Journal of Blood Disorders & Transfusion

Abstract

Thrombotic Thrombocytopenic Purpura Refractory to Plasmapheresis Treated Successfully with Vincristine: A Case Report

Walid H. Elrewihby, Salwa Zaghloul, Nivin Saber, Emad Eldin Hasan and Adel Elattar

Introduction

TTP is a life-threatening clinicopathologic disorder involving multiple organ systems, which remains a management challenge to physicians. If not treated promptly, TTP typically follows a progressive deteriorating course with irreversible renal failure, progressive neurologic deterioration, cardiac ischemia, and death. The immediate administration of plasma exchange has been the essential and urgent treatment for patients with a clinical diagnosis of TTP The reported incidence of patients who do not respond to plasma exchange (PE) [refractory TTP] and require additional therapy varies between 10% and 42%.

Case report

We have described a 24 year female patient of TTP who remained refractory after 27 sessions of PE combined with corticosteroids. We added a slow infusion of 2mg Vincristine (VCR) and followed by another 2 dosed of 1 mg with 6 days between each dose resulting in successful clinical and laboratory improvement.

Conclusion

We conclude that, VCR is a safe, inexpensive, readily available and rapidly acting agent and should be used from the start together with PE.