Thrombotic thrombocytopenic purpura had been thought to be a fatal illness before the evolution of plasma therapy (plasma exchange and/or plasma infusion). In recent days, the survival from TTP has surprisingly increased to 70~90% with
multimocality
treatment including plasma exchange, plasma infusion, high-dose corticosteroids, and immunosuppres-sive drugs.
We reviewed six patients with TTP who underwent plasma exchanges as a part of multimodality treatment at Severance hospital during the period of 1986 to 1991. The classical pictures of TTP were observed in all cases. When admitted, the mean
hemoglobin
and the reticulocyte count of the patients were 8.7 g/dL and 5.4%, respectively. All had thrombocytopenia; the average count was 37.000μl Neurologic abnormalites were present in tree patients. Three had fever and five had renal abnormalities
with
azotemia, hematuria, or proteinuria.
The patients received three to seven plasma exchanges, starting at an average of 5.5 days after diagnosis of TTP. We used FFP or FFP plus 5% albumin as the replacement fluids. The processed plasma volume was 0.6 times of patient's own plasma
volume
in
average, and the total amounts of exchanged plasma were 6~13 L per patients at the day of the first plamsa exchange. Clinical response was noted at an average of 8.8 days from the day of the first plasma exchange. The platelet count and the serum
LDH
level were normalized after an average of 16.3 and 13.7 days from the starting of plasma exchange, respectively. All patients tolerated the procedures well without serious complications. All patients successfully recovered without any sequelae.
We confirmed that in even very severe cases of TTP, plasma exchange could be applied with little risk and might contribute to the good survival.
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