Laboratory Medicine Department, Peking University Third Hospital, Beijing, People's Republic of China.
Department of Blood Transfusion, Peking University People's Hospital, Beijing, People's Republic of China.
J Clin Apher. 2020 Jun;35(3):154-162. doi: 10.1002/jca.21771. Epub 2020 Feb 28.
Thrombotic thrombocytopenic purpura (TTP) is a rare life-threatening thrombotic microangiopathy. Therapeutic plasma exchange (TPE) is the first-line treatment for TTP. In our institution, albumin plus plasma (fresh frozen plasma [FFP] and/or cryoprecipitate-reduced plasma [CRP]) has been used as replacement fluid since 2014. We aimed to evaluate the efficacy of albumin combined with plasma as TPE for TTP.
We retrospectively evaluated 20 patients admitted to our institution due to an acute episode of TTP between January 1, 2014 and February 1, 2019. They were divided into two groups according to the replacement fluid protocols: (a) albumin plus FFP (1:1) and (b) albumin plus mixed plasma [ie, albumin and FFP with CRP (2:1:1)] groups. Data on patient characteristics, replacement parameters, outcome, and hemorrhage risk were collected and analyzed.
There were no significant differences in treatment outcomes between the two groups (P > .05). However, the albumin plus mixed plasma group tended to require fewer plasma exchanges (median, 4) and shorter time to response (median, 15 days) compared to albumin plus FFP group (median, 6; 31 days). Although the cumulative survival of the albumin plus mixed plasma group was higher than the other group starting from day 23 after treatment, we did not observe significant difference (P = .50). No significant increase in the risk for hemorrhage was observed in either group.
The therapeutic efficacy of albumin and mixed plasma (2:1:1) is not inferior to that of albumin and FFP (1:1), and it can be used in treating TTP.
血栓性血小板减少性紫癜（TTP）是一种罕见的危及生命的血栓性微血管病。治疗性血浆置换（TPE）是 TTP 的一线治疗方法。自 2014 年以来，我院一直使用白蛋白加血浆（新鲜冷冻血浆[FFP]和/或冷沉淀减少的血浆[CRP]）作为替代液。我们旨在评估白蛋白联合血浆作为 TPE 治疗 TTP 的疗效。
我们回顾性评估了 2014 年 1 月 1 日至 2019 年 2 月 1 日期间因急性 TTP 发作而入院的 20 名患者。根据替代液方案将他们分为两组：（a）白蛋白加 FFP（1:1）组和（b）白蛋白加混合血浆[即白蛋白和 FFP 加 CRP（2:1:1）]组。收集并分析了患者特征、替代参数、结局和出血风险的数据。
两组的治疗结局无显著差异（P>.05）。然而，与白蛋白加 FFP 组相比，白蛋白加混合血浆组倾向于需要更少的血浆置换（中位数，4 次）和更短的反应时间（中位数，15 天）（中位数，6 次；31 天）。尽管从治疗后第 23 天开始，白蛋白加混合血浆组的累积生存率高于其他组，但我们未观察到显著差异（P=.50）。两组均未观察到出血风险显著增加。
白蛋白和混合血浆（2:1:1）的治疗效果不劣于白蛋白和 FFP（1:1），可用于治疗 TTP。
