[the jugular] is probably the more comfortable way. i mean, they have to stick a lot of holes in your arm. if you think of the size of a person [and] how much blood you have — half that blood is plasma. it’s litres of plasma that you need to replace, so there’s a lot of flow needed in order to do that. if you’re using the arms, the holes are small, and it takes a long time. but when you have the line in your neck, it’s much more efficient.
it can be risky though — the thing about not having platelets is that you bleed, so putting a line in someone’s neck when their platelets are low is something to think about.
ttp is treated by exchanging plasma (plasmapheresis) to remove the antibodies that inhibit the adamts13 enzyme and causes clotting of the platelets and replaces it with normal adamts13. supplied
how often do you have that done?
i’ve had occurrences of ttp five times. there’s this flurry of having your plasma exchanged, and then when everything gets back to normal you go back to your normal life. you really don’t do anything to prevent it after that. the only thing i do is get my blood tested once every month. but i’m not taking any drugs or maintenance to prevent ttp, we’re just monitoring.
are there ways to prevent ttp from happening?
we take a steroid to try to stop it, but there are two drugs — one called rituximab [that] tries to prevent the adamts13 enzyme activity from going low. typically, you either get that while you are being treated for ttp or right after. mine has always been after i had ttp. if my adamts13 levels are dropping, i might get rituximab to try to stop it.
another drug which is very new — it’s been approved by health canada but it hasn’t been approved to be paid for — is called
caplacizumab
. it’s a very expensive drug that basically stops the platelets from clotting.