Clinical StudiesImproved survival with plasma exchange in patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome☆
Section snippets
Study sample
The study sample included consecutive patients with TTP or hemolytic uremic syndrome of all ages who were referred to the therapeutic apheresis service of the Sacramento Medical Foundation Blood Center (a not-for-profit community blood center that serves 41 hospitals in a 17-county area of Northern California with an estimated 2.8 million residents) and the University of California Davis Medical Center from 1978 through 1998. The vast majority of patients referred for treatment were seen in the
Results
Of the 126 patients, 95 (75%) had TTP, while the remainder had the hemolytic uremic syndrome. About two thirds of the patients were female, with an age range from 1.5 to 85 years (Table 2). Their ethnic distribution reflected the demographic characteristics of our region. About 30% of patients had an underlying serious medical disorder. The median platelet count was 29,000/μL, with a range from 7,000 to 121,000/μL; the median hemoglobin level was 9.1 g/dL with a range of 2.8 to 15.6 g/dL. The
Discussion
We studied the effects of early, aggressive plasma exchange in the management of TTP and the hemolytic uremic syndrome. The overall response rate of 77% is remarkably similar to the 76% response to plasma exchange that was reported in a 1982 review (16). The observed 30-day mortality of 10% is comparable with the mortality rate of 9% reported by Bell et al (17), although in that series, all deaths occurred within 4 days of diagnosis and not all patients received plasma exchange therapy. In the
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Supported in part by a grant from the US Public Health Service (HL 55181).