Cargando…
Characterization of the complications associated with plasma exchange for thrombotic thrombocytopaenic purpura and related thrombotic microangiopathic anaemias: a single institution experience
BACKGROUND: Plasma exchange (PEX) is a life-saving therapeutic procedure in patients with thrombotic thrombocytopaenic purpura (TTP) and other thrombotic microangiopathic anaemias (TMAs). However, it may be associated with significant complications, exacerbating the morbidity and mortality in this p...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BlackWell Publishing Ltd
2014
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282311/ https://www.ncbi.nlm.nih.gov/pubmed/24117855 http://dx.doi.org/10.1111/vox.12090 |
_version_ | 1782351111389184000 |
---|---|
author | McGuckin, S Westwood, J-P Webster, H Collier, D Leverett, D Scully, M |
author_facet | McGuckin, S Westwood, J-P Webster, H Collier, D Leverett, D Scully, M |
author_sort | McGuckin, S |
collection | PubMed |
description | BACKGROUND: Plasma exchange (PEX) is a life-saving therapeutic procedure in patients with thrombotic thrombocytopaenic purpura (TTP) and other thrombotic microangiopathic anaemias (TMAs). However, it may be associated with significant complications, exacerbating the morbidity and mortality in this patient group. STUDY DESIGN AND METHODS: We reviewed all PEX procedures over a 72-month period, following the exclusive introduction of solvent–detergent double viral-inactivated plasma in high-volume users, such as TTP, in the United Kingdom (UK). We documented allergic reactions to plasma, citrate reactions, complications relating to central venous access insertion and venous thrombotic events (VTE) in 155 patient episodes and >2000 PEX procedures. RESULTS: The overall complication rate was low. Allergic plasma reactions occurred in 6·45% of the cohort with only one episode of acute anaphylaxis. Similarly, VTEs were 6·45%, not significantly greater than in medical patients receiving thromboprophylaxis, despite added potential risk factors in TTP. Citrate reactions were the most frequent complication documented, but toxicity was significantly reduced by administration of further calcium infusions during the PEX procedure. There were no serious central line infections and no catheter thrombosis. CONCLUSION: Our data confirms that PEX continues to be a life-saving procedure in the acute TTP setting and, the procedure was not associated with an increased mortality and limited morbidity. |
format | Online Article Text |
id | pubmed-4282311 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BlackWell Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-42823112015-01-15 Characterization of the complications associated with plasma exchange for thrombotic thrombocytopaenic purpura and related thrombotic microangiopathic anaemias: a single institution experience McGuckin, S Westwood, J-P Webster, H Collier, D Leverett, D Scully, M Vox Sang Transfusion Medicine and New Therapies BACKGROUND: Plasma exchange (PEX) is a life-saving therapeutic procedure in patients with thrombotic thrombocytopaenic purpura (TTP) and other thrombotic microangiopathic anaemias (TMAs). However, it may be associated with significant complications, exacerbating the morbidity and mortality in this patient group. STUDY DESIGN AND METHODS: We reviewed all PEX procedures over a 72-month period, following the exclusive introduction of solvent–detergent double viral-inactivated plasma in high-volume users, such as TTP, in the United Kingdom (UK). We documented allergic reactions to plasma, citrate reactions, complications relating to central venous access insertion and venous thrombotic events (VTE) in 155 patient episodes and >2000 PEX procedures. RESULTS: The overall complication rate was low. Allergic plasma reactions occurred in 6·45% of the cohort with only one episode of acute anaphylaxis. Similarly, VTEs were 6·45%, not significantly greater than in medical patients receiving thromboprophylaxis, despite added potential risk factors in TTP. Citrate reactions were the most frequent complication documented, but toxicity was significantly reduced by administration of further calcium infusions during the PEX procedure. There were no serious central line infections and no catheter thrombosis. CONCLUSION: Our data confirms that PEX continues to be a life-saving procedure in the acute TTP setting and, the procedure was not associated with an increased mortality and limited morbidity. BlackWell Publishing Ltd 2014-02 2014-10-10 /pmc/articles/PMC4282311/ /pubmed/24117855 http://dx.doi.org/10.1111/vox.12090 Text en © 2014 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion http://creativecommons.org/licenses/by/3.0/ This 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. |
spellingShingle | Transfusion Medicine and New Therapies McGuckin, S Westwood, J-P Webster, H Collier, D Leverett, D Scully, M Characterization of the complications associated with plasma exchange for thrombotic thrombocytopaenic purpura and related thrombotic microangiopathic anaemias: a single institution experience |
title | Characterization of the complications associated with plasma exchange for thrombotic thrombocytopaenic purpura and related thrombotic microangiopathic anaemias: a single institution experience |
title_full | Characterization of the complications associated with plasma exchange for thrombotic thrombocytopaenic purpura and related thrombotic microangiopathic anaemias: a single institution experience |
title_fullStr | Characterization of the complications associated with plasma exchange for thrombotic thrombocytopaenic purpura and related thrombotic microangiopathic anaemias: a single institution experience |
title_full_unstemmed | Characterization of the complications associated with plasma exchange for thrombotic thrombocytopaenic purpura and related thrombotic microangiopathic anaemias: a single institution experience |
title_short | Characterization of the complications associated with plasma exchange for thrombotic thrombocytopaenic purpura and related thrombotic microangiopathic anaemias: a single institution experience |
title_sort | characterization of the complications associated with plasma exchange for thrombotic thrombocytopaenic purpura and related thrombotic microangiopathic anaemias: a single institution experience |
topic | Transfusion Medicine and New Therapies |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282311/ https://www.ncbi.nlm.nih.gov/pubmed/24117855 http://dx.doi.org/10.1111/vox.12090 |
work_keys_str_mv | AT mcguckins characterizationofthecomplicationsassociatedwithplasmaexchangeforthromboticthrombocytopaenicpurpuraandrelatedthromboticmicroangiopathicanaemiasasingleinstitutionexperience AT westwoodjp characterizationofthecomplicationsassociatedwithplasmaexchangeforthromboticthrombocytopaenicpurpuraandrelatedthromboticmicroangiopathicanaemiasasingleinstitutionexperience AT websterh characterizationofthecomplicationsassociatedwithplasmaexchangeforthromboticthrombocytopaenicpurpuraandrelatedthromboticmicroangiopathicanaemiasasingleinstitutionexperience AT collierd characterizationofthecomplicationsassociatedwithplasmaexchangeforthromboticthrombocytopaenicpurpuraandrelatedthromboticmicroangiopathicanaemiasasingleinstitutionexperience AT leverettd characterizationofthecomplicationsassociatedwithplasmaexchangeforthromboticthrombocytopaenicpurpuraandrelatedthromboticmicroangiopathicanaemiasasingleinstitutionexperience AT scullym characterizationofthecomplicationsassociatedwithplasmaexchangeforthromboticthrombocytopaenicpurpuraandrelatedthromboticmicroangiopathicanaemiasasingleinstitutionexperience |