Sawant R B, Rajadhyaksha S B
Department of Transfusion Medicine, Tata Memorial Hospital, Parel, Mumbai, India.
J Assoc Physicians India. 2005 Nov;53:981-3.
A 17 years old female diagnosed with acute myeloid leukemia (AML)-M2 received an allogeneic haematopoietic stem cell transplant (HSCT) and was given graft versus host disease (GVHD) prophylaxis with methotrexate, cyclosporin-A (CsA) and methyl prednisolone. On day +42 post-transplant, she was diagnosed to have thrombotic thrombocytopenic purpura (TTP). Therapeutic plasma exchange (TPE) (40 ml/kg body mass) using fresh frozen plasma was performed on 8 consecutive days. The renal function, LDH levels, platelet count and peripheral smear findings improved but the neurological symptoms persisted even after TPE. Few reports are available in literature on the effectiveness of therapeutic plasma exchange (TPE) in post-bone marrow transplant (BMT) TTP. The good hematologic response achieved in this patient suggests that TPE could be life-saving and should be tried in every patient with post-BMT TTP.
一名17岁诊断为急性髓系白血病（AML）-M2型的女性接受了异基因造血干细胞移植（HSCT），并采用甲氨蝶呤、环孢素A（CsA）和甲基泼尼松龙预防移植物抗宿主病（GVHD）。移植后第42天，她被诊断为血栓性血小板减少性紫癜（TTP）。连续8天使用新鲜冰冻血浆进行治疗性血浆置换（TPE）（40 ml/kg体重）。肾功能、乳酸脱氢酶水平、血小板计数和外周血涂片检查结果有所改善，但即使在TPE后神经症状仍持续存在。关于治疗性血浆置换（TPE）在骨髓移植（BMT）后TTP中的有效性，文献报道较少。该患者取得的良好血液学反应表明，TPE可能挽救生命，应在每例BMT后TTP患者中尝试使用。
