Thrombotic thrombocytopenic purpura: optimal management of plasma exchange, platelets and infection prevention

Abstract

PREVIEW

Dear Sir,

We would like to offer some reflections on the recently published article in your journal, "Diagnosis and clinical management of thrombotic thrombocytopenic purpura (TTP): a consensus statement from the TTP Catalan group"¹.

Replacement solutions in therapeutic plasma exchanges (TPE) should not be used interchangeably. There is extensive literature that has shown that TPE with methylene blue inactivated plasma (MBIP) has worse results compared to fresh frozen quarantined plasma (FFQC), such as greater risk of mortality due to progression and recurrence of thrombotic thrombocytopenic purpura (TTP), lower probability of maintaining the response beyond 8-9 days^2-3, as well as the need for a greater number of sessions and a greater volume of plasma to achieve remission³. Further, Pereira et al.⁴ describe increased demand for plasma and plasma derivatives in cases treated with MBIP, probably to compensate its poor hemostatic capacity and worse outcomes and higher transfusion rates in trauma patients with massive hemorrhage. For all these reasons, they conclude that the premise of savings with the use of MBIP is a conclusion based on an incomplete evaluation of the available data.  [ … ]