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Does cryosupernatant plasma improve outcome in thrombotic thrombocytopenic purpura? No answer yet

  1. Gail Rock1,
  2. David Anderson2,
  3. William Clark3,
  4. Pierre Leblond4,
  5. Douglas Palmer5,
  6. Marion Sternbach6,
  7. David Sutton7,
  8. George Wells8,
  9. members of the Canadian Apheresis Group and members of the Canadian Association of Apheresis Nurses†

Article first published online: 14 MAR 2005

DOI: 10.1111/j.1365-2141.2005.05418.x

Issue

British Journal of Haematology

British Journal of Haematology

Volume 129, Issue 1, pages 79–86, April 2005

Additional Information

How to Cite

Rock, G., Anderson, D., Clark, W., Leblond, P., Palmer, D., Sternbach, M., Sutton, D., Wells, G. and members of the Canadian Apheresis Group and members of the Canadian Association of Apheresis Nurses (2005), Does cryosupernatant plasma improve outcome in thrombotic thrombocytopenic purpura? No answer yet. British Journal of Haematology, 129: 79–86. doi: 10.1111/j.1365-2141.2005.05418.x

Author Information

  1. 1

    Division of Hematology and Transfusion Medicine, Ottawa Civic Hospital, University of Ottawa, Ottawa, ON

  2. 2

    Division of Hematology, Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, NS

  3. 3

    Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, ON

  4. 4

    Department of Medicine, Laval University, Quebec, QC

  5. 5

    National Testing Laboratory, Canadian Blood Services, Ottawa, ON

  6. 6

    Department of Medicine, St Joseph's Hospital, McMaster University, Hamilton, ON

  7. 7

    Department of Hematology, University of Health Network, Toronto, ON

  8. 8

    Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada

  1. †

    The members of the Canadian Apheresis Study Group at the time of this study were as follows: David Anderson, Barrett Benny, Noel Buskard, William Clark, Ramachand Devaraj, S. Dolan, John Freedman, John Klassen, T. Kovithavongs, Pierre Leblond, Gail Rock, David Sheridan, Sappora Shore, Kenneth Shumak, Marion Sternbach, David Sutton, and Linda Vickers.

*Dr Gail Rock, The Canadian Apheresis Group, 199-435 St Laurent Blvd., Ottawa, ON, Canada K1K 2Z8. E-mail: cag@ca.inter.net

Publication History

  1. Issue published online: 21 MAR 2005
  2. Article first published online: 14 MAR 2005
  3. Received 12 October 2004; accepted for publication 28 December 2004

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Keywords:

  • thrombotic thrombocytopenic purpura;
  • cryosupernatant;
  • plasma exchange

Summary

A randomized prospective trial compared cryosupernatant plasma (CSP) to fresh frozen plasma (FFP) for treatment of thrombotic thrombocytopenic purpura (TTP). A total of 236 patients were required: 28 patients were treated with CSP and 24 with FFP within 30 months. There were no differences in survival at 1 month. By day 9, 17 of 26 patients with CSP and 18 of 24 with FFP had a platelet count >100 × 109/l. At entry, von Willebrand factor (VWF) multimers were normal in all patients (range 1·1–3·95 IU/ml). ADAMTS-13 levels showed large variations ranging from 10% to 100% activity. At entry, no individual had <5% VWF cleaving protease. By day 9 (end of cycle), 89% (FFP) and 67% (CSP) had levels >50% of the controls. At 6 months some patients showed inhibitors to the enzyme in spite of adequate or normal platelet counts. The data from this study do not show an apparent advantage to the use of CSP in TTP. A large number of patients will be required to determine appropriate replacement therapy. We were not able to find a statistically significant relationship between the low level of protease activity at presentation of TTP and response.

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