Cryosupernatant and solvent detergent fresh-frozen plasma (Octaplas) usage at a single centre in acute thrombotic thrombocytopenic purpura.
BACKGROUND
Thrombotic thrombocytopenic purpura (TTP) is an acute, life-threatening disorder and plasma exchange (PEX) remains the mainstay of treatment.


METHODS
We reviewed 50 acute TTP episodes to establish the efficacy and safety of cryosupernatant (CPP) and Octaplas.


RESULTS
Twelve episodes used CPP only and 15 episodes started with CPP and changed to Octaplas. Once Octaplas had been used, it was continued on further admissions. Cryosupernatant was used exclusively in 24% and Octaplas exclusively in 42% of all episodes. The number of citrate reactions and allergic (plasma) reactions were halved in those receiving only Octaplas compared with cryosupernatant. There were 22 line infections and in approximately 70% of cases the infection was associated with a reduction in platelet count. In all 50 episodes, the only documented thrombosis was a superficial non-central vein. In episodes receiving only cryosupernatant or Octaplas, there was no significant difference in the median number of PEX to remission, 7.0 (interquartile range, IQR 5-8.8) and 8.0 (IQR 6.5-22), respectively. Baseline viral screen in all episodes was negative after discharge following an acute episode.


CONCLUSIONS
There was no difference in number of PEX to remission with cryosupernatant and solvent/detergent fresh-frozen plasma (Octaplas). However, allergic/urticarial and citrate reactions were more common with cryosupernatant. There was no documented viral transmission with either product.
Haemostasis Research Unit, Department of Haematology, University College London, 51 Chenies Mews, London, UK. m.scully@ucl.ac.uk
M
M
Scully
I
I
Longair
M
M
Flynn
J
J
Berryman
S J
SJ
Machin
D000208:Acute Disease; D019343:Citric Acid / Q000009:adverse effects; D003902:Detergents / Q000009:adverse effects; D006801:Humans; D006967:Hypersensitivity; D007239:Infections / Q000139:chemically induced; D010949:Plasma / Q000737:chemistry*; D010951:Plasma Exchange / Q000009:adverse effects / Q000379:methods*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications / Q000628:therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D012997:Solvents / Q000009:adverse effects; D013927:Thrombosis / Q000139:chemically induced
D003902:Detergents; D012997:Solvents; D019343:Citric Acid