血栓性血小板減少性紫斑症之血漿療法

Plasma Exchange in Thrombotic Thrombocytopenic Purpura

自1977年血漿療法已顯著地改善血栓性血小板減少性紫班症(TTP)之預後。血漿交換及血漿輸注皆可治癒大部分TTP病人，唯此兩種血漿療法之相互優劣比較及引發TTP之致病假說，迄今仍尚無定論。在此，我們報告一例TTP，病程中前後共嘗試2種血漿療法。初期以連續16次雙重過濾血漿分離術配合每天之血漿輸注療法，病人之臨床徵狀卻依然持續惡化，只得改用傳統血漿交換術。結果在2天之內血小板數目及神智狀態顯著進步，於2週後康復出院。比較此2種血漿療法之個別差異，發現血漿交換術中每次使用之血漿量大約是血漿輸注法之三倍。因此，大量的血漿輸注應是治療成功之主因。

Plasma therapy has dramatically improved the prognosis of thrombotic thrombocytopenic purpura (TTP) since 1977. Plasma exchange (PE) and plasma infusion (PI) are both effective in the treatment of TTP; however, the superiority of either regimen and the rationale for each therapy are still in controversial. Here we report a patient with sporadic TTP treated first with double filtration plasmapheresis (DFPP) with PI then with PE. The clinical course continued to deteriorate in spite of 16 consecutive sessions of DFPP with PI. When we changed the plasma therapy to PE, however a dramatic response in recovery of platelet count and consciousness was achieved within 2 days. The larger amount of plasma infused (3 fold larger in PE) may be the key determinant for the success of treatment with PE.