William F. Clark, MD, FRCPC; Gail Rock, PhD, MD; Kenneth A. Shumak, MD, FRCPC
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Clark W., Rock G., Shumak K.; Therapeutic Plasma Exchange. Ann Intern Med. 2000;132:760-761. doi: 10.7326/0003-4819-132-9-200005020-00020
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Published: Ann Intern Med. 2000;132(9):760-761.
We thank Fakhouri and colleagues for commenting on our article and sharing their experience with six cases of TTP treated with plasma infusion. They question the validity of Rock and coworkers' study, which compared a plasma infusion regimen with a plasma exchange regimen, both in the first cycle and over long-term follow-up (1). We agree that the patients receiving plasma exchange did receive larger volumes of plasma, but the duration of therapy in the first cycle was similar and the outcomes were different. At the end of the first treatment cycle, the response rate (defined by an increase in platelet count) was higher in patients who received plasma exchange (24 of 51 patients) than in those who received plasma infusion (13 of 51 patients) (P ≤ 0.025). Two of the 51 patients treated with plasma exchange died, compared with 8 of the 51 patients who received plasma infusion (P = 0.035).
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