From the Research
Plasmapheresis for thrombotic thrombocytopenic purpura (TTP) should be continued daily until the patient's platelet count normalizes and clinical symptoms resolve, with treatment generally lasting 1-3 weeks, as supported by the most recent study 1.
Key Considerations
- The treatment typically involves daily sessions, with most patients requiring 7-10 sessions, though some may need more extensive treatment lasting several weeks 1.
- Each session typically takes 2-4 hours to complete, and after initial response, plasmapheresis is usually continued for at least 2 days after platelet normalization, then gradually tapered by decreasing frequency to every other day before discontinuation.
- The treatment works by removing autoantibodies against ADAMTS13 (the enzyme deficient in TTP) and replenishing this enzyme through fresh frozen plasma replacement.
- Close monitoring of platelet counts, hemolysis markers, and clinical symptoms is essential throughout treatment, as some patients may experience relapse requiring resumption of daily treatments.
- Adjunctive therapies like rituximab or caplacizumab may be used alongside plasmapheresis in certain cases, as noted in 1.
Factors Influencing Treatment Duration
- The number of plasmapheresis sessions required can vary depending on the patient's response to treatment, with some studies suggesting that the median number of sessions is around 13 2.
- The presence of refractory thrombocytopenia may require prolonged treatment, and consecutive ADAMTS13 activity and inhibitor levels can be used to guide the decision to stop treatment with TPE 3.
- The underlying cause of TTP, such as primary or secondary TTP, can also influence the treatment duration and response to plasmapheresis, as noted in 4.