Thrombotic thrombocytopenic purpura plasma exchange

The use of vincristine to treat thrombotic thrombocytopenic purpura has also been reported to be successful 14,18). This rare disease of sporadic thrombosis of small vessels with consequent intravascular hemolysis has been successfully treated recently with both plasma exchange and plasma infusion. However, there are obvious disadvantages to plasma infusion, including volume overload, transmission of infection, and cost and scarcity of plasma. Several patients have been successfully treated with vincristine alone or in association with plasma therapy. At present, however, this treatment should probably not be used alone because of the high success rate of plasma infusion and/or exchange. 

Thrombotic thrombocytopenic purpura is a possible complication of interferon alfa in patients with chronic myelogenous leukemia, and can develop even after a successful prolonged (2-3 years) treatment (234). Complete recovery is expected after prompt medical management with plasma exchange and glucocorticoids. 

Intensive plasma exchange has been studied in the treatment of numerous diseases, above all in Waldenstrom s macroglobulinemia, hypercholesterolemia, hyperviscosity syndrome, thrombotic thrombocytopenic purpura, systemic lupus erythematosus, myasthenia... 

Fresh frozen plasma contains the components of the coagulation system and is indicated for the replacement of deficient coagulation factors II, V, VII, X, XI, and XIII. Factor VIII and IX deficiencies are treated with specific factor concentrates. Fresh frozen plasma is also used for the rapid reversal of warfarin anticoagulation and in the treatment of disseminated intravascular coagulation. Thrombotic thrombocytopenic purpura is treated by means of therapeutic plasma exchange with fresh frozen plasma as the replacement fluid. Cryo-precipitate, which contains factor VIII, von Willebrand s factor, and fibrinogen, is indicated for the treatment of von Willebrand s disease that does not respond to desmopressin acetate, and for fibrinogen replacement (see Chap. 100). 

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