Outcomes of platelet transfusion in patients with thrombotic thrombocytopenic purpura: a retrospective case series study

Abstract

Current guidelines advise against the transfusion of platelets in patients with thrombotic thrombocytopenic purpura (TTP) except in cases of life-threatening hemorrhage. We conducted a retrospective medical chart review to examine the outcomes of patients with TTP who received platelet transfusion at our institution from September 2002 to September 2012. A search for "thrombotic thrombocytopenic purpura" in the discharge summary identified 233 patients, out of which only 15 patients had TTP and received platelet transfusion. Primary outcomes were death due to any cause, myocardial infarction, ischemic stroke, coma, seizure, or worsening neurologic status within 24 h of platelet transfusion. Secondary outcomes included bleeding and worsening thrombocytopenia. No adverse outcomes occurred within 24 h of platelet transfusion. Two patients experienced bleeding following renal biopsy despite having platelet counts of greater than 50,000/μl and receiving one pack of pooled platelets prior to the procedures. The response to transfusion was variable. In general, platelet transfusion was not detrimental in this population; however, the efficacy is uncertain.

Diagnosis and management of thrombotic thrombocytopenic purpura (TTP) in Australia: findings from the first 5 years of the Australian TTP/thrombotic microangiopathy registry

“…Platelet transfusions have previously been considered to be absolutely contraindicated in TTP because of a theoretical risk of platelet‐rich thrombi increasing tissue ischaemia/infarction. This view was supported by early case studies; however, subsequent studies involving larger cohorts have cast doubt over this contraindication . Of note, a common documented reason for platelet transfusion in our cohort was insertion of central venous lines for PEx where platelet transfusion has not shown efficacy in decreasing hemorrhagic complications …”

Efficiency of Intensive Immune -Suppression Treatment with Rituximab in Acquired Thrombotic Thrombocytopenic Purpura: A Chinese Case study

“…Except for life-threatening hemorrhage, platelets infusion is contradicted among TTP patients prior to the introduction of PEX, which exacerbate the severity of microvascular thrombi formation, worsen the patient's condition seriously [16]. Although PEX was used 7 times and rituximab infusion given twice, a patient died in our cohort because of platelet infusion before the diagnosis.…”

Platelet transfusion in thrombotic thrombocytopenic purpura

“…Alternatively, a few case reports suggested that PLT transfusion may be safe . Recent evidence for harm from PLT transfusion in patients with TTP is still uncertain .…”

“…Recently, a study from the University of Pittsburgh Medical Center reported on the adverse events of PLT transfusion in TTP within 24 h of transfusion . The investigators found that of 233 patients with TTP, 15 patients received PLT with 2 deaths beyond 24 h from transfusion.…”