Time from suspected thrombotic thrombocytopenic purpura to initiation of plasma exchange and impact on survival: A 10-year provincial retrospective cohort study

Benchmarking the centralized urgent plasma exchange service for patients admitted with a diagnosis of suspected acquired thrombotic thrombocytopenic purpura at a large healthcare system

“…The lack of a significant relationship between the time to initiation and clinical outcomes in aTTP patients is most likely explained by the fact that most procedures were initiated within an 8‐hour time frame, compared to the findings of Pereira et al, 9 where the average time to initiation of TPE was 5 ± 5 days in the complete remission group and 12 ± 4 days in the early death group. Notably, Sawler et al, in their 10‐year provincial retrospective cohort study, found that 59% of patients did not have TPE performed within 8 hours of request, in contradistinction to the proportion of patients with late initiation of TPE in this analysis, but they also found no association between time to initiation and mortality as long as TPE was initiated within 24 hours of request 13 . Other studies have defined “early plasmapheresis” as a time to initiation ≤24 hours, and have shown an association between early TPE initiation and clinical outcomes; however, those studies had higher proportions of patients receiving TPE outside the 24‐hour window (37.7% 14 and 28.8% 15 ) compared to the results of this analysis.…”

Thrombotic Thrombocytopenic Purpura: When Basic Science Meets Clinical Research

“…TPE needs to be started as soon as possible because any delay worsens the prognosis. 37,38 TPE can be performed either using centrifugation or filtration depending on team's experience and/or availability of the corresponding device. Centrifugation plasmapheresis is the historical modality and consists in the centrifugation of whole blood to separate plasma from platelets, white blood cells, and erythrocytes.…”

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“…In the French TMA registry, 20% of iTTP patients were initially misdiagnosed [12]. In a recent Canadian study, TPE initiation delay was >24h in 24% of patients with suspected new onset or relapsing iTTP [11]. Our second observation is that neurological events occurred much more frequently in patients with delayed diagnosis (67% vs 30%).…”

“…in a patient with TMA still relies on simple clinical-biological assessment [17][18][19]. Contemporary data regarding diagnostic delay in iTTP are rare [11,12]. Our study aimed to assess the frequency, clinical consequences and determinants of diagnostic delay in iTTP.…”