Patterns of platelet response in idiopathic TTP/HUS: frequency of declining platelet counts with plasma exchange and the recognition and significance of a pseudo refractory state
| Autor: | Mark E. Brecher, Jennifer A. Egan, Nicholas Bandarenko, Peter A. Millward, Shauna N. Hay |
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| Rok vydání: | 2006 |
| Předmět: |
Adult
Blood Platelets Male medicine.medical_specialty Adolescent Endpoint Determination Thrombotic thrombocytopenic purpura L-Lactate dehydrogenase Gastroenterology Internal medicine medicine Humans In patient Platelet Mean platelet volume Child Aged Retrospective Studies Retrospective review L-Lactate Dehydrogenase Plasma Exchange Purpura Thrombotic Thrombocytopenic business.industry Platelet Count Retrospective cohort study Hematology Middle Aged medicine.disease Treatment Outcome Nephrology Immunology Hemolytic-Uremic Syndrome Female business Refractory state |
| Zdroj: | Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. 10(3) |
| ISSN: | 1744-9979 |
| Popis: | For thrombotic thrombocytopenic purpura (TTP), daily plasma exchange (TPE) is typically discontinued when the platelet count normalizes (150 x 10(9)/L). We observed a decline in platelet count during TPE and in patients who appeared pseudo-refractory because of a platelet count plateau (100-150 10(9)/L range). In the present study, we evaluated platelet count trends in TTP patients. Retrospective review of TTP patients from 01/1999 to 12/2004 was completed. Patients were categorized based on platelet count trends: Group I, counts rose then decreased to levels100 x 10(9)/L; Group II, counts declined following TPE initiation; Group III, counts rose continuously; Group IV, counts decreased after the count was100 x 10(9)/L. Additionally, we identified pseudo-refractory patients caused by a platelet count plateau (100 x 10(9)/L but150 x 10(9)/L). We identified 60 TTP patients. Within Group I (17 patients/17 series/19.1% of total), the mean decrease in platelet count was 67.3% +/- 22.1% following initial rise. Within Group II (24 patients/25 series/28.1% of total), the mean decrease was 28% +/- 5.3% following presentation. Group III included 31 patients/39 series (43.8% of the total). Within Group IV (seven patients/eight series/9.0% of total), the mean decrease was 17.4% +/- 12.6% following a sustained rise100 x 10(9)/L. With a declining platelet count and daily TPE, it is generally sufficient to stay the course and the decline will reverse. Our limited experience with pseudo-refractory patients supports discontinuing TPE when counts plateau between 100 and 150 x 10(9)/L when a therapy goal is a platelet count of 150 x 10(9)/L. Recognition of this pseudo-refractory state can minimize the risks of prolonged TPE and the risks of adjunct interventions. |
| Databáze: | OpenAIRE |
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