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Thrombotic Thrombocytopenic Purpura

Hospital Progress Report

The patient was transferred to the Intensive Care Unit (ICU) where she was transfused with one unit of packed red blood cells and 4 units of fresh frozen plasma. The patient's clinical presentation deteriorated. She developed shortness of breath and fluid retention. The patient was put on a ventilator and was given a high dose of corticosteroids. The patient was immediately scheduled for daily plasma exchanges using cryosupernatant (or cryo depleted FFP) for the next two weeks.

The patient was managed by daily 3000 ml (3L) plasma exchange using cryo depleted FFP. Packed red blood cells were also transfused at regular intervals and platelet transfusion was withheld. Platelets usually exacerbate the situation.

By day 7 her neurologic symptoms disappeared and her platelet count rose to 137,000/ul, and by day 14 her platelet count exceeded 200,000 mm/ul. The serum LDH level returned to normal and the cryosupernatant was administered for an additional 7 days.

Following this treatment the patient was discharged from the hospital. Five months later the patient experienced a recurrence and was readmitted to the hospital. She was then given daily plasma exchange with cryoprecipitate-poor plasma for 6 days and was discharged the following morning.

In the two years since the second episode, the patient has not experienced a recurrence.