Therapeutic plasma exchange in thrombotic thrombocytopenic purpura

Picod, Adrien; François, Patrice; Coppo, Paul

doi:10.1016/j.lpm.2019.08.024

Cited by 10 publications

(6 citation statements)

References 64 publications

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“…Results of the assay also require time, and it is not routine to wait for ADAMSTS13 results before initiating PEX if the suspicion of TTP is high. Further complicating matters, PEX is not an effective treatment for secondary TMAs, and is itself associated with complications such as risks of transfusion of blood products, symptomatic electrolyte disturbance, hypovolemia, sepsis from catheter-related bloodstream infections, and complications of catheter insertion, such as hemorrhage, pneumothorax, and catheter-related thrombosis [6].…”

Section: Discussionmentioning

confidence: 99%

Hypertensive Emergency with Thrombotic Microangiopathy or TTP? A Case Series and Literature Review

Song,

Lee,

Chee

et al. 2024

JCM

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Thrombotic microangiopathy (TMA) is associated with both hypertensive emergency and primary thrombocytopenia purpura (TTP). However, their clinical management is vastly different, with the latter necessitating urgent plasma exchange (PEX). We report two cases of hypertension-associated TMA (HTN-TMA) and a literature review of the clinical management of malignant hypertension. We suggest that in patients presenting with hypertensive emergency associated with TMA, a clinical diagnosis of HTN-TMA should be made, with emergent treatment to lower blood pressure started immediately. Although TTP is a differential diagnosis for TMA, PEX should not be started concurrently in the absence of other supporting evidence for TTP.

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Section: Discussionmentioning

confidence: 99%

Hypertensive Emergency with Thrombotic Microangiopathy or TTP? A Case Series and Literature Review

Song,

Lee,

Chee

et al. 2024

JCM

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“…TPE is used to remove antibodies and immune complexes from circulation [11]. It is the standard of care in thrombotic thrombocytopenic purpura, in which it removes ADAMTS13-blocking antibodies [12]. However, TPE is not 2…”

Section: Discussionmentioning

confidence: 99%

Gemtuzumab-Ozogamicin-Related Impaired Hemoglobin-Haptoglobin Scavenging as On-Target/Off-Tumor Toxicity of Anti-CD33 AML Therapy: A Report of Two Cases

Rajala

Anttila

Haapio

et al. 2021

Case Reports in Hematology

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Gemtuzumab-ozogamicin (GO) is a humanized anti-CD33 antibody, which is conjugated to a cytotoxic calicheamicin. It is used to treat acute myeloid leukemia (AML) in combination with chemotherapy. We describe here two GO-treated acute myeloid leukemia (AML) cases: both patients suffered from a toxic syndrome, which manifested as impaired hemoglobin-haptoglobin scavenging and accumulation of hemolysis-related products. Our observations and earlier reports indicated that the reaction was caused by GO-targeted destruction of CD33 + CD163+ monocytes/macrophages, which are responsible for the clearance of hemoglobin-haptoglobin complexes. The rise of plasma lactate dehydrogenase was an early sign of the reaction, and both patients had high levels of free plasma hemoglobin, but plasma haptoglobin and bilirubin levels were paradoxically normal. Symptoms included septic fever and abnormalities in cardiac tests and in the case of the first patient, severe neurological symptoms which required intensive care unit admittance. Therapeutic plasma exchanges supported the patients until the recovery of normal hematopoiesis. The symptoms may be easily confounded with infectious complications-related organ damage. Regarding the increasing use of gemtuzumab-ozogamicin and other emerging CD33-targeted cell therapies, we want to highlight this mostly unknown and probably underdiagnosed toxicity.

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“…Meanwhile, initial plasma exchange in most of aTTP patients was supplemented with corticosteroids administration. Additionally, a B‐cell depletion molecule, rituximab, is frequently used in immune‐mediated TTP as an adjunction to initial therapy or as first‐line treatment [ 36 ]. Nevertheless, poor capacity to follow‐up patients prevented us from including the number of cases treated with rituximab in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic microangiopathies: First report of 294 cases from a single institution experience in Argentina

Santos

Paiva

Romero

et al. 2021

eJHaem

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Introduction: Introduction: Thrombotic microangiopathies (TMAs) are rare disorders associated with fatal outcomes if left uncared for. However, healthcare problems in developing countries tend to limit medical assistance to patients.Methods: Methods: We prospectively studied an Argentine cohort of 294 consecutive patients from 2013 to 2016. Patients' subcategory classification relied on clinical symptoms and presence or absence of trigger events associated with TMA.Results: Main suspected disorders were the primary TMAs known as thrombotic thrombocytopenic purpura (TTP) (n = 72/294, 24%) and atypical haemolytic uraemic syndrome (aHUS) (n = 94/294, 32%). In acute phase, demographic parameters for acquired TTP (aTTP) (n = 28) and aHUS (n = 47) showed that both groups were characterised by a young median age (37 and 25 years, respectively) and female predominance (60% and 86%). Median of a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 activity was significantly lower in aTTP than in aHUS group (1.4% vs 83%) and was associated with a more severe thrombocytopenia (15 × 10 9 vs 53 × 10 9 /L). Creatinine (Cr) and urea (Ur) were significantly increased in aHUS compared to aTTP subjects (Cr: 3.7 vs 0.7 mg/dL, Ur: 118 vs 33 mg/dL).Gastrointestinal and neurological symptoms were more frequent in aHUS and aTTP, respectively. Conclusion:The first description of a TMA cohort in Argentina revealed similar clinical presentations to those of other countries. K E Y W O R D SADAMTS13, atypical haemolytic uraemic syndrome, thrombotic microangiopathies, thrombotic thrombocytopenic purpura INTRODUCTIONThrombotic microangiopathies (TMAs) represent a group of rare diseases generally characterised by microangiopathic haemolyticThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Therapeutic plasma exchange in thrombotic thrombocytopenic purpura

Cited by 10 publications

References 64 publications

Hypertensive Emergency with Thrombotic Microangiopathy or TTP? A Case Series and Literature Review

Hypertensive Emergency with Thrombotic Microangiopathy or TTP? A Case Series and Literature Review

Gemtuzumab-Ozogamicin-Related Impaired Hemoglobin-Haptoglobin Scavenging as On-Target/Off-Tumor Toxicity of Anti-CD33 AML Therapy: A Report of Two Cases

Thrombotic microangiopathies: First report of 294 cases from a single institution experience in Argentina

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