Treatment of Thrombotic Thrombocytopenic Purpura with Plasma

Thrombotic thrombocytopenic purpura, the acute form of which is usually fatal, is characterized clinically by thrombocytopenia, microangiopathic hemolytic anemia, fluctuating neurologic signs and renal dysfunction, and pathologically by diffuse thrombotic occlusions in the microcirculation, in which platelets are consumed.1 2 3 4Since the pathogenesis of this disease is not understood, treatment has been empirical or with an assumed rationale. Among the various modes of therapy tried, four are especially advocated: splenectomy and use of antiplatelet agents, of high doses of glucocorticoids, and of exchange transfusions. The value of splenectomy remains undefined.5 Proponents of antiplatelet treatment argue that whether or not platelet adhesion . . .