%0 Journal Article %J Transfusion//Transfusion %D 2012 %T Decreasing frequency of plasma exchange complications in patients treated for thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, 1996 to 2011. %A Som, Sumit %A Deford, Cassandra C %A Kaiser, Mandi L %A Terrell, Deirdra R %A Kremer Hovinga, Johanna A %A Lammle, Bernhard %A George, James N %A Vesely, Sara K %K *Hemolytic-Uremic Syndrome/mo [Mortality] %K *Hemolytic-Uremic Syndrome/th [Therapy] %K *Plasma Exchange/ae [Adverse Effects] %K *Plasma Exchange/mo [Mortality] %K *Purpura, Thrombotic Thrombocytopenic/mo [Mortality] %K *Purpura, Thrombotic Thrombocytopenic/th [Therapy] %K ADAM Proteins/me [Metabolism] %K Adrenal Cortex Hormones/tu [Therapeutic Use] %K Adult %K Antibodies, Monoclonal, Murine-Derived/tu [Therapeutic Use] %K Antineoplastic Agents/tu [Therapeutic Use] %K Catheter-Related Infections/mo [Mortality] %K Catheterization, Central Venous/ae [Adverse Effects] %K Education, Medical, Continuing %K Female %K Hemolytic-Uremic Syndrome/dt [Drug Therapy] %K Humans %K Male %K Morbidity %K Oklahoma/ep [Epidemiology] %K Purpura, Thrombotic Thrombocytopenic/dt [Drug Therapy] %K Registries/sn [Statistics & Numerical Data] %K Remission Induction %K Risk Factors %K rituximab %K Sepsis/mo [Mortality] %X 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 © 2012 American Association of Blood Banks. %B Transfusion//Transfusion %C United States %V 52 %P 2525 - 2524 %8 2012 %@ 1537-2995 %G eng %N 12 %< http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medl&NEWS=N&AN=22501034