Abstract
Background - Daily therapeutic plasma exchange (TPE) is the cornerstone of treatment for immune-mediated thrombotic thrombocytopenic purpura (iTTP). However, TPE is not a risk-free procedure and there is scarce evidence regarding its safety in iTTP. This study aims to describe the TPE-related clinical complications occurred in a cohort of patients hospitalized for an acute iTTP episode.
Materials and methods - In this cross-sectional study, patients hospitalized for an acute iTTP episode at the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico (Milan) between January 2016 and April 2022 undergoing a central venous catheter (CVC) placement to start TPE were enrolled.
Results - Thirty-three iTTP episodes from 32 patients were included, 20 (61%) first episodes and 2 (6%) complicated with acute exacerbations.
Twenty-one episodes (64%) were complicated with at least one major
TPE-related complication, 18 (55%) with at least one CVC-related complication, of which 9 (27%) with a major complication. Among major CVC-related complications, 5 were venous thromboses (VTs) requiring heparin treatment and CVC removal, and 3 infections (2 systemic) requiring systemic antibiotic treatment and CVC removal. The 19 CVC-related bleeds (in 16 episodes) were minor bleeds and required only local hemostatic medications. Among the major procedure-related complications, the most common were allergic reactions (present in 16 episodes, 49%), mostly urticarial rashes requiring systemic steroids and antihistamines, and clinical hypocalcemia (in 8 episodes, 24%). The episodes complicated with CVC-related VT or infection required a longer hospitalization and those complicated with CVC-related infection required also a higher number of TPE procedures.
Discussion - TPE procedure was well tolerated in our cohort of acute iTTP patients in the majority of cases, with CVC-related minor bleeds and allergic reactions being the most common complications. The occurrence of
CVC-related major complications, as VT or infections, was associated with a longer hospitalization (medians: 30 vs 11.5 days).
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Authors
Pasquale Agosti Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
Ilaria Mancini Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
Andrea Artoni Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
Chiara Cardone
Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Pasqualina De Leo
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
Christian Bichard
Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
Addolorata Truma
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
Barbara Ferrari Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
Juri Alessandro Giannotta
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
Norma Nadia Fantini Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Maria Cristina Mocellin Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Daniele Prati
Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Flora Peyvandi Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
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