 |
|
Treatment Outcomes in Patients With Adult Thrombotic Thrombocytopenic Purpura—Hemolytic Uremic Syndrome
Catherine P. M. Hayward, MD;
David M. C. Sutton, MD;
Walter H. Carter, Jr, PhD;
Eleanor D. Campbell, MS;
J. Gerald Scott, MD;
William H. Francombe, MD;
Kenneth H. Shumak, MD;
Michael A. Baker, MD
Arch Intern Med. 1994;154(9):982-988.
Abstract
| |
Background
Plasma treatment has improved the outcomes in adults with thrombotic thrombocytopenic purpura (TTP)—hemolytic uremic syndrome (HUS). We reviewed our experience in treating unselected patients to determine the clinical outcomes and to evaluate the treatments given in addition to plasma.
Methods
A chart review of all cases of TTP and HUS in adults treated at the Toronto (Ontario) Hospital, the largest treatment center for adults with TTP-HUS in the province of Ontario, was conducted.
Results
Sixty-seven episodes of TTP-HUS in 52 consecutive adult patients were treated during a 12-year period. Plasma was the primary form of therapy, and most patients received plasma exchange. A complete hematologic remission was achieved in 65 of 67 episodes; however, two patients in remission were brain-dead. The time to complete remission varied from 3 to 58 days (median, 13 days). The death rate during the acute illness was 8%. Long-term sequelae included relapses, persisting renal impairment, hepatitis, and transfusion-associated acquired immunodeficiency syndrome. Relapses occurred in 21% of patients during a median follow-up of 1.1 years (range, 0.1 to 18 years). Analyses of the treatment given in addition to plasma did not demonstrate a significant benefit in terms of reducing the illness duration, mortality, or long-term sequelae.
Conclusions
While most patients recovered from TTP-HUS, deaths still occurred and many patients suffered long-term complications. The role of the treatments given in addition to plasma is uncertain.
(Arch Intern Med. 1994;154:982-987)
Author Affiliations
From the Departments of Hematology and Oncology, The Toronto (Ontario) Hospital (Drs Hayward, Sutton, Scott, Francombe, Shumak, and Baker); and the Department of Biostatistics, Virginia Commonwealth University, Richmond (Drs Carter and Campbell).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
A chicken sandwich leading to intensive care
Som et al.
BMJ 2009;338:b200-b200.
FULL TEXT
Catastrophic antiphospholipid syndrome during pregnancy and puerperium: maternal and fetal characteristics of 15 cases
Gomez-Puerta et al.
Ann Rheum Dis 2007;66:740-746.
ABSTRACT
| FULL TEXT
Clinical Outcome of Thrombotic Microangiopathy after Living-Donor Liver Transplantation Treated with Plasma Exchange Therapy
Nishi et al.
CJASN 2006;1:811-819.
ABSTRACT
| FULL TEXT
Thrombotic microangiopathy in United States long-term dialysis patients
Perkins et al.
Nephrol Dial Transplant 2006;21:191-196.
ABSTRACT
| FULL TEXT
Effect of plasma exchange on plasma ADAMTS13 metalloprotease activity, inhibitor level, and clinical outcome in patients with idiopathic and nonidiopathic thrombotic thrombocytopenic purpura
Zheng et al.
Blood 2004;103:4043-4049.
ABSTRACT
| FULL TEXT
ADAMTS13 activity in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: relation to presenting features and clinical outcomes in a prospective cohort of 142 patients
Vesely et al.
Blood 2003;102:60-68.
ABSTRACT
| FULL TEXT
Laparoscopic Splenectomy in Patients With Refractory or Relapsing Thrombotic Thrombocytopenic Purpura
Schwartz et al.
Arch Surg 2001;136:1236-1238.
ABSTRACT
| FULL TEXT
How I treat patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome
George
Blood 2000;96:1223-1229.
ABSTRACT
| FULL TEXT
|
