Decreasing frequency of plasma exchange complications in patients treated for thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, 1996 to 2011.

TitleDecreasing frequency of plasma exchange complications in patients treated for thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, 1996 to 2011.
Publication TypeJournal Article
Year of Publication2012
AuthorsSom S, Deford CC, Kaiser ML, Terrell DR, Hovinga JA, Lammle B, George JN, Vesely SK
JournalTransfusion//Transfusion
Volume52
Issue12
Pagination2525 - 2524
Date Published2012
ISBN Number1537-2995
Other Numberswdn, 0417360
Keywords*Hemolytic-Uremic Syndrome/mo [Mortality], *Hemolytic-Uremic Syndrome/th [Therapy], *Plasma Exchange/ae [Adverse Effects], *Plasma Exchange/mo [Mortality], *Purpura, Thrombotic Thrombocytopenic/mo [Mortality], *Purpura, Thrombotic Thrombocytopenic/th [Therapy], ADAM Proteins/me [Metabolism], Adrenal Cortex Hormones/tu [Therapeutic Use], Adult, Antibodies, Monoclonal, Murine-Derived/tu [Therapeutic Use], Antineoplastic Agents/tu [Therapeutic Use], Catheter-Related Infections/mo [Mortality], Catheterization, Central Venous/ae [Adverse Effects], Education, Medical, Continuing, Female, Hemolytic-Uremic Syndrome/dt [Drug Therapy], Humans, Male, Morbidity, Oklahoma/ep [Epidemiology], Purpura, Thrombotic Thrombocytopenic/dt [Drug Therapy], Registries/sn [Statistics & Numerical Data], Remission Induction, Risk Factors, rituximab, Sepsis/mo [Mortality]
Abstract

BACKGROUND: Plasma exchange (PEX) treatment for patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) has risk for major complications., STUDY DESIGN AND METHODS: Data for PEX-related complications have been prospectively collected on all patients enrolled in the Oklahoma TTP-HUS Registry, 1996 to 2011. PEX-related complications have been defined as major or minor and as central venous catheter related or plasma related., RESULTS: During 15 years, 1996 to 2011, 72 (24%) of 302 consecutive patients had major PEX-related complications. Analysis of five consecutive 3-year cohorts demonstrated that there has been a significant trend for decreasing frequency of all PEX-related major complications (p = 0.014) and central venous catheter-related major complications (p = 0.021) but not for the less common plasma-related major complications (p = 0.380). ADAMTS13 activity was measured in 288 (95%) of the 302 patients. Analysis of the 66 patients with ADAMTS13 activity of less than 10% demonstrated a significant trend for decreasing frequency of PEX-related major complications (p = 0.036); the trend for the 222 patients with ADAMTS13 activity of at least 10% was not significant (p = 0.118). The decreased frequency of PEX-related major complications among patients with ADAMTS13 activity of less than 10% may be related to a significant trend for decreasing duration of PEX treatment (p = 0.040) and decreasing frequency of requirement for more than one central venous catheter (p = 0.044). The decreased duration of PEX treatment may be related to increased use of adjunctive treatments: corticosteroids (p

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