Clinical presentation, management and outcome of thrombotic thrombocyopenic purpura at the Charlotte Maxeke Johannesburg academic hospital
Date
2017
Authors
Swart, Leanne
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Abstract
This is a retrospective study of the clinical and laboratory features, management, and outcome of 41 adults diagnosed with thrombotic thrombocytopenic purpura (TTP) at the Charlotte Maxeke Johannesburg Academic Hospital.
There were 45 TTP events during the five-year review period, 41 of which met the inclusion criteria. Most study patients were of black ethnicity (95.1%) and female gender (78.1%). TTP was most commonly secondary to human immunodeficiency virus infection (78.0%). Neurological (82.9%) and bleeding (78.1%) symptoms were frequent. Management included initial plasma infusion (78.1%), therapeutic plasma exchange (87.8%), intensive care admission (41.5%), renal dialysis (12.2%), highly active antiretroviral therapy (78.3%), corticosteroids (61.0%) and other immunosuppressive agents (4.9%). The median (range) number of therapeutic plasma exchanges was 10.0 (7.015.0). The relapse rate was low (8.9%), however refractory disease (70.7%) was frequent. Haemoglobin level, platelet count, lactate dehydrogenase, red cell distribution width and creatinine level were reliable therapeutic end-points (P < 0.05).
The high mortality rate (29.3%) emphasises the importance of early diagnosis, referral and management of TTP.
Description
A Research Report submitted to the Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg
in part fulfillment of the requirements for
the degree of Master of Medicine in the branch of Haematology
Johannesburg, 2017
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Citation
Swart, Leanne (2019) Clinical presentation, management and outcome of thrombotic thrombocytopenic purpura at the Charlotte Maxeke Johannesburg Academic Hospital, , University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/28101>