Thrombotic Thrombocytopenic Purpura |
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Once a diagnosis of TTP has been made, plasma exchange should be initiated as soon as possible. If plasma exchange will be delayed for more than a few hours, FFP should be continuously infused until the procedure is started. Daily plasma exchanges using 40 to 60 mL of ABO compatible plasma per kg of body weight should be performed until the platelet count increases above 150,000/uL. Thereafter, plasma exchange should be performed every other day for at least 5 days after the platelet count and lactate dehydrogenase level have normalized. Often times, 15 to 20 treatments may be necessary to achieve remission. Discontinuing plasma exchange too early may result in relapse. Platelet count, hemoglobin and lactate dehydrogenase should be monitored daily throughout the treatment period.
Some investigators have advocated using cryopoor plasma instead of FFP because it contains vWF metalloproteinase, but lacks vWF multimers. However, response rates with cryopoor plasma have not been significantly different from FFP. In some hospitals, Cryo Poor Plasma is substituted for FFP if a patient has not responded after five plasma exchanges with FFP.
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