Treatment of thrombotic thrombocytopenic purpura by exchange transfusion

Three successive patients with thrombotic thrombocytopenic purpura (TTP) were treated by exchange transfusion on a total of 5 occasions in addition to receiving more conventional therapy such as corticosteroids, platelet inhibitors, heparin, and splenectomy. Dramatic relief of symptoms and objective improvement in hematologic values occurred within 24 hours of each exchange. One patient subsequently died of complications resulting from a massive hemorrhage, but in hematologic remission. The remaining 2 are now apparently well. These observations appear to confirm recent reports of a beneficial effect of exchange transfusion in TTP. Although the reason for its effectiveness is not yet known, exchange transfusion may be a highly useful adjunct in the treatment of this disorder and further evaluation of this form of therapy appears warranted.