Clinical experience in treatment of thrombotic thrombocytopenic purpura - hemolytic uremic syndrome with 28 patients
2013
Background: Neither optimal treatment nor significance of ADAMTS13 (A
Desintegrin And Metalloprotease with ThromboSpondin type 1 repeats) activity
for diagnosis and therapy of thrombotic thrombocytopenic purpura (TTP) and
hemolytic-uremic syndrome (HUS) have not been defined yet. The aim of the
report is to analyze response to different volumes of plasma exchange (PE),
and relationship to ADAMTS13. Design and methods: 28 patients clinically
diagnosed with idiopathic TTP (n=18), secondary TTP (n=4), atypical HUS (n=3)
and typical HUS (n=3) manifested 31 acute episodes. Patients were treated
with PE in 26, and with plasma transfusion in 5 episodes with additional
different therapies. Results: PE volumes were as follows: 1 in 7, 1.5 in 3, 2
in 14, and intensifying schedule (1 to 1.5) in 2 episodes. Procedure number
was lower in patients treated with 2 and 1.5 (p=0.019) than in those treated
with 1 volume exchange and PE intensifying, respectively (p=0.010). PE
response rate was 25/26 (96.15%). Exacerbation frequency was higher in
idiopathic TTP patients (3/19) treated with 1 compared with patients treated
with >1 volume exchange (p=0.003). Survival rate was 25/28 (89.29%). ADAMTS13
activity was reduced in 22 with severe deficiency in 14 patients. Conclusion:
Patients responded to different treatments regardless of ADAMTS13 activity,
requiring less PEs with larger volume exchanges.
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