Extracorporeal treatment of thrombotic microangiopathy: a ten year experience.
We reviewed 24 episodes of thrombotic microangiopathy (TMA) representing 22 patients from July 1989 to July 1998. Nine cases presented with a community acquired (CA group) thrombotic thrombocytopenic purpura or hemolytic uremic syndrome (TTP/HUS), 3 cases were related to pregnancy (P group), 10 cases were compatible with TMA after bone marrow transplantation or chemotherapy (BMT/C group), and 2 cases had a background of scleroderma (SC group). Twenty episodes were treated exclusively with therapeutic plasma exchange (TPE) using fresh frozen plasma (FFP) replacement. In the BMT/C group, 4 patients underwent immunoadsorption with the Prosorba protein A column in addition to TPE. The CA, P, and SC groups had favorable outcomes with 78% (7 of 9), 100% (3 of 3), and 100% (2 of 2) survival, respectively. Despite intensive therapy, there was only 1 survivor in the BMT/C group (1 of 10). Successful outcome required up to 57 TPE treatments. We could not document any benefit to immunoadsorption with the Prosorba protein A column.
Bueno
D
D
Division of Nephrology, University of Connecticut Health Center, Farmington 06030, USA.
Sevigny
J
J
Kaplan
A A
AA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D005112:Extracorporeal Circulation; D005260:Female; D017359:HELLP Syndrome / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D011379:Prognosis; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome