Plasma exchange for treatment of thrombotic thrombocytopenic purpura in critically ill patients

1997 ◽  
Vol 23 (1) ◽  
pp. 44-50 ◽  
Author(s):  
P. Knöbl ◽  
C. Rintelen ◽  
G. Kornek ◽  
C. Wiltschke ◽  
P. Kalhs ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Thrombocytopenic Purpura

Removal of elevated circulating angiopoietin-2 by plasma exchange – A pilot study in critically ill patients with thrombotic microangiopathy and anti-glomerular basement membrane disease

2010 ◽  
Vol 104 (11) ◽  
pp. 1038-1043 ◽  
Author(s):  
Carsten Hafer ◽  
Jan Kielstein ◽  
Marion Haubitz ◽  
Hermann Haller ◽  
Svjetlana Lovric ◽  
...  
Keyword(s):  
Basement Membrane ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Glomerular Basement Membrane ◽  
Critically Ill Patients ◽  
Plasma Levels ◽  
Vascular Inflammation ◽  
Endothelial Damage ◽  
Healthy Controls ◽  
Angiopoietin 2

SummaryIn critically ill patients, the massive release of angiopoietin-2 (Ang-2) from Weibel-Palade bodies interferes with protective angiopoietin-1 (Ang-1)/Tie2 signalling in endothelial cells, thus leading to vascular inflammation and subsequent organ-dysfunction. We hypothesised that plasma exchange (PE) is efficient for lowering excess Ang-2 levels in critically ill patients with thrombocytic microangiopathy (TMA) or anti-glomerular basement membrane (anti-GBM) disease. Plasma Ang-1 and Ang-2 were measured by immuno-luminometric assays in patients with TMA (n=9) or anti-GBM disease (n=4) before and after up to four PE sessions. Twenty apparently healthy volunteers served as controls. Median (IQR) plasma levels of Ang-2 were markedly increased in patients with TMA (7.3 (2.4–21.1) ng/ml) and anti-GBM disease (5.8 (3.4–7.0) ng/ml) compared to healthy controls (1.0 (0.9–1.4) ng/ml, p <0.001). Moreover, Ang-1 plasma levels were decreased in both, TMA (1.02 (0.62–1.62) ng/ml) and anti-GBM disease patients (0.74 (0.59–3.62) ng/ml) compared to healthy controls (2.5 (1.93–3.47) ng/ ml, p <0.005). During a total of 32 treatments, PE effectively lowered elevated mean (SD) Ang-2 plasma levels by 36.7 ± 19.6 % per treatment (p <0.0001), whereas low Ang-1 plasma levels remained unchanged (0.3 ± 58.5 %; p =0.147). Ang-2 levels declined to almost normal values during ≤4 PE treatments (Friedman´s test p <0.0001). PE is an effective method to remove excess circulating Ang-2. It remains to be elucidated if the removal of Ang-2 is crucial to ameliorate endothelial damage in critically ill patients with severely altered endothelial integrity.

Response to Plasma Exchange and Steroids as Combined Therapy for Patients with Thrombotic Thrombocytopenic Purpura

1999 ◽  
Vol 102 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Javier de la Rubia ◽  
Aurelio López ◽  
Francisco Arriaga ◽  
Ana Rosa Cid ◽  
Ana Isabel Vicente ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Combined Therapy ◽  
Thrombocytopenic Purpura

scholarly journals A Signet Ring Cell Carcinoma Presented as Refractory Acquired Thrombotic Thrombocytopenic Purpura

2020 ◽  
Vol 13 (3) ◽  
pp. 1368-1372
Author(s):  
Umit Yavuz Malkan ◽  
Murat Albayrak ◽  
Hacer Berna Ozturk ◽  
Merih Reis Aras ◽  
Bugra Saglam ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Unknown Origin ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Thrombocytopenic Purpura ◽  
Signet Ring ◽  
Gastric Endoscopy ◽  
Ring Cell

Microangiopathic hemolytic anemia (MAHA) can be observed as a paraneoplastic syndrome (PS) in certain tumors. MAHA-related signet ring cell carcinoma (SRCC) of an unknown origin is very infrequent. Herein we present a SRCC case presented with refractory acquired thrombotic thrombocytopenic purpura (TTP). A 35-year-old man applied to the emergency service with fatigue and headache. His laboratory tests resulted as white blood cell 9,020/µL, hemoglobin 3.5 g/dL, platelet 18,000/µL. Schistocytes, micro-spherocytes, and thrombocytopenia were observed in his blood smear. MAHA was present and he was considered as having TTP. Plasma exchange treatment was initiated; however, he was refractory to this treatment. Thorax and abdomen computerized tomography revealed thickening of minor curvature in stomach corpus with hepatogastric and paraceliac lymphadenopathy. Bone marrow (BM) investigation by our clinic resulted as the metastasis of adenocarcinoma. Ulceration and necrosis were observed by gastric endoscopy procedure. Biopsy was taken during endoscopic intervention, which resulted as SRCC. MAHA may be seen as a PS in some tumors, especially gastric cancers. Tumor-related MAHA is generally accompanied by BM metastases. As a result, BM investigation may be used as the main diagnostic method to find the underlying cancer. The clinical course of cases with tumor-related MAHA is usually poor, and these cases are usually refractory to plasma exchange treatment. In conclusion, physicians should suspect a malignancy and BM involvement when faced with a case of refractory TTP.

Plasma exchange in critically ill patients with sickle cell disease

2007 ◽  
Vol 37 (1) ◽  
pp. 17-22 ◽  
Author(s):  
C. Boga ◽  
I. Kozanoglu ◽  
H. Ozdogu ◽  
Emel Ozyurek
Keyword(s):  
Sickle Cell Disease ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Sickle Cell ◽  
Critically Ill Patients ◽  
Cell Disease

Thrombotic Thrombocytopenic Purpura Associated with Transient Chromosomal Aberrations: Successful Treatment with Plasma Exchange

1990 ◽  
Vol 84 (4) ◽  
pp. 209-211
Author(s):  
Yoshitoshi Itoh ◽  
Tomoyuki Taniguchi ◽  
Naoshi Takeyama ◽  
Hideki Kuriki ◽  
Takaya Tanaka
Keyword(s):  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Successful Treatment ◽  
Chromosomal Aberrations ◽  
Thrombocytopenic Purpura
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