Separate (Asynchronous) Therapeutic Plasma Exchange (TPE) and Plasma Transfusion in the Patient with Severe TPE Complications: A Case Report

Saeid Anvari; Amirhossein Larijani; Nasim Ghorbannejad

doi:10.18502/ijhoscr.v19i1.17827

Saeid Anvari Department of Hematology and Medical Oncology, Guilan University of Medical Sciences, Rasht, Iran
Amirhossein Larijani Regenerative Medicine, Organ Procurement and Transplantation Multi-Disciplinary Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Nasim Ghorbannejad Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran

DOI: https://doi.org/10.18502/ijhoscr.v19i1.17827

Keywords: Plasma exchange; Separate; Thrombotic thrombocytopenic purpura (TTP); Complications

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a medical condition characterized by a decreased activity of the ADAMTS13 protease, which is responsible for cleaving the von Willebrand factor. It contributes to thrombotic microangiopathy. In this report, we described a case of TTP followed by significant adverse effects during therapeutic plasma exchange (TPE) treatment. The patient received TPE with a time interval from plasma transfusion.

A 30-year-old female was evaluated for headaches and bruises on her arms and legs. Laboratory testing revealed thrombocytopenia and anemia. The identification of thrombocytopenia with severe schistocytosis was verified by the analysis of a peripheral blood smear. After confirming a diagnosis of TTP, TPE was performed as therapy. To avoid the complications arising during the previous TPE sessions, we conducted plasma exchange with albumin followed by FFP injection, with a six-hour interval between them. This strategy successfully alleviated the patient's symptoms.

Therapeutic plasma exchange (TPE) with a time interval from plasma transfusion can be successfully used in patients with severe TPE complications.