Therapeutical plasma exchange for thrombotic thrombocytopenic purpura in the emergency department: A single center experience

• Published in: The American journal of emergency medicine Vol. 46; pp. 556 - 559
• Main Authors: Li, Xiang-Min, Mo, Xiao-Ye, Huang, Guo-Qing, Zhang, Fang-Jie
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01.08.2021; Elsevier Limited
• Subjects: Anemia; Apheresis; Bilirubin; Blood platelets; Blood products; Coma; Creatinine; Dehydrogenases; Emergency; Emergency medical care; Females; Fever; Glucocorticoids; Hemoglobin; Laboratories; Mortality; Nervous system; Patients; Plasma; Purpura; Remission (Medicine); Therapeutical plasma exchange; Thrombocytopenia; Thrombocytopenic purpura; Thrombotic microangiopathy; Thrombotic thrombocytopenic purpura; Thrombotic thrombocytopenic purpura; Therapeutical plasma exchange; Emergency
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2020.11.019

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening and easily misdiagnosed thrombotic microangiopathy disease. Few studies have reported the use of therapeutic plasma exchange (TPE) for TTP in emergency departments in China. The present study was a retrospective analysis of patients with TTP who were treated with TPE in our emergency intensive care unit (EICU). This study retrospectively analyzed patients with TTP who received TPE management from July 1, 2014 to February 1, 2020. The following clinical data of these patients were collected: laboratory results, first symptoms, ADAMTS13 levels, glucocorticoid levels, TPE times and outcomes. The study included 19 patients (9 male and 10 female) with 20 clinical episodes, and 1 female patient had two episodes. TPE was used in 17 patients, and TPE was performed once every 2–3 days in patients. The volume for each TPE treatment was 2000 ml. In total, 4 male patients died, and 15 patients survived. One female experienced a relapse. No significant differences in age, RBC, HGB, PLT, ALT, AST, BUN, Cr, LDH, or bilirubin were noted between the survival and death groups. The mortality rate of male patients was significantly higher than that of female patients(p = 0.0325, p < 0.05), and the mean age of deceased patients was 64.25 ± 4.78 years, which was older than the mean age of survivors (47.38 ± 4.30). However, no significant difference was noted (p = 0.0787). TPE had satisfactory results for TTP patients although it was not performed every day. Older male TTP patients exhibited a relatively increased risk of death.