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Akpinar S, Tekgunduz E, Esen R, Yilmaz M, Karakus V, Vural F, Gediz F, Aydogdu I, Kaynar L, Goker H, Kelkitli E, Ayyildiz O, Demirkan F. Prospective registry of adult patients receiving therapeutic plasma exchange with a presumptive diagnosis of thrombotic microangiopathy (TMA): The Turkish hematology research and education group (ThREG)-TMA02 study. Transfus Apher Sci 2022; 61:103365. [PMID: 35120823 DOI: 10.1016/j.transci.2022.103365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thrombotic microanjiopathy (TMA) is a pathological diagnosis characterized by abnormalities of small vessels leading to microvascular thrombosis of arterioles and capillaries. The current prospective, non-interventional, multicenter study aimed to define the distribution of different TMA forms in adult Turkish patients who were referred for therapeutic plasma exchange (TPE) for presumptive diagnosis of TMA. Patients with serum ADAMTS13 activity <5% were diagnosed as having acquired thrombotic thrombocytopenic purpura (aTTP). Patients presenting with ADAMTS13 activity 6-10 % / normal renal function and patients with ADAMTS13 activity >10 %, normal renal function and no secondary TMA were treated as unclassified TMA. The study included a total of 80 patients (women: 50; man: 30) with a median age of 48 (20-74). Detailed evaluation at 1 month after hospital admission revealed aTTP, secondary TMA, infection/complement-associated hemolytic uremic syndrome and unclassified TMA in 29 (36.2 %), 22 (27.5 %), 23 (28.8 %) and 6 (7.5 %) patients respectively. As subclassification of various TMAs will dictate specific therapy, proper diagnosis in a timely manner is of utmost clinical significance.
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Affiliation(s)
- Seval Akpinar
- Namık Kemal University Medical School, Department of Internal Medicine, Division of Hematology, Tekirdag, Turkey.
| | - Emre Tekgunduz
- Memorial Bahcelievler Hospital Adult Hematology and BMT Clinic, Istanbul, Turkey
| | - Ramazan Esen
- Yuzuncu Yıl University Medical School, Department of Internal Medicine, Division of Hematology, Van, Turkey
| | - Mehmet Yilmaz
- Sanko University Medical School, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey
| | - Volkan Karakus
- Mugla Sıtkı Kocman University Medical School, Department of Internal Medicine, Division of Hematology, Mugla, Turkey
| | - Filiz Vural
- Ege University Medical School, Department of Internal Medicine, Division of Hematology, Izmir, Turkey
| | - Fusun Gediz
- Medicalpark Hospital, Hematology and BMT Clinic, Izmir, Turkey
| | - Ismet Aydogdu
- Celal Bayar University Medical School, Department of Internal Medicine, Division of Hematology, Manisa, Turkey
| | - Leylagul Kaynar
- Erciyes University Medical School, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Hakan Goker
- Hacettepe University Medical School, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Engin Kelkitli
- Ondokuz Mayis University Medical School, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Orhan Ayyildiz
- Dicle University Medical School, Department of Internal Medicine, Division of Hematology, Diyarbakir, Turkey
| | - Fatih Demirkan
- Dokuz Eylul University Medical School, Department of Internal Medicine, Division of Hematology, Izmir, Turkey
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Akpınar S, Tekgunduz E, Erkurt MA, Esen R, Yılmaz M, Karakus V, Vural F, Gediz F, Aydogdu I, Kaynar L, Korkmaz S, Goker H, Kelkitli E, Ayyıldız O, Demirkan F. Prospective registry of adult patients receiving therapeutic plasma exchange with a presumptive diagnosis of thrombotic microangiopathy (TMA): The Turkish hematology research and education group (ThREG)-TMA02 study. Transfus Apher Sci 2021:103312. [PMID: 34799244 DOI: 10.1016/j.transci.2021.103312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Thrombotic microangiopathy(TMA) is a pathological diagnosis characterized by abnormalities of small vessels leading to microvascular thrombosis of arterioles and capillaries. The current prospective, non-interventional, multicenter (n:18) study aimed to define distribution of different TMA forms in adult Turkish patients who were referred for therapeutic plasma exchange (TPE) for a presumptive diagnosis of TMA. Patients with serum ADAMTS13 activity <5% were diagnosed as acquired thrombotic thrombocytopenic purpura (aTTP). Patients presenting with ADAMTS13 activity 6-10 % / normal renal function and patients with ADAMTS13 activity >10 %, normal renal function and no secondary TMA were treated as unclassified TMA. The study included a total of 97 patients (female: 60; male: 30) with a median age of 48 (18-74). Detailed evaluation at 1 month after hospital admission revealed aTTP, secondary TMA, infection/complement-associated hemolytic uremic syndrome and unclassified TMA in 32 (33 %), 33 (34 %), 26 (27 %) and 6 (6%) patients respectively. As subclassification of various TMAs will dictate specific therapy, proper diagnosis in a timely manner is of utmost clinical significance.
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Affiliation(s)
- Seval Akpınar
- Namık Kemal University Medical School, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey.
| | - Emre Tekgunduz
- Memorial Bahcelievler Hospital Adult Hematology and BMT Clinic, Istanbul, Turkey
| | - Mehmet Ali Erkurt
- Inonu University Medical School, Department of Internal Medicine, Division of Hematology, Malatya, Turkey
| | - Ramazan Esen
- Yuzuncu Yıl University Medical School, Department of Internal Medicine, Division of Hematology, Van, Turkey
| | - Mehmet Yılmaz
- Sanko University Medical School, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey
| | - Volkan Karakus
- Mugla Sıtkı Kocman University Medical School, Department of Internal Medicine, Division of Hematology, Mugla, Turkey
| | - Filiz Vural
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Izmir, Turkey
| | - Fusun Gediz
- Medicalpark Hospital, Hematology and BMT Clinic, Izmir, Turkey
| | - Ismet Aydogdu
- Celal Bayar University Medical Faculty, Department of Internal Medicine, Division of Hematology, Manisa, Turkey
| | - Leylagul Kaynar
- Erciyes University Faculty of Medicine, Department of Hematology, Kayseri, Turkey
| | - Serdal Korkmaz
- University of Health Sciences, Kayseri City Training and Research Hospital, Department of Hematology, Kayseri, Turkey
| | - Hakan Goker
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Engin Kelkitli
- Ondokuz Mayis University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Orhan Ayyıldız
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakir, Turkey
| | - Fatih Demirkan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, Izmir, Turkey
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Thejeel B, Garg AX, Clark WF, Liu AR, Iansavichus AV, Hildebrand AM. Long-term outcomes of thrombotic microangiopathy treated with plasma exchange: A systematic review. Am J Hematol 2016; 91:623-30. [PMID: 26910131 DOI: 10.1002/ajh.24339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/17/2016] [Indexed: 12/12/2022]
Abstract
With the adoption of plasma exchange as standard treatment for thrombotic microangiopathy (TMA), more patients are surviving and long-term outcomes have greater relevance. We conducted a systematic review to synthesize and evaluate the quality of evidence on long-term outcomes of TMA among adults treated with plasma exchange and to identify factors that may be associated with a worse long-term prognosis. We searched databases from 1980 to 2013 for eligible articles published in any language. We included studies that reported outcomes in at least ten adults with a history of TMA treated with plasma exchange and at least 6 months of follow-up. We abstracted data in duplicate and assessed the methodological quality of each study using an assessment tool developed based on recommended validity criteria. We screened 6672 articles, reviewed 213, and included 34 studies totaling 1182 patients (study median [range], 24 [10-118]). The mean (or median) follow-up ranged from 6 months to 13 years. The cumulative incidence of relapse and mortality was highly variable and ranged from 3 to 84 and 0 to 61%, respectively. The incidence of other outcomes across 10 studies also varied (outcomes included hypertension, kidney disease, preeclampsia, stroke, seizure, severe cognitive impairment, and depression); in three other studies, long-term neurocognitive function and health-related quality of life were significantly lower than in the general population. Patients who survive an episode of TMA may be susceptible to long-term vascular complications, but the magnitude of this risk and how to mitigate it remains unclear. Am. J. Hematol. 91:623-630, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Bashiar Thejeel
- Schulich School of Medicine; Western University; London Ontario Canada
- Kidney Clinical Research Unit, London Health Sciences Centre; London Ontario Canada
| | - Amit X. Garg
- Kidney Clinical Research Unit, London Health Sciences Centre; London Ontario Canada
- Department of Epidemiology and Biostatistics; Western University; London Ontario Canada
- Division of Nephrology; Western University; London Ontario Canada
| | - William F. Clark
- Kidney Clinical Research Unit, London Health Sciences Centre; London Ontario Canada
- Division of Nephrology; Western University; London Ontario Canada
| | - Aiden R. Liu
- Kidney Clinical Research Unit, London Health Sciences Centre; London Ontario Canada
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Sagheer S, Moiz B, Usman M, Khurshid M. Retrospective Review of 25 Cases of Thrombotic Thrombocytopenic Purpura in Pakistan. Ther Apher Dial 2011; 16:97-103. [DOI: 10.1111/j.1744-9987.2011.00998.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ito-Habe N, Wada H, Matsumoto M, Fujimura Y, Murata M, Izuno T, Sugita M, Ikeda Y. A second national questionnaire survey of TMA. Int J Hematol 2010; 92:68-75. [DOI: 10.1007/s12185-010-0599-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 04/09/2010] [Accepted: 05/10/2010] [Indexed: 10/19/2022]
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National questionnaire survey of TMA. Int J Hematol 2009; 90:328-335. [PMID: 19760483 DOI: 10.1007/s12185-009-0421-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/19/2009] [Accepted: 08/30/2009] [Indexed: 10/20/2022]
Abstract
A questionnaire survey of Japanese patients with thrombotic microangiopathy (TMA) was carried out to investigate the frequency, laboratory abnormalities, and outcome in 2004. Out of 185 patients, there were 13 with familial TMA and 172 with acquired TMA. In acquired TMA, there were 66 with Escherichia coli O-157 infection (O-157)-related TMA, 35 with ADAMTS13-related TMA, and 22 with other types of TMA. The frequency of TMA in O-157-related TMA was high in patients from 0- to 15-year-old, and acquired TMA without O-157 was frequently observed in patients ranging from 31 to 65 years of age. In the treatment of acquired TMA, including plasma exchange (PE), steroid, antiplatelet agent, and anticoagulant, PE was carried out in 94.3% of ADAMTS13-related TMA, 77.3% of other TMA, and 7.6% of O-157-related TMA. The efficacy of PE and steroid therapy tended to be higher in ADAMTS13 TMA than in other types of TMA. The complete remission rate is the highest in O-157 TMA. The mortality rate was the lowest for O-157 TMA, and this rate also tended to be lower in ADAMTS13-related TMA than in other types of TMA. However, the determination of ADAMTS13 was not universal in Japan at the time of this questionnaire.
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