Predictors of response and relapse in a cohort of adults with thrombotic thrombocytopenic purpura‐hemolytic uremic syndrome: a single‐institution experience

Tuncer, Hande H.; Oster, Robert A.; Huang, Shu T.; Marques, Marisa B.

doi:10.1111/j.1537-2995.2007.01071.x

Cited by 33 publications

(51 citation statements)

References 35 publications

(49 reference statements)

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“…One potential strength of this study is that we present data on a large number of consecutive patients from a single institution with inclusion criteria of referral for plasma exchange and a blood picture consistent with thrombotic microangiopathy (regardless of presumed underlying cause). Our patient population of 65 cases was comparable with that of other series published in the literature [20][21][22]. Our consistent approach over the years has previously allowed us to aid identification of significant predisposing factors to TMA [2].…”

Section: Discussionsupporting

confidence: 71%

Infection frequently triggers thrombotic microangiopathy in patients with preexisting risk factors: A single‐institution experience

Douglas

Pollock

Young

et al. 2010

J of Clinical Apheresis

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Thrombotic microangiopathies are rare conditions characterized by microangiopathic hemolytic anemia, microthrombi, and multiorgan insult. The disorders, which include hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, are often acute and life threatening. We report a retrospective analysis of 65 patients presenting to our institution from 1997 to 2008 with all forms of thrombotic microangiopathy. Therapeutic plasma exchange was a requirement for analysis and 65 patients were referred to our institution; 66% of patients were female and median age at presentation was 52 years. Bacterial infection was the most commonly identified etiologic factor and in the multivariate model was the only significant variable associated with survival outcome (odds ratio 5.1, 95% confidence interval, 1.2-21.7). As infection can be considered a common trigger event for thrombotic microangiopathy, patients with hepatobiliary sepsis may benefit from elective cholecystectomy. We conclude that bacterial infection frequently triggers TTP and other thrombotic microangiopathies in patients with preexisting risk factors and propose a model for the development of these syndromes. J. Clin. Apheresis 25:47-53, 2010. V V C 2010 Wiley-Liss, Inc.

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Section: Discussionsupporting

confidence: 71%

Infection frequently triggers thrombotic microangiopathy in patients with preexisting risk factors: A single‐institution experience

Douglas

Pollock

Young

et al. 2010

J of Clinical Apheresis

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“…Previous studies have indicated that elderly age, severe neurological manifestations, fever, and low hemoglobin level at presentation are poor prognostic indicators. [21][22][23] However, none of these factors is specific for idiopathic TTP. Platelet count and lactate dehydrogenase level have been routinely used as laboratory parameters to monitor clinical responses of TTP to therapy.…”

Section: Discussionmentioning

confidence: 99%

ADAMTS13 activity and antigen during therapy and follow-up of patients with idiopathic thrombotic thrombocytopenic purpura: correlation with clinical outcome

Yang¹,

Jin²,

Lin³

et al. 2011

Haematologica

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BackgroundThe assay for ADAMTS13 activity helps clinicians to confirm the clinical diagnosis of idiopathic thrombotic thrombocytopenic purpura. The clinical value of testing for the antigen level of ADAMTS13 protein is, however, less clear. Design and MethodsIn this study, both ADAMTS13 antigen and activity levels were measured in 835 sequential samples from 40 consecutive patients who were followed for an average of 29 months throughout the course of acute episode plasma exchange treatment and clinical remission. ResultsDuring acute episodes, ADAMTS13 activity was severely deficient while ADAMTS13 antigen levels were more variable, ranging from severely deficient to as high as within the reference range. A severe depletion of ADAMTS13 antigen level during acute disease was, however, statistically associated with disease mortality (P=0.0322). For patients who achieved initial clinical responses, ADAMTS13 antigen levels appeared to be restored faster than ADAMTS13 activity to the normal range. Further analysis demonstrated that the ADAMTS13 antigen level at the time of initial clinical recovery was significantly higher in the patients who subsequently achieved a sustained clinical remission than in the group who soon after had an exacerbation (P=0.0187). ConclusionsOur data suggest that evaluation of ADAMTS13 antigen levels during the course of therapy and follow-up may offer additional useful information for the management of patients with thrombotic thrombocytopenic purpura.Key words: thrombotic thrombocytopenic purpura, ADAMTS13, prognosis, biomarker.Citation: Yang S, Jin M, Lin S, Cataland S, and Wu H. ADAMTS13 activity and antigen during therapy and follow-up of patients with idiopathic thrombotic thrombocytopenic purpura: correlation with clinical outcome Haematologica 2011;96(10)

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“…The search terms "thrombotic thrombocytopenic purpura" and "TTP" retrieved 3317 articles; 65 additional retrospective case series published after 1981 that described у25 patients were identified: 43 (66%) did not mention HIV infection, 10 (15%) specifically excluded patients with HIV infection, and 12 (19%) [5][6][7][18][19][20][21][22][23][24][25][26] described the presence (9 articles) or absence (3 articles) of patients with HIV infection at the time of diagnosis of TTP. These 19 case series are presented in table 1.…”

Section: Systematic Literature Reviewmentioning

confidence: 99%

Frequency and Significance of HIV Infection among Patients Diagnosed with Thrombotic Thrombocytopenic Purpura

et al. 2009

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HIV infection, similar to other inflammatory conditions, may trigger acute episodes of TTP in susceptible patients. More commonly, acquired immunodeficiency syndrome-related disorders may mimic the clinical features of TTP. If the diagnosis of TTP is suggested in a patient with HIV infection, there should be careful evaluation for alternative diagnoses and cautious consideration of plasma exchange, the required treatment for TTP.

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Predictors of response and relapse in a cohort of adults with thrombotic thrombocytopenic purpura‐hemolytic uremic syndrome: a single‐institution experience

Cited by 33 publications

References 35 publications

Infection frequently triggers thrombotic microangiopathy in patients with preexisting risk factors: A single‐institution experience

Infection frequently triggers thrombotic microangiopathy in patients with preexisting risk factors: A single‐institution experience

ADAMTS13 activity and antigen during therapy and follow-up of patients with idiopathic thrombotic thrombocytopenic purpura: correlation with clinical outcome

Frequency and Significance of HIV Infection among Patients Diagnosed with Thrombotic Thrombocytopenic Purpura

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