High incidence of relapses in thrombotic thrombocytopenic purpura

Rose, Michal G.; Eldor, Amiram

doi:10.1016/0002-9343(87)90753-4

Cited by 144 publications

(100 citation statements)

References 28 publications

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“…Several reports indicate that platelet infusion is usually followed by rapid clinical deterioration [4À8] that may lead to death [5,6]. Post-mortem examination of patients who have died after platelet transfusion, showed consistent extensive platelet aggregates in central nervous system.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of platelet transfusions after plasma exchange in adult thrombotic thrombocytopenic purpura: A report of two cases

et al. 2001

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Plasma infusion (PI) and plasma exchange (PE) are the most efficient treatment of thrombotic thrombocytopenic purpura (TTP), allowing achievement of complete remission in 60 to 90% of cases. Life‐threatening bleeding, related to severe thrombocytopenia, is one of the main complications of the disease. Thrombocytopenia may also preclude invasive procedures such as splenectomy, which may be required during the management of TTP. Platelet concentrates transfusions are usually thought to worsen the disease, especially if not associated with the appropriate treatment of this latter, and thus should be avoided. We report hereon 2 patients with TTP who experienced a surgical procedure i.e., a cholecystectomy for a cholecystitis, and a splenectomy for a refractory TTP. In both patients, the surgical procedure was preceded by a 60 mL/kg plasma exchange with solvent/detergent treated plasma as replacement fluid, followed by platelet transfusion, with a corrected count increment of 57.1% (Patient 1) and 69.3% (Patient 2). Using this sequential treatment, the patients did not experience any deterioration of their status. Both patients had a favorable outcome after surgery. However, until such a procedure will be validated on a larger series of patients, it should be restricted to patients presenting with a refractory life‐threatening thrombocytopenia and/or requiring surgery or any kind of invasive procedure. Am. J. Hematol. 68:198–201, 2001. Published 2001 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of platelet transfusions after plasma exchange in adult thrombotic thrombocytopenic purpura: A report of two cases

et al. 2001

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“…In brief, the diagnosis of idiopathic TTP was based on the presence of haemolytic anaemia with schistocytes in the blood smear and thrombocytopenia in the absence of renal failure, a positive antiglobulin test, disseminated intravascular coagulation, malignant hypertension, neoplasm, stem cell transplantation, concurrent infection or positive HIV serology. Disease severity at presentation was evaluated by Rose and Eldor score [17]. The patient's first medical attendance was established as the TTP debut.…”

Section: Patients and Study Designmentioning

confidence: 99%

Newly diagnosed versus relapsed idiopathic thrombotic thrombocytopenic purpura: a comparison of presenting clinical characteristics and response to treatment

et al. 2009

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et al.. Newly diagnosed versus relapsed idiopathic thrombotic thrombocytopenic purpura: a comparison of presenting clinical characteristics and response to treatment. Annals of Hematology, Springer Verlag, 2009, 88 (10), pp.973-978. 10.1007/s00277-009-0707-9 . hal-00535035 ORIGINAL ARTICLENewly diagnosed versus relapsed idiopathic thrombotic thrombocytopenic purpura: a comparison of presenting clinical characteristics and response to treatment Abstract The remission rate with plasma exchange (PE) in thrombotic thrombocytopenic purpura (TTP) exceeds 80%, but the disease relapses in up to 20-30% of the cases. Clinical characteristics and response to treatment of relapsed TTP are not well defined. The objective of the present study was to compare the clinical and biological characteristics at presentation and the response to treatment between de novo and relapsed TTP. For such purpose, a total of 102 episodes of idiopathic TTP (70 de novo and 32 relapses) included in a recent multicentric prospective cohort study were analysed. All patients were homogeneously treated with daily PE and costicosteroids. In comparison with de novo TTP, episodes of relapsed TTP showed a higher Hb level (median, 122 g/l versus 91 g/l, p < 0.001) and lower serum lactate dehydrogenase (2.2-versus 4.5-fold above the upper limit of normality, p < 0.001). Neurological symptoms and fever were less frequently observed in patients with relapsed TTP than in patients with de novo TTP. Patients with relapsed TTP needed fewer PE sessions Ann Hematol (2009) 88:973-978 DOI 10.1007 Alberto Alvarez-Larrán and Julio del Río-Garma contributed equally to this article. (five versus ten, p = 0.02) and a smaller volume of plasma (221 ml/kg versus 468 ml/kg, p = 0.004) to achieve remission than those with de novo TTP. There was no significant difference in the rate of recrudescence under treatment, the need of complementary treatments or the frequency of refractoriness to PE therapy. In conclusion, relapsed TTP has a milder clinical profile and responds more easily to PE than de novo TTP.

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“…Severity of TTP was characterized according to the staging system of Rose and Eldor. 6 The scoring system has 4 categories: platelet count, hemoglobin level, serum creatinine level, and neurological changes. The 2 test was used for univariate comparisons.…”

Section: Data Completeness Assessmentmentioning

confidence: 99%

Clopidogrel-Associated TTP

Zakarija

Bandarenko

Pandey

et al. 2004

Stroke

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Background and Purpose-Since the 1999 identification of clopidogrel-associated thrombotic thrombocytopenic purpura (TTP) through independent active surveillance, subsequent cases have been identified by pharmaceutical suppliers of clopidogrel and the Food and Drug Administration (FDA). For cases of clopidogrel-associated TTP reported between 1998 to 2002, we evaluated the quality and timeliness of data from 3 reporting systems-independent active surveillance (nϭ13), pharmaceutical suppliers (nϭ24), and the FDA (nϭ13)-and identified prognostic factors associated with mortality. Methods-This study assessed the completeness of information on TTP diagnosis, treatment response, and causality from the 3 reporting systems. In addition, predictors of mortality were identified through classification tree analysis. Results-Completeness, timeliness, and certainty of diagnosis were best for cases obtained by active surveillance, intermediate for cases reported to the pharmaceutical supplier, and poorest for cases reported directly to the FDA. Clopidogrel had been used for Յ2 weeks by 65%. The survival rate for patients with clopidogrel-associated TTP was 71.2%. Receipt of therapeutic plasma exchange within 3 days of onset of TTP increased the likelihood of survival (100% versus 27.3%, PϽ0.001). Conclusions-Compared

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High incidence of relapses in thrombotic thrombocytopenic purpura

Cited by 144 publications

References 28 publications

Effectiveness of platelet transfusions after plasma exchange in adult thrombotic thrombocytopenic purpura: A report of two cases

Effectiveness of platelet transfusions after plasma exchange in adult thrombotic thrombocytopenic purpura: A report of two cases

Newly diagnosed versus relapsed idiopathic thrombotic thrombocytopenic purpura: a comparison of presenting clinical characteristics and response to treatment

Clopidogrel-Associated TTP

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