Is Cryoprecipitate-Reduced Plasma an Efficacious Replacement Fluid for Therapeutic Plasma Exchange for Patients with Thrombotic Microangiopathy? A Single-Center Retrospective Experience

Abstract

Objective: We designed a study to compare the efficacy of cryoprecipitate-reduced plasma (CRP) and fresh frozen plasma (FFP), at the level of individual sessions, for treating refractory thrombotic microangiopathy (TMA) with therapeutic plasma exchange (TPE).

Materials and methods: Platelet counts (× 10³/μL) and lactate dehydrogenase (LD; IU/L) levels were measured before and after each session. We compared the mean-percentage and absolute changes in platelet count and LD after each TPE session.

Results: The data from 33 patients treated for TMA between 2009 and 2018 were collected for this study. Both absolute and percentage increases in the platelet count were statistically significant (P = .003 and P = .011, respectively) when CRP was used. However, when patients were divided into subgroups according to specific diagnosis, no significant differences were found among the groups, except in terms of the absolute platelet count increase in the thrombotic thrombocytopenic purpura group (P <.001).

Conclusion: The platelet count increase was higher when patients received CRP than when they received FFP. We found that CRP may be a rescue option for patients with refractory TMA.

Keywords: cryoprecipitate-reduced plasma; fresh frozen plasma; microangiopathic hemolytic anemia; therapeutic plasma exchange; thrombotic microangiopathy; thrombotic thrombocytopenic purpura.