Effectiveness of platelet transfusions after plasma exchange in adult thrombotic thrombocytopenic purpura: A report of two cases

Plasma infusion (PI) and plasma exchange (PE) are the most efficient treatm ent of thrombotic thrombocytopenic purpura (TTP), allowing achievement of c omplete remission in 60 to 90% of cases. Life-threatening bleeding, related to severe thrombocytopenia, is one of the main complications of the diseas e. Thrombocytopenia may also preclude invasive procedures such as splenecto my, which may be required during the management of TTP. Platelet concentrat es transfusions are usually thought to worsen the disease, especially if no t associated with the appropriate treatment of this latter, and thus should be avoided. We report hereon 2 patients with TTP who experienced a surgica l procedure i.e., a cholecystectomy for a cholecystitis, and a splenectomy for a refractory TTP. In both patients, the surgical procedure was preceded by a 60 mL/kg plasma exchange with solvent/detergent treated plasma as rep lacement fluid, followed by platelet transfusion, with a corrected count in crement of 57.1% (Patient 1) and 69.3% (Patient 2). Using this sequential t reatment, the patients did not experience any deterioration of their status . Both patients had a favorable outcome after surgery. However, until such a procedure will be validated on a larger series of patients, it should be restricted to patients presenting with a refractory life-threatening thromb ocytopenia and/or requiring surgery or any kind of invasive procedure.