-
Charles L Bennett,
Sony Jacob,
Brianne L Dunn,
Peter Georgantopoulos,
X Long Zheng,
Hau C Kwaan,
June M McKoy,
Jametta S Magwood,
Zaina P Qureshi, Nicholas Bandarenko, [......],
Patricia M Carey,
Ravindra Sarode,
Joseph E Kiss,
Constance Danielson,
Thomas L Ortel,
William F Clark,
Richard J Ablin,
Gail Rock,
Masanori Matsumoto,
Yoshihiro Fujimura
British Journal of Haematology 03/2013; · 4.94 Impact Factor
-
Sony Jacob,
Brianne L Dunn,
Zaina P Qureshi, Nicholas Bandarenko,
Hau C Kwaan,
Dilip K Pandey,
June M McKoy,
Sara E Barnato,
Jeffrey L Winters,
John F Cursio, [......],
William F Clark,
Gail Rock,
Masanori Matsumoto,
Yoshihiro Fujimura,
X Long Zheng,
Hao Chen,
Fei Chen,
John M Armstrong,
Dennis W Raisch,
Charles L Bennett
[show abstract]
[hide abstract]
ABSTRACT: Thienopyridine-derivatives (ticlopidine, clopidogrel, and prasugrel) are the primary antiplatelet agents. Thrombotic thrombocytopenic purpura (TTP) is a rare drug-associated syndrome, with the thienopyridines being the most common drugs implicated in this syndrome. We reviewed 20 years of information on clinical, epidemiologic, and laboratory findings for thienopyridine-associated TTP. Four, 11, and 11 cases of thienopyridine-associated TTP were reported in the first year of marketing of ticlopidine (1989), clopidogrel (1998), and prasugrel (2010), respectively. As of 2011, the FDA received reports of 97 ticlopidine-, 197 clopidogrel-, and 14 prasugrel-associated TTP cases. Severe deficiency of ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) was present in 80% and antibodies to 100% of these TTP patients on ticlopidine, 0% of the patients with clopidogrel-associated TTP (p < 0.05), and an unknown percentage of patients with prasugrel-associated TTP. TTP is associated with use of each of the three thienopyridines, although the mechanistic pathways may differ.
Seminars in Thrombosis and Hemostasis 10/2012; · 4.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Stored red blood cells (RBCs) accumulate biochemical and biophysical changes. Maximum storage duration is based on acceptable in vitro characteristics and 24-hour survival, but not RBC function. Relatively little is known about the impact of RBC storage duration on oxygenation and the microcirculation. STUDY DESIGN AND METHODS: Eight healthy subjects donated a double RBC apheresis, which were prestorage leukoreduced and processed in AS-3. Subjects were transfused 1 unit of RBCs at 7 and 42 days after blood collection. Measurements of percentage of tissue oxygenation in the thenar eminence muscle (StO(2) ) and brain (SctO(2) ) were recorded with Food and Drug Administration-cleared noninvasive devices. Sublingual microvascular blood flow (microcirculatory flow index [MFI]) was quantified before and after RBC transfusion using a video microscope. Raw electronic data for all measurements were analyzed by a blinded observer at a core laboratory. RESULTS: The only pre- versus posttransfusion change observed in measurements of SctO(2) , StO(2) , or MFI was a very small increase in SctO(2) , from 70.4 to 71.8 (means, p = 0.032) at 7 days. There was no significant difference in the amount of pre-post change at 7 days versus 42 days for any of the measures. CONCLUSION: Transfusion of 1 unit of 42-day-stored RBCs to healthy subjects has no overt detrimental effect on tissue oxygenation or the microcirculation assessed by clinically available monitors.
Transfusion 03/2012; · 3.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Platelet factor 4 (PF4)/heparin antibody, typically associated with heparin therapy, is reported in some heparin-naive people. Seroprevalence in the general population, however, remains unclear. We prospectively evaluated PF4/heparin antibody in approximately 4,000 blood bank donors using a commercial enzyme-linked immunosorbent assay for initial and then repeated (confirmatory) testing. Antibody was detected initially in 249 (6.6%; 95% confidence interval [CI], 5.8%-7.4%) of 3,795 donors and repeatedly in 163 (4.3%; 95% CI, 3.7%-5.0%) of 3,789 evaluable donors. "Unconfirmed" positives were mostly (93%) low positives (optical density [OD] = 0.40-0.59). Of 163 repeatedly positive samples, 116 (71.2%) were low positives, and 124 (76.1%) exhibited heparin-dependent binding. Predominant isotypes of intermediate to high seropositive samples (OD >0.6) were IgG (20/39 [51%]), IgM (9/39 [23%]), and indeterminate (10/39 [26%]). The marked background seroprevalence of PF4/heparin antibody (4.3%-6.6%) with the preponderance of low (and frequently nonreproducible) positives in blood donors suggests the need for further assay calibration, categorization of antibody level, and studies evaluating clinical relevance of "naturally occurring" PF4/heparin antibodies.
American Journal of Clinical Pathology 11/2010; 134(5):774-80. · 2.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Red blood cell (RBC) transfusion is common during cardiac surgical procedures. Empiric crossmatching, without attempting to estimate individual transfusion requirements is typical. We hypothesized that a clinical prediction tool could be developed to estimate the number of units of RBCs needed for coronary artery bypass grafting (CABG) surgery.
With institutional review board approval, detailed demographic, risk factor, and transfusion data of primary elective CABG procedures (n=5887) from September 1, 1993, to June 20, 2002, were studied and the data set was divided into development and validation subgroups. Multivariable ordinal logistic regression was used to develop and validate transfusion risk factors, assign them a relative weight, and create a model to stratify patients into groups depending on predicted need for 0, 2, 4, or more than 4 RBC units. The model was compared with current standard practice of crossmatching 4 RBC units in terms of observed blood product usage over the study period.
Demographic and transfusion risk factor variables in the development (n=3876) and validation (n=2011) data sets were similar. The predictive value of the model was good for the development and validation groups, with a c-index of 0.79 and 0.78, respectively. Applying the predictive model reduced the number of crossmatches by 30% without underproviding RBC units and increased the percentage of patients crossmatched exactly for the required number of units from 11% to 21%.
Predictive factors for RBC transfusion were identified and used to construct a clinical tool to conserve blood bank resources without increasing patient risk.
Transfusion 11/2010; 50(11):2337-43. · 3.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Transfusion-related acute lung injury (TRALI) has been identified as the most common cause of transfusion-related death. Although extensive literature supports restrictions on female-donor plasma to reduce antibody-mediated TRALI, only a few outcome studies have assessed for effects of this change, and some, but not all, have endorsed the policy. A recent report even suggests poorer outcomes in cardiac surgery patients with a shift to male-donor-only plasma, raising concerns that TRALI alone, whether catastrophic or more survivable, is insufficient compared with broader measures, such as short-term mortality or long-term survival, as an end point to assess for overall improvements in patient care.
Expert Review of Hematology 10/2010; 3(5):551-8. · 1.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Pulmonary dysfunction is common in transfused patients recovering from heart surgery. Plasma transfusion from female donors has been linked with rare catastrophic lung injury, but its relationship with outcome after cardiac surgery is poorly understood. We examined whether plasma donor gender is related to postcardiac surgery pulmonary dysfunction and death or prolonged hospitalization.
In this retrospective case-control study, cardiac surgery candidates who received plasma perioperatively from only female donors were compared with male-only recipients who were matched for the number of units transfused and surgery date.
In a dataset of 2157 recipients, there were no blood bank-reported complications, but escalating plasma transfusion was associated with increased 30-day mortality (odds ratio, 1.52 per unit; P = .0001). From the 1069 recipients receiving plasma exclusively from female or male donors, 390 matched pairs were identified. Recipients of female compared with male donor plasma had a lower incidence of pulmonary dysfunction (5.9% vs 10.8%; P = .01) and death or hospitalization more than 10 days (9% vs 16.4%; P = .002) but similar long-term survivals.
Escalating plasma transfusion was associated with 30-day mortality, but female donor plasma recipients had less pulmonary dysfunction and fewer poor outcomes compared with male-only recipients. Although our retrospective study findings neither support nor refute a strategic policy to exclude female donor plasma to reduce catastrophic transfusion-related acute lung injury, they raise concern that such a policy may have unanticipated effects on outcome in patients undergoing cardiac surgery and highlight a need for additional studies in this and other patient groups.
The Journal of thoracic and cardiovascular surgery 02/2010; 140(6):1353-60. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The American Society for Apheresis (ASFA) Apheresis Applications Committee is charged with a review and categorization of indications for therapeutic apheresis. Beginning with the 2007 ASFA Special Issue (fourth edition), the subcommittee has incorporated systematic review and evidence-based approach in the grading and categorization of indications. This Fifth ASFA Special Issue has further improved the process of using evidence-based medicine in the recommendations by refining the category definitions and by adding a grade of recommendation based on widely accepted GRADE system. The concept of a fact sheet was introduced in the Fourth edition and is only slightly modified in this current edition. The fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis. The article consists of 59 fact sheets devoted to each disease entity currently categorized by the ASFA as category I through III. Category IV indications are also listed.
Journal of Clinical Apheresis 01/2010; 25(3):83-177. · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Recent evidence demonstrates an association between duration of storage of red blood cells (RBC) and morbidity and mortality after cardiac surgery. We studied the feasibility of two different schemes for categorizing and randomizing age of RBC units transfused in cardiac surgical patients.
In Phase 1, 20 subjects were randomly assigned to standard of care (SOC) versus no RBCs with more than 21 days' storage duration. In Phase 2, 23 subjects were randomized to RBCs of 7 +/- 4 versus 21 +/- 4 days' storage duration. The age of study RBC units was masked.
In Phase 1, no patients received RBCs 31 days or older in SOC, and there was overlap in storage age shared in both arms so the predefined feasibility criteria were not met. In Phase 2, it was feasible to deliver specified age RBCs to the 7-day arm (achieved in 100% of subjects), but feasibility was not demonstrated for the 21-day arm (only 50% of subjects transfused with target age RBCs). Significant differences, however, were observed between the 7 +/- 4- and 21 +/- 4-day arms with respect to age of all RBC units (6 +/- 2 vs. 18 +/- 7, p = 0.0002) and maximum age (7 +/- 2 vs. 20 +/- 7, p < 0.0001).
Given the current storage age distribution of available RBC inventory, use of a SOC arm in future studies is unlikely to result in a large exposure to "old" blood. It is feasible to randomize patients to "younger" RBCs (3-11 days) but design strategies are needed to provide "intermediate-aged" or "old" blood as a comparator.
Transfusion 04/2009; 49(7):1375-83. · 3.22 Impact Factor
-
Anaadriana Zakarija,
Hau C Kwaan,
Joel L Moake, Nicholas Bandarenko,
Dilip K Pandey,
June M McKoy,
Paul R Yarnold,
Dennis W Raisch,
Jeffrey L Winters,
Thomas J Raife,
John F Cursio,
Thanh Ha Luu,
Elizabeth A Richey,
Matthew J Fisher,
Thomas L Ortel,
Martin S Tallman,
X Long Zheng,
Masanori Matsumoto,
Yoshihiro Fujimura,
Charles L Bennett
[show abstract]
[hide abstract]
ABSTRACT: Thrombotic thrombocytopenic purpura (TTP) is a fulminant disease characterized by platelet aggregates, thrombocytopenia, renal insufficiency, neurologic changes, and mechanical injury to erythrocytes. Most idiopathic cases of TTP are characterized by a deficiency of ADAMTS13 (a disintegrin and metalloprotease, with thrombospondin-1-like domains) metalloprotease activity. Ironically, use of anti-platelet agents, the thienopyridine derivates clopidogrel and ticlopidine, is associated with drug induced TTP. Data were abstracted from a systematic review of English-language literature for thienopyridine-associated TTP identified in MEDLINE, EMBASE, the public website of the Food and Drug Administration, and abstracts from national scientific conferences from 1991 to April 2008. Ticlopidine and clopidogrel are the two most common drugs associated with TTP in FDA safety databases. Epidemiological studies identify recent initiation of anti-platelet agents as the most common risk factor associated with risks of developing TTP. Laboratory studies indicate that most cases of thienopyridine-associated TTP involve an antibody to ADAMTS13 metalloprotease, present with severe thrombocytopenia, and respond to therapeutic plasma exchange (TPE); a minority of thienopyridine-associated TTP presents with severe renal insufficiency, involves direct endothelial cell damage, and is less responsive to TPE. The evaluation of this potentially fatal drug toxicity can serve as a template for future efforts to comprehensively characterize other severe adverse drug reactions.
Kidney international. Supplement 03/2009;
-
Nancy M Archin,
Joseph J Eron,
Sarah Palmer,
Anne Hartmann-Duff,
Jeffery A Martinson,
Ann Wiegand, Nicholas Bandarenko,
John L Schmitz,
Ronald J Bosch,
Alan L Landay,
John M Coffin,
David M Margolis
[show abstract]
[hide abstract]
ABSTRACT: Valproic acid and intensified antiretroviral therapy may deplete resting CD4+ T-cell HIV infection. We tested the ability of valproic acid to deplete resting CD4+ T-cell infection in patients receiving standard antiretroviral therapy.
Resting CD4+ T-cell infection was measured in 11 stably aviremic volunteers twice prior to, and twice after Depakote ER 1000 mg was added to standard antiretroviral therapy. Resting CD4+ T-cell infection frequency was measured by outgrowth assay. Low-level viremia was quantitated by single copy plasma HIV RNA assay.
A decrease in resting CD4+ T-cell infection was observed in only four of the 11 patients. Levels of immune activation and HIV-specific T-cell response were low and stable. Valproic acid levels ranged from 26 to 96 microg/ml when measured near trough. Single copy assay was performed in nine patients. In three patients with depletion of resting CD4+ T-cell infection following valproic acid, single copy assay ranged from less than 1-5 copies/ml. Continuous low-level viremia was observed in three patients with stable resting CD4+ T-cell infection (24-87, 8-87, and 1-7 copies/ml respectively) in whom multiple samples were analyzed.
The prospective addition of valproic acid to stable antiretroviral therapy reduced the frequency of resting CD4+ T-cell infection in a minority of volunteers. In patients in whom resting CD4+ T-cell infection depletion was observed, viremia was rarely detectable by single copy assay.
AIDS (London, England) 06/2008; 22(10):1131-5. · 4.91 Impact Factor
-
Transfusion 12/2007; 47(11):1963-71. · 3.22 Impact Factor
-
Charles L Bennett,
Benjamin Kim,
Anaadriana Zakarija, Nicholas Bandarenko,
Dilip K Pandey,
Charlie G Buffie,
June M McKoy,
Amul D Tevar,
John F Cursio,
Paul R Yarnold, [......],
Joseph E Kiss,
Dennis W Raisch,
Charles Davidson,
J Evan Sadler,
Thomas L Ortel,
X Long Zheng,
Seiji Kato,
Masanori Matsumoto,
Masahito Uemura,
Yoshihiro Fujimura
[show abstract]
[hide abstract]
ABSTRACT: We sought to describe clinical and laboratory findings for a large cohort of patients with thienopyridine-associated thrombotic thrombocytopenic purpura (TTP).
The thienopyridine derivatives, ticlopidine and clopidogrel, are the 2 most common drugs associated with TTP in databases maintained by the U.S. Food and Drug Administration (FDA).
Clinical reports of TTP associated with clopidogrel and ticlopidine were identified from medical records, published case reports, and FDA case reports (n = 128). Duration of thienopyridine exposure, clinical and laboratory findings, and survival were recorded. ADAMTS13 activity (n = 39) and inhibitor (n = 30) were measured for a subset of individuals.
Compared with clopidogrel-associated TTP cases (n = 35), ticlopidine-associated TTP cases (n = 93) were more likely to have received more than 2 weeks of drug (90% vs. 26%), to be severely thrombocytopenic (84% vs. 60%), and to have normal renal function (72% vs. 45%) (p < 0.01 for each). Compared with TTP patients with ADAMTS13 activity >15% (n = 13), TTP patients with severely deficient ADAMTS13 activity (n = 26) were more likely to have received ticlopidine (92.3% vs. 46.2%, p < 0.003). Among patients who developed TTP >2 weeks after thienopyridine, therapeutic plasma exchange (TPE) increased likelihood of survival (84% vs. 38%, p < 0.05). Among patients who developed TTP within 2 weeks of starting thienopyridines, survival was 77% with TPE and 78% without.
Thrombotic thrombocytopenic purpura is a rare complication of thienopyridine treatment. This drug toxicity appears to occur by 2 different mechanistic pathways, characterized primarily by time of onset before versus after 2 weeks of thienopyridine administration. If TTP occurs after 2 weeks of ticlopidine or clopidogrel therapy, therapeutic plasma exchange must be promptly instituted to enhance likelihood of survival.
Journal of the American College of Cardiology 09/2007; 50(12):1138-43. · 14.16 Impact Factor
-
Beth H Shaz,
Michael L Linenberger, Nicholas Bandarenko,
Jeffrey L Winters,
Haewon C Kim,
Marisa B Marques,
Ravindra Sarode,
Joseph Schwartz,
Robert Weinstein,
Ashka Wirk,
Zbigniew M Szczepiorkowski
[show abstract]
[hide abstract]
ABSTRACT: The American Society for Apheresis (ASFA) Committee on Clinical Applications systematically and critically reviews published information on the use of therapeutic apheresis in clinical practice. On the basis of this review, selected diseases are assigned one of five categories (category I, II, III, IV, and P). The diseases, which were classified as category IV indications, and the rationale for such assignment are reviewed in this article. The diseases assigned to category I, II, III, and newly created category P are discussed in a separate article in this issue.
Journal of Clinical Apheresis 07/2007; 22(3):176-80. · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The American Society for Apheresis (ASFA) Apheresis Applications Committee is responsible for a review and categorization of indications for therapeutic apheresis. The results of the review process were previously published in 1986, 1993, and 2000 as the ASFA Special Issues. The ASFA categories consist of categories I through IV, and category P (pending). This article describes the novel methodology, based on structured systematic review of the published literature, used to assign categories for indications for therapeutic apheresis. This is the first time each entity is presented as a fact sheet, which summarizes the evidence for the use of therapeutic apheresis. A detailed description of the fact sheet format and the individual fact sheets for categories I through III and category P are presented in the main article of this Special Issue. The diseases assigned to category IV are discussed in a separate article in this issue. Information on how the Apheresis Applications Committee proposes to include new diseases for category assignment is also provided.
Journal of Clinical Apheresis 06/2007; 22(3):96-105. · 1.93 Impact Factor
-
Zbigniew M Szczepiorkowski, Nicholas Bandarenko,
Haewon C Kim,
Michael L Linenberger,
Marisa B Marques,
Ravindra Sarode,
Joseph Schwartz,
Beth H Shaz,
Robert Weinstein,
Ashka Wirk,
Jeffrey L Winters
[show abstract]
[hide abstract]
ABSTRACT: The American Society for Apheresis (ASFA) Apheresis Applications Committee is charged with a review and categorization of indications for therapeutic apheresis. This elaborate process had been undertaken every 7 years resulting in three prior publications in 1986, 1993, and 2000 of "The ASFA Special Issues." This article is the integral part of the Fourth ASFA Special Issue. The Fourth ASFA Special Issue is significantly modified in comparison to the previous editions. A new concept of a fact sheet has been introduced. The fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis. A detailed description of the fact sheet is provided. The article consists of 53 fact sheets devoted to each disease entity currently categorized by the ASFA. Categories I, II, and III are defined as previously in the Third Special Issue. However, a few new therapeutic apheresis modalities, not yet approved in the United States or are currently in clinical trials, have been assigned category P (pending) by the ASFA Clinical Categories Subcommittee. The diseases assigned to category IV are discussed in a separate article in this issue.
Journal of Clinical Apheresis 06/2007; 22(3):106-75. · 1.93 Impact Factor
-
Nicholas Bandarenko,
Jose Cancelas,
Edward L Snyder,
Shauna N Hay,
Neeta Rugg,
Tammy Corda,
Amy D Joines,
Jennifer F Gormas,
Gayle P Pratt,
Richard Kowalsky,
Michael Rose,
Leslie Rose,
Jim Foley,
Mark A Popovsky
[show abstract]
[hide abstract]
ABSTRACT: Previously, cryopreserved red blood cell (RBC) units derived from CPD/AS-5 whole-blood (WB) collections have been limited to 24 hours postthaw storage (1-6 degrees C).
Sixty-four leukoreduced (LR) and 54 nonleukoreduced (NLR) AS-5 (n = 118) RBC units from 500-mL WB collections were stored for 6 days, glycerolized, frozen (-70 +/- 5 degrees C) for at least 14 days, thawed, deglycerolized, and stored (1-6 degrees C) for 15 days resuspended in AS-3, using an automated closed-system cell processor (ACP 215, Haemonetics). Frozen units were stored in either ethylene vinyl acetate (EVA) or polyvinylchloride (PVC) bags. In vitro parameters were tested in all units 15 days after deglycerolization. In vivo 24-hour recovery was measured in 77 of 118 donors.
Postdeglycerolization in vitro RBC mass recoveries (mean +/- SD) were 96.8 +/- 5.7 and 94.7 +/- 5.6% for EVA LR and NLR units, respectively, and 97.3 +/- 6.2 and 94.7 +/- 6.2% for PVC LR and NLR units, based on unit weight and hematocrit after sampling for in vitro testing, immediately before glycerolization. Hemoglobin content (g/unit, mean +/- SD) after deglycerolization was 40.4 +/- 5.6 and 42.6 +/- 6.0 for EVA LR and NLR units, respectively, and 40.7 +/- 4.8 and 43.0 +/- 7.7 for PVC LR and NLR units. Hemolysis was 0.61 +/- 0.23 and 0.54 +/- 0.16% for EVA LR and NLR units, and 0.47 +/- 0.14 and 0.43 +/- 0.12% for PVC LR and NLR units. In vivo 24-hour recoveries on Day 15 were 83.0 +/- 6.7% (PVC NLR) up to 86.2 +/- 5.7% (EVA NLR).
With processing on the ACP 215 system, CPD/AS-5 LR and NLR thawed RBC units can be stored for up to 14 days after frozen storage at -65 degrees C or colder in EVA or PVC bags with acceptable in vivo and in vitro RBC quality.
Transfusion 05/2007; 47(4):680-6. · 3.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This article reviews numerous multi-center clinical trials, either ongoing or in planning stages, which involve diverse clinical applications and emerging technologies in apheresis and transfusion medicine. The investigations summarized herein involve the following specific areas: platelet dosing strategy, thrombotic thrombocytopenia purpura, inflammatory bowel disease, seven-day platelet storage, dendritic cell vaccines, and age-related macular degeneration.
Transfusion and Apheresis Science 03/2007; 36(1):5-12. · 1.25 Impact Factor
-
Biology of Blood and Marrow Transplantation 08/2006; 12(7):786-8. · 3.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: For thrombotic thrombocytopenic purpura (TTP), daily plasma exchange (TPE) is typically discontinued when the platelet count normalizes (>150 x 10(9)/L). We observed a decline in platelet count during TPE and in patients who appeared pseudo-refractory because of a platelet count plateau (100-150 10(9)/L range). In the present study, we evaluated platelet count trends in TTP patients. Retrospective review of TTP patients from 01/1999 to 12/2004 was completed. Patients were categorized based on platelet count trends: Group I, counts rose then decreased to levels <100 x 10(9)/L; Group II, counts declined following TPE initiation; Group III, counts rose continuously; Group IV, counts decreased after the count was >100 x 10(9)/L. Additionally, we identified pseudo-refractory patients caused by a platelet count plateau (>100 x 10(9)/L but <150 x 10(9)/L). We identified 60 TTP patients. Within Group I (17 patients/17 series/19.1% of total), the mean decrease in platelet count was 67.3% +/- 22.1% following initial rise. Within Group II (24 patients/25 series/28.1% of total), the mean decrease was 28% +/- 5.3% following presentation. Group III included 31 patients/39 series (43.8% of the total). Within Group IV (seven patients/eight series/9.0% of total), the mean decrease was 17.4% +/- 12.6% following a sustained rise >100 x 10(9)/L. With a declining platelet count and daily TPE, it is generally sufficient to stay the course and the decline will reverse. Our limited experience with pseudo-refractory patients supports discontinuing TPE when counts plateau between 100 and 150 x 10(9)/L when a therapy goal is a platelet count of 150 x 10(9)/L. Recognition of this pseudo-refractory state can minimize the risks of prolonged TPE and the risks of adjunct interventions.
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 07/2006; 10(3):237-41. · 1.39 Impact Factor
