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Therapeutic plasma exchange-related complications in patients with immune-mediated thrombotic thrombocytopenic purpura.
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Agosti Pasquale, Mancini Ilaria, Artoni Andrea, Cardone Chiara, De Leo Pasqualina, Bichard Christian, Truma Addolorata, Ferrari Barbara, Giannotta Juri A, Fantini Norma N, Mocellin Maria Cristina, Prati Daniele, Peyvandi Flora
Аннотация
BACKGROUND: Daily therapeutic plasma exchange (TPE) is the cornerstone of treatment for immune-mediated thrombotic thrombocytopenic purpura (iTTP). However, TPE is not a risk-free procedure and there is scarce evidence regarding its safety in iTTP. This study aims to describe the TPE-related clinical complications occurred in a cohort of patients hospitalized for an acute iTTP episode.
MATERIALS AND METHODS: In this cross-sectional study, patients hospitalized for an acute iTTP episode at the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (Milan) between January 2016 and April 2022 undergoing a central venous catheter (CVC) placement to start TPE were enrolled.
RESULTS: Thirty-three iTTP episodes from 32 patients were included, 20 (61%) first episodes and 2 (6%) complicated with acute exacerbations. Twenty-one episodes (64%) were complicated with at least one major TPE-related complication, 18 (55%) with at least one CVC-related complication, of which 9 (27%) with a major complication. Among major CVC-related complications, 5 were venous thromboses (VTs) requiring heparin treatment and CVC removal, and 3 infections (2 systemic) requiring systemic antibiotic treatment and CVC removal. The 19 CVC-related bleeds (in 16 episodes) were minor bleeds and required only local hemostatic medications. Among the major procedure-related complications, the most common were allergic reactions (present in 16 episodes, 49%), mostly urticarial rashes requiring systemic steroids and antihistamines, and clinical hypocalcemia (in 8 episodes, 24%). The episodes complicated with CVC-related VT or infection required a longer hospitalization and those complicated with CVC-related infection required also a higher number of TPE procedures.
DISCUSSION: TPE procedure was well tolerated in our cohort of acute iTTP patients in the majority of cases, with CVC-related minor bleeds and allergic reactions being the most common complications. The occurrence of CVC-related major complications, as VT or infections, was associated with a longer hospitalization (medians: 30 vs 11.5 days).
MATERIALS AND METHODS: In this cross-sectional study, patients hospitalized for an acute iTTP episode at the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (Milan) between January 2016 and April 2022 undergoing a central venous catheter (CVC) placement to start TPE were enrolled.
RESULTS: Thirty-three iTTP episodes from 32 patients were included, 20 (61%) first episodes and 2 (6%) complicated with acute exacerbations. Twenty-one episodes (64%) were complicated with at least one major TPE-related complication, 18 (55%) with at least one CVC-related complication, of which 9 (27%) with a major complication. Among major CVC-related complications, 5 were venous thromboses (VTs) requiring heparin treatment and CVC removal, and 3 infections (2 systemic) requiring systemic antibiotic treatment and CVC removal. The 19 CVC-related bleeds (in 16 episodes) were minor bleeds and required only local hemostatic medications. Among the major procedure-related complications, the most common were allergic reactions (present in 16 episodes, 49%), mostly urticarial rashes requiring systemic steroids and antihistamines, and clinical hypocalcemia (in 8 episodes, 24%). The episodes complicated with CVC-related VT or infection required a longer hospitalization and those complicated with CVC-related infection required also a higher number of TPE procedures.
DISCUSSION: TPE procedure was well tolerated in our cohort of acute iTTP patients in the majority of cases, with CVC-related minor bleeds and allergic reactions being the most common complications. The occurrence of CVC-related major complications, as VT or infections, was associated with a longer hospitalization (medians: 30 vs 11.5 days).