Diagnosis and management of acquired thrombotic thrombocy- topenic purpura in southeast China： a single center experience of 60 cases  

作　　者：Xinping Zhou XingnongYe Yanling Ren Chen Mei Liya Ma Jiansong Huang Weilai Xu Juying Wei Li Ye Wenyuan Mai Wenbin Qian Haitao Meng Jie Jin Hongyan Tong 

机构地区：[1]Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China [2]Department of Hematology, the Forth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu 322000, China

出　　处：《Frontiers of Medicine》2016年第4期430-436,共7页医学前沿（英文版）

摘　　要：Acquired thrombotic thrombocytopenic purpura （TTP） is a rare life-threatening thrombotic microangiopathy. This study aimed to provide a profile of the diagnosis and management of patients with acquired TTP collected in 10 years in a single center in southeast China. A total of 60 patients diagnosed with acute acquired TTP from March 2005 to August 2015 were enrolled. Among the 60 patients, 52 patients presented with their first episodes, and eight patients had two or more episodes. The median age at presentation was 49 （range, 17 to 78） years with a female predominance （male：female ratio, 1：1.60）. ADAMTS 13 activity were analyzed in 43 patients, among whom 33 （76.7%） patients had a baseline level of 〈 5%. Mortality was 30%. Plasma exchange （PEX） was performed in 62 of 69 （89.9%） episodes. Corticosteroids were administered in 54 of 69 （78.3%） episodes. Other immunosuppressants （e.g., vincristine, cyclosporine, and cyclosporin） were used in 7 of 69 （10.1%） episodes. Rituximab was documented in 4 patients with refractory/relapsed TTP for 5 episodes, showing encouraging results. In conclusion, the diagnosis of TTP depended on a comprehensive analysis of clinical data. Plasma ADAMTS13 activity assay helped confirm a diagnosis. PEX was the mainstay of the therapy, and rituximab can be used in relapsed/refractory disease.Acquired thrombotic thrombocytopenic purpura （TTP） is a rare life-threatening thrombotic microangiopathy. This study aimed to provide a profile of the diagnosis and management of patients with acquired TTP collected in 10 years in a single center in southeast China. A total of 60 patients diagnosed with acute acquired TTP from March 2005 to August 2015 were enrolled. Among the 60 patients, 52 patients presented with their first episodes, and eight patients had two or more episodes. The median age at presentation was 49 （range, 17 to 78） years with a female predominance （male：female ratio, 1：1.60）. ADAMTS 13 activity were analyzed in 43 patients, among whom 33 （76.7%） patients had a baseline level of 〈 5%. Mortality was 30%. Plasma exchange （PEX） was performed in 62 of 69 （89.9%） episodes. Corticosteroids were administered in 54 of 69 （78.3%） episodes. Other immunosuppressants （e.g., vincristine, cyclosporine, and cyclosporin） were used in 7 of 69 （10.1%） episodes. Rituximab was documented in 4 patients with refractory/relapsed TTP for 5 episodes, showing encouraging results. In conclusion, the diagnosis of TTP depended on a comprehensive analysis of clinical data. Plasma ADAMTS13 activity assay helped confirm a diagnosis. PEX was the mainstay of the therapy, and rituximab can be used in relapsed/refractory disease.

关 键 词：thrombotic thrombocytopenic purpura ADAMTS 13 plasma exchange 

分 类 号：R[医药卫生]