ITP and cryo poor plasma

[adiescast]

Does anyone know why cryo poor plasma is the product of choice for plasma exchanges in ITP? I was just wondering...

[SMW]

[will assume you meant TTP........] Cryo-reduced Plasma has lower levels of the high-molecular-weight forms of vWF (multimers).

[adiescast]

Yes, thanks. Slip of the finger...

So how does having lower levels of high molecular weight vWF multimers in the exchange fluid help with TTP?

[L106]

Quoting a CAP article I have from 1989: "...theory suggests that the primary event consists of an intravascular platelet aggregation precipitated by one of several incompletely delifined and inconsistently present plasma factors, such as platelet-agglutination protein (PAP p37) or an unusually lon=rge von Willebrand factor multimer.... The circulating platelet clumps secondarily induce widespread endothelial cell injury in arterioles and capillaries, leading to microthrombi..... Blood flow through thrombotic obstacles results in traumatic fragmentation of RBCs, causing intravascular hemolysis and anemia."

As SMW stated above, Cryo-reduced plasma has lower levels of high-molecular-weight multimers, so many consider it to be the replacement fluid of choice when performing plasma exchange for TTP. (However, I have seen more recent studies that showed similar mortality rates and response times when either Cryo-reduced plasma or fresh frozen plasma was used.)

[heathervaught]

In Indiana, our hospital customers start exchanges with FP24. If the patient shows evidence of being refractory to FP24, they will request cryopoor.

[mrpessimist]

many literature reports dont' suffragate that criodepleted plasma is the first choice for TTP it's only if there is refractary to FFP

we do it in my hospital in perugia italy

[clmergen]

We almost always start with cyroreduced plasma and only use FP24 if the fibrinogen drops.

[profbaud]

You mean TTP? ITP is treated with steroids. At our blood bank we try using regular FFP first [cheaper and more available]. If the patient doesn't respond, then we switch to Cryo-poor plasma, since it still contains the enzyme ADAMTS13 which is deficient or not working in TTP patients and they don't need the extra factors in reg. FFP.

[Yanxia]

Please help me, what is FP24? Thanks in advance!

[L106]

"Frozen Plasma - 24 Hours" is donor plasma that is separated and frozen within 24 hours from the time the unit of Whole Blood was donated. ("Fresh Frozen Plasma" must be separated and frozen within 8 hours from the time of donation.)

[Yanxia]

What is the differnce between common plasma(plasma not fresh) with FP24 ? As to TTP, we will use cryopoor.

[profbaud]

Plasma frozen within 24 hrs. It's pretty similar to FFP but FFP is frozen within 8 hrs of collection.

[adiescast]

What is the differnce between common plasma(plasma not fresh) with FP24 ? As to TTP, we will use cryopoor.

When you say "common plasma (not fresh)" do you mean plasma that is separated from whole blood, but never frozen or do you mean plasma (frozen in whatever manner) that is thawed and retained past 24 hours?

[NedB]

TTP is usually caused by an autoantibody directed to the enzyme ADAMST13 which splits up the vWF multimer into small subunits that do not react with platelets. When the large multimers are not cleaved by the enzyme they react with and clear platelets from the circulation. FFP serves primarily to replenish the enzyme. The production of the autoantibody is self-limited. Many Patients experience a short-term relapse of autoantibody production a month or so after the initial resolution, but then never experience another episode. The exchanges are cumbersome to the Blood Bank and to the Dialysis Staff, but the procedure works.

As for ITP, the last issue of Blood has two articles about H. pylori being one of the causes - specifically IgG antibodies to H. pylori seem to attract P-selectin from platelets.

[Yanxia]

When you say "common plasma (not fresh)" do you mean plasma that is separated from whole blood, but never frozen or do you mean plasma (frozen in whatever manner) that is thawed and retained past 24 hours?

I mean plasma seperated from whole blood long than 6 hours after drow。

[Deny Morlino]

Shily,

FP 24 is plasma that does not make the time cutoff of FFP (that is frozen within 8 hours of collection), but is processed and frozen within 24 hours. Other that the 6 hour time you indicated versus the 8 hour stipulated here it sounds the same.