Thrombotic thrombocytopenic purpura (TTP): initial treatment with plasma exchange plus steroids and immunosuppressive...

The thrombotic thrombocytopenic purpura (TTP) is a rare disorder with a high mortality rate if untreated or delayed therapy. Whether immediate diagnosis and promptly treated with plasma exchange can change the grave prognosis?

Retrospective analysis was performed on clinical characteristics and treatment outcome of 13 patients diagnosed and treated during a 6-year period, from August 1994 to August 2000, in a tertiary care university hospital in Taiwan.

Among the patients, 8 were males and 5 were females, 10 were idiopathic, 2 were ticlopidine, and 1 was SLE-induced; 12 (92.3%) had neurological abnormalities, 11 (84.6%) had ecchymosis, 8 (61.5%) had fever, and 6 (46.2%) had renal impairment (creatinine > or = 1.5 mg/dL) at initial presentation of the syndrome. Excluding the SLE patient, 6 of 10 (60%) had shown antinuclear antibody (ANA) non-specific positive (titer > or = 1:40). All patients were initially treated with plasma exchange plus steroids. Of these 13 patients, 11 (84.6%) achieved complete remission, one had partial remission, and one, which was ticlopidine-induced, had no response and died of a progressive disease complicated with pneumonia. Within a median follow-up period of 31 months, 4 of 11 patients who achieved complete remission relapsed after one week, two weeks, three weeks, and three months, respectively. In the four relapsing patients, three late relapsing patients received FFP infusion, increased steroid dosages, added cyclophosphamide plus vincristine; and one early relapsing patient, relapsing twice, received an additional two courses of plasma exchange and added cyclophosphamide plus vincristine. All of the four patients achieved complete remission again. The patient who had partial remission relapsed early and responded promptly to another course of plasma exchange plus cyclophosphamide and vincristine and achieved complete remission.

Based on the results in this study, we conclude that plasma exchange plus steroids can effectively treat TTP. For patients with a refractory or relapsing disease, immunosuppressive therapy with cyclophosphamide plus vincristine should be administered as well.