PLASMA-EXCHANGE WITH SOLVENT DETERGENT-TREATED PLASMA OF RESISTANT THROMBOTIC THROMBOCYTOPENIC PURPURA/

A patient with unremitting thrombotic thrombocytopenic purpura (TTP), with circulating ron Willebrand factor (VWF) multimers of unusually hi gh molecular weight, and refractory to standard plasma exchange therap y, was treated with solvent detergent (S/D) plasma, The patient achiev ed a sustained clinical and haematological remission, with normal VWF multimeric profile. Spontaneous remission of this patient's condition could not be excluded but would appear unlikely. S/D plasma was effica cious and potentially safe for repeated large-volume plasma exchange w ith respect to viral safety and reduction of anaphylactoid reactions. We have assayed coagulation factors and physiological inhibitors of ha emostasis in S/D plasma, which were comparable to normal plasma except in the distribution of VWF multimers. The use of S/D plasma, previous ly reported in paediatric chronic relapsing TTP, should be assessed in further cases of adult TTP in the context of a clinical trial.