Predictive Value of Schistocytes in Recurrence of Acquired Thrombotic Thrombocytopenic Purpura With Severe ADAMTS13 Deficiency at Discontinuation of Daily Therapeutic Plasma Exchange.

Acquired thrombotic thrombocytopenic purpura (TTP) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and commonly ADAMTS13 deficiency. Patients with TTP and severe ADAMTS13 deficiency have high risk of disease recurrence, yet the ability to predict which patients will have recurrence remains limited. We assessed whether the presence of persistent schistocytes in TTP patients with severe ADAMTS13 deficiency at the time of daily therapeutic plasma exchange (TPE) discontinuation was predictive of disease recurrence.

Treatment of acquired Thrombotic Thrombocytopenic Purpura in the U.S. remains heterogeneous: Current and future points of clinical equipoise.

Background: The purpose of this survey was to describe current practices in the U.S. for treatment of acquired Thrombotic Thrombocytopenic Purpura (TTP), compare these with prior U.

Addressing the risk of bacterial contamination in platelets: a hospital economic perspective.

Background: Bacterially contaminated platelets (PLTs) remain a serious risk. The Food and Drug Administration has issued draft guidance recommending hospitals implement secondary testing or transfuse PLTs that have been treated with pathogen reduction technology (PRT). The cost implications of these approaches are not well understood.

Clinical decision support improves physician guideline adherence for laboratory monitoring of chronic kidney disease: a matched cohort study.

Background: Guidelines exist for chronic kidney disease (CKD) but are not well implemented in clinical practice. We evaluated the impact of a guideline-based clinical decision support system (CDSS) on laboratory monitoring and achievement of laboratory targets in stage 3-4 CKD patients.

Methods: We performed a matched cohort study of 12,353 stage 3-4 CKD patients whose physicians opted to receive an automated guideline-based CDSS with CKD-related lab results, and 42,996 matched controls whose physicians did not receive the CDSS.

How we approach an acquired thrombotic thrombocytopenic purpura patient.

Acquired thrombotic thrombocytopenic purpura (TTP) is a disease characterized by microangiopathic hemolytic anemia and thrombocytopenia, in addition to variable fever and neurologic and renal dysfunction, without an underlying cause. Recent advances in elucidating the pathophysiology of acquired TTP have led to new testing that we have incorporated into our current management of patients with suspected acquired TTP. Despite these developments, much of the treatment for acquired TTP beyond therapeutic plasma exchange (TPE) is based on low-quality evidence.

Thrombotic thrombocytopenic purpura: 2012 American Society for Apheresis (ASFA) consensus conference on classification, diagnosis, management, and future research.

The American Society for Apheresis (ASFA) conducted a 1 day consensus conference on Thrombotic Thrombocytopenic Purpura (TTP) during its annual meeting in Atlanta, GA, on April 10, 2012. The authors of this article, a subcommittee of ASFA's Clinical Applications Committee, developed several questions with regard to definitions, classification, pathophysiology, diagnosis, management, and future research in TTP. These questions were provided to the seven invited speakers who are the experts in the field of TTP.

Survey of methods used to detect bacterial contamination of platelet products in the United States in 2011.

Background: Testing of platelets (PLTs) for bacterial contamination is required by the AABB Standards but is not fully standardized. On January 31, 2011, a new AABB Standard, 5.1.

Rapid increases in parasitemia following red cell exchange for malaria.

Exchange transfusion is frequently used as an adjunctive treatment of severe malaria, although the efficacy of exchange transfusion as therapy for severe malaria remains controversial. The major perceived benefit of exchange transfusion is the rapid reduction of parasite load. However, no previous report has shown the dynamic change in parasitemia shortly following an acute load reduction.

Validation of a microbial detection system for use with ACD-A platelets with PAS III platelet additive solution.

Background: The BacT/ALERT microbial detection system (BTA) is used for testing leukoreduced apheresis platelets (LR-AP) in plasma. Platelet additive solutions (PASs) such as InterSol (PAS III) may be used to reduce the amount of plasma transfused in LR-AP. This study evaluated the performance of the two-bottle BTA testing scheme in the recovery of seeded microorganisms from LR-AP in InterSol-plasma compared to a reference plate culture method.

ABO blood type and longevity.

To assess the observation that blood type B might be a marker for longevity, we reviewed the records and determined the ABO blood types of all patients who died in our hospital in 2004. Age was stratified by decade of death, and linear regressions were calculated by ABO percentage. ABO survival curves were compared.

Thrombotic thrombocytopenic purpura and urinary tract infections: is there a connection?

Most cases of thrombotic thrombocytopenic purpura (TTP) are considered idiopathic without an identifiable etiologic agent. It has been previously reported that a number of patients with TTP had a urinary tract infection (UTI). Apheresis records were searched for patients with TTP from 1999 through 2007.

Dose of prophylactic platelet transfusions and prevention of hemorrhage.

Background: We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia.

Methods: We randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1x10(11), 2.

Is it quinine TTP/HUS or quinine TMA? ADAMTS13 levels and implications for therapy.

Thrombocytopenia with or without microangiopathy following quinine is often referred to as quinine "hypersensitivity." When schistocytes are present it is frequently termed "quinine-associated TTP/HUS." A severe deficiency of the vWF-cleaving protease, ADAMTS13, is associated with idiopathic TTP.

The impact of discontinuation of 7-day storage of apheresis platelets (PASSPORT) on recipient safety: an illustration of the need for proper risk assessments.

Background: Seven-day stored apheresis platelets (APs) were withdrawn from the US market after detection of two culture-positive units from 2571 tested at outdate in the PASSPORT surveillance study. The impact of this discontinuation on recipient safety was explored using mathematical modeling.

Study Design And Methods: Risk models for septic transfusion reactions (STRs) and transfusion-related acute lung injury (TRALI) were developed.

ADAMTS13 activity levels in patients with human immunodeficiency virus-associated thrombotic microangiopathy and profound CD4 deficiency.

Background: Thrombotic microangiopathy (TMA) encompasses a number of disorders with hemolytic anemia and thrombocytopenia, including thrombotic thrombocytopenic purpura (TTP). A deficiency in ADAMTS13 enzyme levels, along with an inhibitory antibody, is found in most patients with idiopathic TTP. Patients with human immunodeficiency virus (HIV) infection can have a TTP-like illness; however, it appears to have a different etiology.

Is it HIV TTP or HIV-associated thrombotic microangiopathy?

Thrombocytopenia is a common complication of Human Immunodeficiency Virus (HIV) infection. With advanced HIV disease, the presence of both thrombocytopenia and schistocytosis are frequently observed. In such cases, the diagnosis of HIV associated TTP is often considered.