INTENSIVE PLASMAPHERESIS FOR SEVERE THROMBOTIC THROMBOCYTOPENIC PURPURA - LONG-TERM CLINICAL OUTCOME

Plasma exchange is of proven efficacy in the treatment of thrombotic t hrombocytopenic pupura (TTP). In most series, less than 40 plasma exch anges (PE) were required for treatment and as many as two thirds of pa tients had permanent residual organ damage. We report on 4 patients wh o required very intensive PE for the resolution of?TP (37, 68, 102 and 108 procedures, respectively). The maximum number of PE procedures pe r attack was 102. None of these patients has any permanent sequellae o f TTP (other than those associated with splenectomy, which was perform ed on all patients). Two of the female patients had uncomplicated preg nancies since resolution of the disease. We conclude that even highly refractory cases of ?TP can have an excellent clinical outcome with in tense PE therapy. (C) 1997 Wiley-Liss, Inc.