@article {4572,
	title = {Decreasing frequency of plasma exchange complications in patients treated for thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, 1996 to 2011.},
	journal = {Transfusion//Transfusion},
	volume = {52},
	year = {2012},
	note = {Comment in: Transfusion. 2012 Dec;52(12):2498-501; PMID: 23231672},
	month = {2012},
	pages = {2525 - 2524},
	address = {United States},
	abstract = {BACKGROUND: Plasma exchange (PEX) treatment for patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) has risk for major complications., STUDY DESIGN AND METHODS: Data for PEX-related complications have been prospectively collected on all patients enrolled in the Oklahoma TTP-HUS Registry, 1996 to 2011. PEX-related complications have been defined as major or minor and as central venous catheter related or plasma related., RESULTS: During 15 years, 1996 to 2011, 72 (24\%) of 302 consecutive patients had major PEX-related complications. Analysis of five consecutive 3-year cohorts demonstrated that there has been a significant trend for decreasing frequency of all PEX-related major complications (p = 0.014) and central venous catheter-related major complications (p = 0.021) but not for the less common plasma-related major complications (p = 0.380). ADAMTS13 activity was measured in 288 (95\%) of the 302 patients. Analysis of the 66 patients with ADAMTS13 activity of less than 10\% demonstrated a significant trend for decreasing frequency of PEX-related major complications (p = 0.036); the trend for the 222 patients with ADAMTS13 activity of at least 10\% was not significant (p = 0.118). The decreased frequency of PEX-related major complications among patients with ADAMTS13 activity of less than 10\% may be related to a significant trend for decreasing duration of PEX treatment (p = 0.040) and decreasing frequency of requirement for more than one central venous catheter (p = 0.044). The decreased duration of PEX treatment may be related to increased use of adjunctive treatments: corticosteroids (p < 0.001) and rituximab (p < 0.001)., CONCLUSIONS: The frequency of PEX-related major complications has decreased from 1996 to 2011, possibly related to increased use of corticosteroids and rituximab and the decreased duration of PEX required to achieve remission.Copyright {\textcopyright} 2012 American Association of Blood Banks.},
	keywords = {*Hemolytic-Uremic Syndrome/mo [Mortality], *Hemolytic-Uremic Syndrome/th [Therapy], *Plasma Exchange/ae [Adverse Effects], *Plasma Exchange/mo [Mortality], *Purpura, Thrombotic Thrombocytopenic/mo [Mortality], *Purpura, Thrombotic Thrombocytopenic/th [Therapy], ADAM Proteins/me [Metabolism], Adrenal Cortex Hormones/tu [Therapeutic Use], Adult, Antibodies, Monoclonal, Murine-Derived/tu [Therapeutic Use], Antineoplastic Agents/tu [Therapeutic Use], Catheter-Related Infections/mo [Mortality], Catheterization, Central Venous/ae [Adverse Effects], Education, Medical, Continuing, Female, Hemolytic-Uremic Syndrome/dt [Drug Therapy], Humans, Male, Morbidity, Oklahoma/ep [Epidemiology], Purpura, Thrombotic Thrombocytopenic/dt [Drug Therapy], Registries/sn [Statistics \& Numerical Data], Remission Induction, Risk Factors, rituximab, Sepsis/mo [Mortality]},
	isbn = {1537-2995},
	author = {Som, Sumit and Deford, Cassandra C and Kaiser, Mandi L and Terrell, Deirdra R and Kremer Hovinga, Johanna A and Lammle, Bernhard and George, James N and Vesely, Sara K}
}
