The effect of therapeutic plasma exchange on clinical and biochemical parameters in thrombotic thrombocytopenic purpura

TTP is a rare and fatal disorder characterized with microangiopathic hemolytic anemia, thrombocytopenia, fever, neurological symptoms and kidney failure. Therapeutic Plasma Exchange (TPE) has been considered to be a first-line therapy in treatment of TTP.Between 2003 and 2008, patients diagnosed with TTP at Hematology and Intensive Care Units in University of Cukurova Department of Internal Medicine were included in this study. The aim of this study was to analyze the effect of TPE on clinical and biochemical parameters as well as on the clinical outcomeTwenty-seven patients consisting 16 men and 11 women with TTP are reviewed in this study. The average age was 43.4 years old (range 18-73). 18 patiens (66,7 %) were considered to be idiopathic TTP, where as 9 patiens (33,3 %) were accepted as TTP with secondary causes.Complete blood count, ESR (Erythrocyte sedimentation rate), Direct coombs, anti nuclear antibody (ANA), coagulation tests and serum biochemistry were performed at the baseline. We measured complate blood count, coagulation tests, BUN (Blood urine nitrogen), creatinin, total protein, serum albumin, LDH (Lactic Dehydrogenase), total and ionized calcium before and after each session.The mean LDH level before apheresis was 2456 U/L and 1056 U/L after the treatment (p=0,003). The baseline average platelet count was 25.5x109/L, whereas this was increased up to 179.5x109/L (p<0,001) after TPE sessions.There was no significant difference on the level of serum sodium, potassium, uric acid, albumin, immunoglobulins, bilirubins, transaminases, ESR, total and ionized calcium and leukocyte count (p>0,05). There was a statistically significant decrease in the level of BUN, creatinine, C-reactive protein and ferritine (p<0,05). We have also found a significant decrease on coagulation tests (p<0,001), and a considerable increase on the level of total protein and hemoglobin (p<0,05). There was no effect of use of steroid on the responses (p > 0,05).As a result; 13 of 27 patients showed complete response (48.1 %), 2 patients (7.4 %) showed partial response, 4 (14.8 %) had a relapse, 4 (14.8 %) were unresponsive, 4 (14.8 %) did not respond and died despite the treatment. Although we have found that the outcome of the Therapeutic Plasma Exchange treatment was similar to the results observed in our country, the rate of complete response was lower than the similar studies in the literature (65.5 %, 80 % respectively). The mortality rate was found to be similar to the literature (14.8 %).Key word: Thrombotic Thrombocytopenic Purpura, Therapeutic Plasma Exchange, Steroid