Summary
We report two patients with thrombotic thrombocytopenic purpura who were subjected to plasma exchange. In one case, the plasma levels of platelet factor 4, measured shortly after plasma exchange, increased significantely during plasma exchange. This was followed, however, by a failure to respond to therapy. Repeated plasmapheresis over 3 weeks gave no therapeutic benefit and reversible deep coma occurred. This patient recovered completely after treatment with vincristine. In the second patient, a decline in platelet factor 4 was observed after plasma exchange. This was accompanied by improvement of the patient's condition and a slow rise in platelet count. Plasma exchange was again carried out in this patient because of a recurrence of thrombotic thrombocytopenic purpura 3 years later; again decreased platelet factor 4 plasma levels were observed after plasma exchange and again a therapeutic response followed. Platelet factor 4, therefore, seems to be an effective and early index for the therapeutic benefit of plasma exchange in thrombotic thrombocytopenic purpura.
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Abbreviations
- PF4:
-
platelet factor 4
- βTG:
-
beta-thromboglobulin
- PE:
-
plasma exchange
- TTP:
-
thrombotic thrombocytopenic purpura
- 5% HSA:
-
5% human albumin
References
Abramson N (1978) Treatments for thrombotic thrombocytopenic purpura. Plasma, vincristine, hemodialysis and exchange transfusions. N Engl J Med 298:972
Amir J, Krauss S (1973) Treatment of thrombotic thrombocytopenic purpura with antiplatelet drugs. Blood 42:27
Amorosi EL, Karpatkin S (1977) Antiplatelet treatment of thrombotic thrombocytopenic purpura. Ann Intern Med 86:102
Aul C, Scharf RE, Königshausen Th, Schneider W (1985) Thrombotisch-thrombozytopenische Purpura. Klin Wochenschr 63:123
Budd GT, Bukowski RM, Lucas FV, Cato AE, Cocchetto DM (1980) Prostacyclin therapy of thrombocytopenic purpura. Lancet II:915
Bukowski RM, King JW, Hewlett JS (1977) Plasmapheresis in the treatment of thrombotic thrombocytopenic purpura. Blood 50:413
Bukowski RM, Hewlett JS, Reimer RR, Groppe CW, Weick JK, Livingston RB (1981) Therapy of thrombotic thrombocytopenic purpura. An overview. Semin Thromb Hemostas 7:1
Bukowski RM (1982) Thrombotic thrombocytopenic purpura. A review. In: Spaet TH (ed) Progress in hemostasis and thrombosis. vol 6. Grune and Stratton, New York, p 287
Byrnes JJ, Khurana M (1977) Treatment of thrombotic thrombocytopenic purpura with plasma. N Engl J Med 297:1386
Craig JM, Gitlin D (1957) The nature of hyaline thrombi in the thrombotic thrombocytopenic purpura. Am J Pathol 33:251
Cuttner J (1974) Splenectomy, Steroids, and dextran 70 in thrombotic thrombocytopenic purpura. JAMA 227:397
Cuttner J (1980) Thrombotic thrombocytopenic purpura. A ten-year experience. Blood 56:302
Ekberg M, Nilson IM, Danneberg T (1974) Coagulation studies in hemolytic uremic syndrome and thrombotic thrombocytopenic purpura. Acta Med Scand 196:373
Faguet GB, King MD (1974) Thrombotic thrombocytopenic purpura. Treatment with antiplatelet agents. Am J Med Sci 268:113
Gore I (1950) Disseminated arteriolar and capillary platelet thrombosis. A morphologic study of its histogenesis. Am J Pathol 26:155
Gutterman L, Stevenson TD (1979) Vincristine in the treatment of thrombotic thrombocytopenic purpura. Blood 54:242
Hussey CV, Hause LL, Gottschall JL, Anderson T (1986) A platelet aggregating factor in thrombotic thrombocytopenic purpura: initial activity, fluctuations, and removal by plasma exchange. Thromb Res 44:355
Kaplan KL, Owen J (1981) Plasma levels of β-thromboglobulin and platelet factor 4 as indices of platelet activation in vivo. Blood 2:199
Lian ECY (1980) The role of increased platelet aggregation in TTP. Semin Thromb Hemostas 6:401
Lorenz R, Vogel GE, Bottermann P, Larcher A (1985) PF4 Bestimmung mittels Enzymimmunoassay in der klinischen Anwendung. Lab Med 9:168
Moschcowitz E (1925) An acute febrile pleiochromic anemia with hyaline thrombosis of the terminal arterioles and capillaries. Arch Intern Med 31:89
Myers TJ (1981) Treatment of thrombotic thrombocytopenic purpura with combined exchange plasmapheresis and anti-platelet agents. Semin Thromb Hemostas 7:37
Neame PB (1980) Immunologic and other factors in thrombotic thrombocytopenic purpura (TTP). Semin Thromb Hemostas 6:416
Rubenstein MD, Wall RT (1981) Clinical use of β-thromboglobulin levels in diagnosing and treating consumptive and immune thrombocytopenia. Am J Hematol 10:369
Umlas J, Kaiser J (1970) Thrombohemolytic thrombocytopenic purpura (TTP). A disease or a syndrome? Am J Med 49:723
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Wiedemann, G., Kantner, I., Schenke, M. et al. Platelet factor 4 and the response to plasma exchange in the treatment of thrombotic thrombocytopenic purpura. Klin Wochenschr 67, 551–555 (1989). https://doi.org/10.1007/BF01719782
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DOI: https://doi.org/10.1007/BF01719782