Resolution of refractory, classic thrombotic thrombocytopenic purpura after staphylococcal protein A immunoadsorption.
BACKGROUND
Multiple therapeutic interventions are available for treatment of thrombotic thrombocytopenic purpura. Resolution of thrombotic thrombocytopenic purpura may require use of several of these interventions.


METHODS
A patient presenting with classic (non-cancer chemotherapy-associated) thrombotic thrombocytopenic purpura had an initial response to intensive, daily plasma exchange with fresh-frozen plasma and cryosupernatant. Multiple attempts over a period of 2 months to decrease the frequency of plasma exchange resulted in exacerbations of disease activity, indicated by increased schistocytosis, decreased hematocrit, increased serum lactate dehydrogenase, and decreased platelet counts. After a total of 39 plasma exchanges, the patient was begun on immunoadsorption therapy utilizing a staphylococcal protein A immunoadsorption treatment column. After six 2000-mL protein A immunoadsorption treatments, the patient's platelet count, lactate dehydrogenase, and peripheral smear normalized, and they have remained normal over nearly 4 months of follow-up.


CONCLUSIONS
Treatment by protein A immunoadsorption may be of benefit in patients with classic thrombotic thrombocytopenic purpura who are not achieving a sustained remission with conventional plasma exchange therapy.
University Hospital of Arkansas Blood Bank, University of Arkansas for Medical Sciences, Little Rock.
M J
MJ
Drew
D005260:Female; D006400:Hematocrit; D006801:Humans; D007163:Immunosorbent Techniques; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008875:Middle Aged; D010949:Plasma; D010951:Plasma Exchange; D010976:Platelet Count; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood / Q000628:therapy*; D012074:Remission Induction; D013205:Staphylococcal Protein A
D013205:Staphylococcal Protein A; D007770:L-Lactate Dehydrogenase