The Adaptation of Hemodialysis to Facilitate Rapid Exchange Transfusion in Patients with Thrombotic Thrombocytopenic Purpura (TTP)

Ec, Rossi; F, Del Greco

doi:10.1055/s-2007-1005065

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Nevertheless, in TTP the early institution of plasma exchange or plasma infusion has dramatically changed the course of the disease. 15,18,19,36,[113][114][115] This may in part be due to provision of a factor or factors that modify the production of PGI 2 by the blood vessel wall or the stability of PGI 2 in the plasma. 22,37,92,107 Un fortunately, the methods for recognizing a defi ciency in such a factor in the patient's plasma or an absence of 6 keto-PGF 1α , in the patient's plasma are, at present, too complex to enable this infor mation to be a guide to the management of the patient during the critical initial stages of the pa tient's illness.…”

Section: Treatment Of Ttp and Husmentioning

confidence: 99%

Thrombotic Thrombocytopenic Purpura and the Hemolytic Uremic Syndrome

Brain¹,

Neame²

1982

Semin Thromb Hemost

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Section: Treatment Of Ttp and Husmentioning

confidence: 99%

Thrombotic Thrombocytopenic Purpura and the Hemolytic Uremic Syndrome

Brain¹,

Neame²

1982

Semin Thromb Hemost

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“…or infusion [30][31][32][33][34][35][36], Consequently, the disease has ceased to be a fulmi nant disorder with an invariably fatal outcome and has resulted in the emergence of a group of patients who recover fully and others whose disease pursues a pro tracted course characterized by recurrent episodes, in whom renal involvement may recur during exacerbation episodes ofTTP or persists as an ongoing chronic prob lem when the disease is in remission [10,[37][38][39][40][41][42][43]. Whereas the results of treating TTP with plasma ex change and infusion have been particularly encouraging, they often result in circulatory overload and electrolyte disturbances in subjects whose renal function is already compromised by the underlying disease process [44,45], Not unexpectedly then, a contributing factor to the over all improvement of survival in TTP has been the avail ability of better general supportive medical care [46], including optimal control and replacement of fluid and electrolytes. In fact, the use of hemodialysis to achieve rapid plasma exchange, volume control, and correction of uremia has come to occupy an important role in the man agement of some patients [44][45][46][47], It is with all these considerations in mind that we undertook the present view of the literature and of the cases ofTTP encountered at the Baylor Affiliated Hospi tals for the period extending from 1966 to 1981. in an attempt to better define and characterize the renal in volvement and complications that develop in patients with TTP.…”

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confidence: 99%

Renal Involvement in Patients with Thrombotic Thrombocytopenic Purpura

Eknoyan

Riggs

1986

Am J Nephrol

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A retrospective review of the records of 15 patients with thrombotic thrombocytopenic purpura (TTP) was performed to determine the spectrum of renal involvement that occurs in this disease. All cases exhibited some evidence of renal involvement, the most common manifestation of which was an abnormal urinalysis. Twelve cases (80%) had some degree of elevation of the serum urea nitrogen (SUN) or creatinine level at some time during the course of their disease. Renal involvement could be categorized into three types depending on the severity of TTP. In those cases presenting as an acute devastating illness, renal insufficiency, when present, was severe and a dominant component of the disease. In those that pursued a more protracted course, with subsequent acute exacerbations of TTP, renal insufficiency was variable and less severe than in the first group. In those presenting with a mild form of TTP, renal involvement consisted primarily of an abnormal urine sediment and azotemia that corrected rapidly following fluid replacement. A review of the literature beginning with 1966, when renal disease was established as part of the features that characterize TTP, provided 216 cases in whom sufficient data on renal involvement were recorded. Of the 168 cases where urinalysis was reported, hematuria was noted in 78% of the cases, proteinuria in 75, pyuria in 31 and cylindriuria in 24%. Of the 181 cases where the admission SUN was reported, it was higher than 20 mg/dl in 69% and greater than 60 mg/dl in 17% of the cases. The level of SUN was a significant determinant of the final prognosis of these patients.

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Thrombotic Thrombocytopenic Purpura

Bartholomew

Bell

1986

J Intensive Care Med

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Thrombotic thrombocytopenic purpura (TTP) is classically highlighted by a pentad of features: fever, hemolytic anemia, thrombocytopenia purpura, transient or permanent central nervous system signs, and renal disease. The antemortem diagnosis is reliant upon the multisystem clinical signs and symptoms in conjunction with severe hemolytic anemia and thrombocytopenia. Relapse is common within the first six months after initial presentation. Laboratory findings have been generally nonspecific per se, and antemortem tissue biopsy findings are frequently unrewarding. Recently, however, unusually large multimers of the Factor VIII:Ag molecule (von Willebrand protein) have been identified in the plasma of patients with TTP who have recovered from an acute attack. This observation is very important because it may lead to essential information on the nature of the inciting event in this devastating illness. The differential diagnosis includes several multisystem disease processes such as the hemolytic uremic syndrome, toxemia of pregnancy, systemic lupus erythematosus, subacute bacterial endocarditis, nonbacterial thrombotic endocarditis, immune thrombocytopenic purpura, and the postpartum renal failure syndrome. The hemolytic uremic syndrome, toxemia of pregnancy, and TTP may resemble each other, exhibit many overlapping features, and are probably related. The cause of TTP remains unknown; the overwhelming majority of cases occur in otherwise healthy people without any recognizable underlying illness. Since 1965 45 to 70% of patients survive, a significant improvement in contrast to the early 1900s when the mortality rate was greater than 90%. The most dramatic advance has been observed in therapeutics, namely the utilization of some mode of plasma therapy (either infusion alone or plasmapheresis followed by plasma infusion). Corticosteroids remain very important in the management of patients with TTP. Vincristine may be very helpful, but additional studies are needed. The efficacy of vinca alkaloids, chronic immunosuppressive therapy, and sple. nectomy remains undefined. At present there is very little, if any, evidence that antiplatelet agents, aspirin, and prostacyclin are beneficial to patients with TTP. Prompt diagnosis and vigorous aggressive therapy is critical for successful management of TTP patients.

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The Adaptation of Hemodialysis to Facilitate Rapid Exchange Transfusion in Patients with Thrombotic Thrombocytopenic Purpura (TTP)

Cited by 3 publications

References 13 publications

Thrombotic Thrombocytopenic Purpura and the Hemolytic Uremic Syndrome

Thrombotic Thrombocytopenic Purpura and the Hemolytic Uremic Syndrome

Renal Involvement in Patients with Thrombotic Thrombocytopenic Purpura

Thrombotic Thrombocytopenic Purpura

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