Do you administer platelets to patients with Thrombotic Thrombocytopenic Purpura (TTP) and Immune Thrombocytopenic Purpura (ITP)?

From the Guidelines

Platelet transfusions are generally contraindicated in patients with thrombotic thrombocytopenic purpura (TTP) but may be used cautiously in certain cases of immune thrombocytopenic purpura (ITP). For TTP patients, giving platelets can worsen the condition by providing more platelets that can form dangerous microthrombi, potentially exacerbating organ damage and increasing mortality risk 1. Platelets should only be considered in TTP if there is life-threatening bleeding. In ITP, platelet transfusions are typically reserved for patients with severe bleeding or those requiring urgent procedures when the platelet count is dangerously low (usually below 10,000-20,000/μL) 1. However, transfused platelets are rapidly destroyed by the patient's autoantibodies, making them less effective than in other thrombocytopenic conditions.

Key Considerations

• The primary treatments for TTP include plasma exchange and immunosuppression, while ITP management focuses on reducing platelet destruction or increasing production through medications like corticosteroids, IVIG, thrombopoietin receptor agonists, or rituximab 1.
• Platelet transfusions should be used judiciously in both conditions, with careful consideration of the risk-benefit ratio in each individual case.
• In cases of life-threatening bleeding, other treatments such as recombinant factor VIIa, antifibrinolytic agents, or emergent splenectomy may be considered, but their use is based on limited evidence and should be approached with caution 1.

Treatment Approach

• For ITP patients with life-, limb-, or sight-threatening hemorrhage, treatments such as IVIg and corticosteroids should be considered to rapidly increase the platelet count 1.
• Platelet transfusions may be used in conjunction with these treatments, but their effect is likely to be short-lived due to the rapid destruction of transfused platelets by the patient's autoantibodies 1.
• The decision to use platelet transfusions in TTP or ITP should be made on a case-by-case basis, taking into account the individual patient's risk factors, the severity of their condition, and the potential benefits and risks of the treatment.

From the Research

Administration of Platelets in TTP and ITP

• Platelet transfusion in patients with Thrombotic Thrombocytopenic Purpura (TTP) is generally contraindicated unless a life-threatening hemorrhage occurs 2, 3, 4, 5.
• The benefit-risk balance of platelet transfusion before central venous catheter insertion for plasma exchange in TTP patients with low platelet count has not been specifically addressed in guidelines 2.
• Some studies suggest that platelet transfusion may not be detrimental in TTP patients, but the efficacy is uncertain 3, 4, 5.
• In patients with Immune Thrombocytopenic Purpura (ITP), there is no direct evidence provided in the given studies to support or refute the administration of platelets.

Specific Scenarios

• Platelet transfusion may be considered in TTP patients who require invasive procedures, such as surgery, and have severe thrombocytopenia 6.
• The use of platelet transfusion in TTP patients undergoing plasma exchange therapy does not appear to be harmful in terms of thrombotic complications 5.
• The decision to administer platelets in TTP patients should be made on a case-by-case basis, taking into account the individual patient's risk of bleeding and thrombosis 2, 4.