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Decreasing frequency of plasma exchange complications in patients treated for thrombotic thrombocytopenic purpura‐hemolytic uremic syndrome, 1996 to 2011 (CME)
Author(s) -
Som Sumit,
Deford Cassandra C.,
Kaiser Mandi L.,
Terrell Deirdra R.,
Kremer Hovinga Johanna A.,
Lämmle Bernhard,
George James N.,
Vesely Sara K.
Publication year - 2012
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2012.03646.x
Subject(s) - medicine , thrombotic thrombocytopenic purpura , adamts13 , gastroenterology , complication , platelet
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 < 0.001) and rituximab (p < 0.001). CONCLUSIONS: The frequency of PEX‐related major complications has decreased from 1996 to 2011, possibly related to increased use of corticosteroids and rituximab and the decreased duration of PEX required to achieve remission.