Successful treatment of recurrent thrombotic thrombocytopenic purpura with plasmapheresis and vincristine

S. Van Gool1, P. Brock1, P. Van Laer1, R. Van Damme-lombaerts1, W. Proesmans1, M. Casteels-Van Daele1
1Department of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium

Tóm tắt

An adolescent girl with severe thrombotic thrombocytopenic purpura (TTP) remained in a critical condition after 3, weeks of combined treatment with antiplatelet drugs, plasma infusions and plasma exchange. The introduction of vincristine resulted in gradual improvement and eventual complete remission which lasted for 2 years. When she relapsed, immediate improvement was observed with the combined treatment of plasmapheresis and vincristine. She has now been in complete remission again for 10 months. It is suggested that plasmapheresis plus vincristine should be used as the initial treatment for children with TTP.

Từ khóa


Tài liệu tham khảo

Bell WR, Braine HG, Ness PM, Kickler TS (1991) Improved survital in thrombotic thrombocytopenic purpurahemolytic uremic syndrome. N Engl J Med 325: 398–403

Byrnes JJ (1980) Thrombotic thrombocytopenic purpura. Adv Intern Med 26: 131–157

Byrnes JJ, Khurana M (1977) Treatment of thrombotic thrombocytopenic purpura with plasma. N Engl J Med 297: 1386–1389

Douzinas EE, Markakis K, Karabinis A, Mandalaki T, Bilalis D, Fessas P (1992) Early plasmapheresis in patients with thrombotic thrombocytopenic purpura. Crit Care Med 20: 57–61

Finazzi G, Bellavita P, Falanga A, Viero P, Barbui T (1992) Inefficacy of intravenous immunoglobulin in patients with low-risk thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome. Am J Hematol 41: 165–169

Gutterman LA (1992) Treatment of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome: the role of vincristine. In: Kaplan B, Trompeter R, Moake J (eds) Hemolytic uremic syndrome and thrombotic thrombocytopenia purpura. Marcel Dekker, New York, pp 513–530

Gutterman LA, Stevenson TD (1982) Treatment of thrombotic thrombocytopenic purpura with vincristine. JAMA 247: 1433–1436

Kolodziej M (1993) Case report: highdose intravenous immunoglobulin as therapy for thrombotic thrombocytopenic purpura. Am J Med Sci 305: 101–102

Murphy WG, Moore JC, Warkentin TE, Hayward CP, Kelton JG (1992) Thrombotic thrombocytopenic purpura. Blood Coagul Fibrinolysis 3: 655–659

Onundarson PT, Rowe JM, Heal JM, Francis CW (1992) Response to plasma exchange and splenectomy in thrombotic thromnocytopenic purpura. A 10-year experience at a single institution. Arch Intern Med 152: 791–796

Remuzzi G (1987) HUS and TTP: variable expression of a single entity. Kidney Int 32: 292–308

Robertson JH, Crozier EH, Woodend BE (1975) Vincristine therapy of thrombocytopenias. N Engl J Med 292: 108–109

Rock G, Shumak K, Kelton J, Blanchette VS, Buskard N, Nair R, Spasoff R (1992) Thrombotic thrombocytopenic purpura: outcome in 24 patients with renal impairment treated with plasma exchange. Canadian Apheresis Study Group. Transfusion 32: 710–714

Rock GA, Shumak KH, Buskard NA, Blanchette VS, Kelton JG, Nair RC, Spasoff RA (1991) Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. N Engl J Med 325: 393–397

Rose M, Eldor A (1987) High incidence of relapses in thrombotic thrombocytopenic purpura. Am J Med 83: 437–444

Ruggenenti P, Remuzzi G (1990) Thrombotic thrombocytopenic purpura and related disorders. Hematol Oncol Clin North Am 4: 219–239

Ruggenenti P, Galbusera M, Cornejo RP, Bellavita P, Remuzzi G (1993) Thrombotic thrombocytopenic purpura: evidence that infusion rather than removal of plasma induces remission of the disease. Am J Kidney Dis 21: 314–318

Shepard KV, Bukowski RM (1987) The treatment of thrombotic thrombocytopenic purpura with exchange transfusions, plasma infusion, and plasma exchange. Semin Hematol 24: 178–193

Toyoshige M, Zaitsu Y, Okafuji K, Inoue Y, Hiroshige Y, Matsumoto N, Kaku K, Kaneko T (1992) Successful treatment of thrombotic thrombocytopenic purpura with high-dose corticosteroid. Am J Hematol 41: 69

Van Damme-Lombaerts R, Proesmans W, Van Damme B, Eeckels R, Muaka BK, Mercieca V, Vlietinck R, Vermylen J (1988) Heparin plus dipyridamole in childhood hemolyticuremic syndrome: a prospective, randomized study. J Pediatr 113: 913–918

Welborn JL, Emrick P, Acevedo M (1990) Rapid improvement of thrombotic thrombocytopenic purpura with vincristine and plasmapheresis. Am J Hematol 35: 18–21

Welborn JL, O'Donnell R, Hsieh T, Eatherton J, Aspry K (1991) Vincristine for thrombocytopenic purpura. Lancet 337: 377–378