Efficacy of plasma exchange with cryosupernatant in treatment of thrombotic thrombocytopenic purpura and its influences on blood coagulation

Abstract

Objective To study the efficacy of plasma exchange (PE) with cryosupernatant in treatment of thrombotic thrombocytopenic purpura (TTP), and its influences on blood coagulation. Methods A case of TTP patient who was treated on January 22, 2017 in Department of Hematology, West China Hospital, Sichuan University was selected as the study subject. On the 3rd to 7th day after admission, the patient was treated by PE with cryosupernatant as displacement liquid once a day, and was infused with fresh frozen plasma (FFP) for the supplement of fibrinogen (Fib) at the same time. Blood routine and coagulation function were detected before and after each time of cryosupernatant treatment, to analyze the efficacy of cryosupernatant in treatment of TTP and its influences on coagulation function. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Results The results of the patient treated by PE with cryosupernatant as displacement liquid showed as follows. ①After receiving the first time of cryosupernatant treatment and infusion of FFP, the mental neurological symptoms of the patient disappeared. And the platelet count gradually recovered from 5×109/L to normal [(100-300)×109/L], and hemoglobin (Hb) value returned to normal (110-150 g/L) from the lowest value of 57 g/L after 5 times of consecutive treatment by cryosupernatant. ②After receiving each time of cryosupernatant treatment, the plasma Fib level of the patient was significantly lower than that before cryosupernatant treatment, however the plasma Fib level recovered to the level before cryosupernatant treatment. After 5 times of cryosupernatant treatment, the patient′s plasma Fib value was lowest to 1.31 g/L (normal reference value was 2.00-4.00 g/L), while there was no significant prolongation of the activated partial thromboplastin (APTT) and prothrombin time (PT). ③The Hb level and platelet count of the patient were maintained at normal level during the half-year following-up after discharge from hospital. Conclusions PE treatment with cryosupernatant as displacement liquid can effectively treat TTP, but it can lead to the decrease of plasma Fib level. If FFP is infused at the same time, it can be corrected. Because this study is just a case study, the efficacy of PE with cryosupernatant as displacement liquid in treatment of TTP remains to be further confirmed by large sample, multicenter, prospective randomized controlled trials. Key words: Purpura, thrombotic thrombocytopenic; Plasma exchange; Blood coagulation; Fibrinogen; Cryosupernatant