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Two approaches to the clinical dilemma of treating TTP with therapeutic plasma exchange in patients with a history of anaphylactic reactions to plasma
Author(s) -
Sidhu Davinder,
Snyder Edward L.,
Tormey Christopher A.
Publication year - 2017
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.21475
Subject(s) - medicine , therapeutic plasma exchange , anaphylaxis , plasmapheresis , thrombotic thrombocytopenic purpura , apheresis , allergy , immunology , platelet , antibody
Background Thrombotic thrombocytopenic purpura (TTP) is a rare but serious disease caused by autoantibody‐mediated deficiency in von Willebrand factor (VWF) cleaving protease, ADAMTS‐13. The primary acute treatment is therapeutic plasma exchange (TPE). However, some patients can develop allergic/anaphylactic reactions to the replacement (i.e., donor) plasma over time. Two potential treatment strategies for patients with TTP who demonstrate severe allergic reactions to plasma used for exchange were examined. Methods Two patients with TTP exacerbations who developed severe allergic reactions to donor plasma were identified. One patient's TPE was re‐initiated with Octaplas, a lot‐batched solvent and detergent treated, type‐specific, pooled donor plasma product. The other patient was exchanged with primarily albumin, followed by slow incremental exposures to donor plasma to mitigate exposures and allergic risks. Both patients were assessed for anaphylaxis. Results: Both treatment strategies were successful in preventing any further clinically significant allergic/anaphylactic reactions and facilitated both patients’ TTP remissions. Conclusions Based on our experience with two similar patients with TTP exacerbations and history of anaphylactic reactions to plasma during TPE, we have identified two possible treatment protocols to achieve remission in this clinical dilemma. Substituting Octaplas for standard plasma or, alternatively, using albumin with slowly increasing amounts of standard plasma may help to mitigate the risk of further anaphylactic adverse events. J. Clin. Apheresis 32:158–162, 2017. © 2016 Wiley Periodicals, Inc.