title: Microvascular thrombosis in pediatric multiple organ failure: Is it a therapeutic target?
abstract: PURPOSE: To discuss the current rationale for the use of specific and nonspecific therapies for thrombotic microangiopathy in thrombocytopenia-associated pediatric multiple organ failure syndromes. Methods: Pertinent PubMed and MEDLINE citations and proceedings of recent critical care meeting presentations were reviewed. RESULTS: Critical care clinicians have reported using antithrombin III concentrate, protein C concentrate, activated protein C, prostacyclin and its analogues, heparin, tissue factor pathway inhibitor concentrate, plasma infusion, plasma exchange, whole blood exchange, pentoxifylline, tissue plasminogen activator, urokinase, and streptokinase with perceived therapeutic benefits in patients with thrombocytopenia-associated multiple organ failure, including those with thrombotic thrombocytopenic purpura/hemolytic uremic syndrome, disseminated intravascular coagulation syndrome, and secondary thrombotic microangiopathy syndrome without prolonged prothrombin time/activated partial thromboplastin time. CONCLUSION: Assuming that underlying disease is remediable, a consensus has developed that thrombotic microangiopathy is a therapeutic target in children with thrombocytopenia-associated multiple organ failure syndromes. Studies are warranted to delineate efficacious use of specific and nonspecific therapies to prevent and reverse thrombotic microangiopathy in these patients.
authors.affiliation: Departments of Critical Care Medicine (Drs. Nguyen, Hall, Han, Fiedor, Watson, and Carcillo) and the Pathology (Dr. Lopez-Plaza), University of Pittsburgh School of Medicine, Pittsburgh, PA; the Institute for Transfusion Medicine, Pittsburgh, PA (Dr. Hasset); and the Department of Pediatrics, University of Malaya, Kuala Lampur, Indonesia (Dr. Lum). E-mail: CarcilloJA@anes.upmc.edu
authors.forename: Trung
authors.initials: T
authors.lastname: Nguyen
authors.forename: Mark
authors.initials: M
authors.lastname: Hall
authors.forename: Yong
authors.initials: Y
authors.lastname: Han
authors.forename: Melinda
authors.initials: M
authors.lastname: Fiedor
authors.forename: Andrea
authors.initials: A
authors.lastname: Hasset
authors.forename: Ileana
authors.initials: I
authors.lastname: Lopez-Plaza
authors.forename: Scott
authors.initials: S
authors.lastname: Watson
authors.forename: Lucy
authors.initials: L
authors.lastname: Lum
authors.forename: Joseph A.
authors.initials: JA
authors.lastname: Carcillo