Platelet transfusion in thrombotic thrombocytopenic purpura

Otrock ZK, Liu C, Grossman BJ.
Vox Sang. 2015 Aug;109(2):168-72. doi: 10.1111/vox.12274. Epub 2015 Apr 20.

Platelet transfusion has been considered contraindicated in patients with thrombotic thrombocytopenic purpura (TTP). However, adverse clinical outcomes and death in patients with TTP after receiving PLT transfusion  were based on case reports prior to routine use of plasma exchange (PEX) therapy. PLT transfusions are often required by the interventional radiologist before the  insertion of a central venous catheter. In this study, the authors evaluate whether PLT transfusions are harmful in patients with TTP undergoing PEX. They retrospectively reviewed the records of consecutive patients with the clinical diagnosis of TTP who received PEX at our institution between January 2004 and September 2014. They defined an adverse event as any complication including seizures, cerebrovascular accident, bleeding, thrombosis, myocardial infarction or death for any reason within 30 days from the PLT transfusion. Analyses were performed on only patients with ADAMTS13 activity <10%. Their cohort included 110 patients with the clinical diagnosis of TTP. Fifty-five patients had ADAMTS13-deficient TTP, 23 of whom received PLT at some point during disease course. The patients who received PLT transfusion were not different from those who did not in terms of age, gender, race, haematocrit, PLT  count, creatinine, LDH and complications. The three patients who received PLT and died had malignancy and complicated disease course. None of their patients died from a thrombotic event. They claimed that all deaths in the transfused group happened in very ill patients that had alternative causes of death and PLT transfusions in patients with TTP do not appear harmful in regard to thrombotic complications.This study will lead to new debate on platelet transfusion in thrombotic thrombocytopenic purpura.

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