Complications
Unusually large multimers of von Willebrand factor (vWF) lead to platelet aggregation and the development of microthrombi, which lead to end-organ dysfunction from ischaemia. Some neurological abnormalities will correct with treatment of the underlying TTP. Patients can make remarkable neurological recovery with treatment.
Unusually large multimers of vWF lead to platelet aggregation and the development of microthrombi, which lead to end-organ dysfunction from ischaemia. Treatment is of the underlying TTP.
Unusually large multimers of vWF lead to platelet aggregation and the development of microthrombi, which lead to end-organ dysfunction from ischaemia. Studies suggest that this can occur in as many as 18% of patients presenting with thrombotic microangiopathies, such as TTP.[79] The rate might be as high as 40% because less than half of patients in this retrospective cohort were diagnosed with TTP; the remaining patients had a variety of other aetiologies for thrombotic microangiopathy. The presence of TTP does not necessitate any changes in the management of MI; the usual treatment is given.
These include infection, bleeding, and pneumothorax. Although plasma exchange can sometimes be performed through peripheral intravenous catheters, many patients require the placement of central catheters for exchange. The rate of these complications is estimated from one study to be approximately 25%, and deaths from complications of plasma exchange were reported to be 2%.[80] The presence of TTP does not necessitate any changes in the management of these complications; the usual treatment of these complications is given.
These include systemic infection, venous thrombosis, hypotension, and serum sickness. Massive fluid shifts occur with plasma exchange, which can result in hypotension. There is also the possibility of systemic infection from the administration of plasma. This risk is estimated to be 26%.[80]
The risk of adverse effects such as osteoporosis, glucose intolerance, and infections is similar to that for other patients requiring long-term corticosteroid treatment and varies with length of treatment and dose.
In the US, the risk of a transfusion-transmitted infectious disease from a standard unit of fresh frozen plasma is the same as for a unit of red cells:HIV risk is 1:2,100,000; human T-lymphotropic virus (HTLV) risk is 1:2,000,000; hepatitis C risk is 1:1,900,000; hepatitis B risk is 1:58,000 to 1:269,000. These frequencies may vary elsewhere in the world.
Patients who contract these infections from blood products should be treated according to standard of care. A high clinical suspicion of the possibility of these infections should be maintained given the large exposure of patients with TTP to plasma products.
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