reported that LDL apheresis decreased urinary protein loss in patients with recurrence of FSGS after kidney transplantation although their recurrent FSGS showed resistance to plasma exchange therapy
. Thus, several authors have used LDL apheresis to treat recurrent FSGS after kidney transplantation, but there have been no reports on performance of LDL apheresis before transplantation to prevent recurrence of this condition.
(5,6) They share a basis on results of coagulation test results; need for replacement of multiple clotting factors; clinical scenarios in which plasma transfusion is highly likely, such as reversal of warfarin effect and liver disease; and therapy for thrombotic thrombocytopenic purpura and other disorders, often as replacement fluid in plasma exchange therapy
 In a randomized clinical trail demonstrating the effectiveness of plasma exchange therapy
, the presence of microangiopathichaemolytic anemia and thrombocytopenia without recognized alternative cause was sufficient for the diagnosis of TTP.
Our patient had been treated with multiple immune-modulatory therapies (i.e., hydrocortisone, IVIG, and plasma exchange therapy
) achieving only moderate reductions in the laboratory parameters that characterize systemic inflammation.
 Plasmapheresis is the treatment of choice for TTP, in addition to steroids, which are initiated immediately after start of plasma exchange therapy
However, the patients' clinical condition did not substantially improve despite the 5-day plasma exchange therapy
and viral load only slightly decreased.
The mortality rate of untreated TTP can exceed 90%, but plasma exchange therapy
has reduced that rate to <20%.
Among the patients who were not receiving concurrent plasma exchange therapy
, the platelet count began to show steady increase within 3 days in each of the 10 cases and was normalized by day 7 in 10 of 12 cases.
Here we present the case report of a patient with metastatic renal cell carcinoma (mRCC) who developed thrombotic thrombocytopenic purpura (TTP) on sunitinib that was completely reversible after treatment withdrawal and plasma exchange therapy
Verre, "Maintenance plasma exchange therapy
for steroid-refractory neuromyelitis optica," Journal of Clinical Apheresis, vol.
Here we present a case of SCD presenting with painful vaso-occlusive crises, acute chest syndrome and thrombocytopaenia secondary to TTP as supported by peripheral blood film and low ADAMTS13 activity and response to plasma exchange therapy