of cases. Life-threatening bleeding, related to severe thrombocytopenia, is one of the main complications of the disease. Thrombocytopenia may also preclude invasive procedures such as splenectomy, which may be required during the management of TTP. Platelet concentrates transfusions are usually thought to worsen the disease, especially if not associated with the appropriate treatment of this latter, and thus should be avoided. We report hereon 2 patients with TTP who experienced a surgical procedure i.e., a cholecystectomy for a cholecystitis, and a splenectomy for a refractory TTP. In both patients, the surgical procedure was preceded by a 60 mL/kg plasma exchange with solvent/detergent treated plasma as replacement fluid, followed by platelet transfusion, with a corrected count increment of 57.1% (Patient 1) and 69.3% (Patient 2). Using this sequential treatment, the patients did not experience any deterioration of their status. Both patients had a favorable outcome after surgery. However, until such a procedure will be validated on a larger series of patients, it should be restricted to patients presenting with a refractory life-threatening thrombocytopenia and/or requiring surgery or any kind of invasive procedure.
引用
收藏
页码:198 / 201
页数:4
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