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Ghariani I, Jmili-Braham N, Azzebi O, Kortas M, Veyradier A, Bakir L. Purpura thrombotique thrombocytopénique chez un nouveau-né. Arch Pediatr 2016; 23:78-81. [DOI: 10.1016/j.arcped.2015.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/19/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
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Bulut C, Oguz EG, Canbakan B, Ayli D. BK virus-related thrombotic microangiopathy in a kidney transplant recipient. INDIAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.1016/j.ijt.2015.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cortés GM, Viveros Sandoval ME, Areán Martínez CA, Vega Gómez HE, López Castañeda SE, García AG. Von Willebrand Factor Plasma Levels Variability In Nonvalvular Atrial Fibrillation. J Atr Fibrillation 2014; 7:1124. [PMID: 27957129 DOI: 10.4022/jafib.1124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/08/2014] [Accepted: 10/31/2014] [Indexed: 01/19/2023]
Abstract
Atrial Fibrillation (AF) is the most common cardiac arrhythmia of clinical significance; it increases the risk of mortality due to stroke. The mechanisms behind cerebral thromboembolism in AF are associated with a prothrombotic state, demonstrated by higher levels of von Willebrand Factor (vWF), a multimeric glycoprotein that plays a crucial role in platelet adhesion and aggregation and it has been proposed as a biomarker of endothelial dysfunction. Plasma vWF levels are elevated in patients with nonvalvular Atrial Fibrillation (NVAF) associated to the presence of cardiovascular risk factors. The variability in vWF plasma levels in healthy subjects has a wide distribution, but there is no description available of the variability in AF patients and among types of AF. The aim of this study was to determine the variability of vWF plasma concentrations in patients with NVAF, associated to cardiovascular risk factors. Search strategy included PubMed and Ovid. Keywords used were "Atrial Fibrillation" and "von Willebrand Factor". It includes original articles, with analysis of plasma vWF levels by ELISA, without acute stroke. Review articles and meta-analysis were excluded. Reviewed studies include 22 trials and 6542 patients with nonvalvular AF associated to cardiovascular disease risk factors: age, sex, hypertension, heart failure, diabetes mellitus, prior stroke, coronary artery disease. Variability in vWF plasma levels was wide, with minimum values of 77 IU/dl and maximum values of 245 IU/dl and a mean of 146 IU/dl. Age of patients ranged between 54 and 78 years, and the percentage of males ranged between 23% and 80%. According to type of AF vWF levels were as follows, in paroxysmal AF: 92-264 IU/dl; persistent AF: 76-234 IU/dl; permanent AF: 91-247 IU/dl. The variability in vWF plasma levels is affected by risk factors and the AF type, however vWF levels in AF patients are higher when compared with healthy subjects.
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Affiliation(s)
- Gerardo Muñoz Cortés
- Laboratory of Haemostasis and Vascular Biology. Faculty of Medical and Biological Sciences "Dr. Ignacio Chavez". Michoacan University of San Nicolas de Hidalgo. Biomedical Research Center of Michoacán. Mexican Social Security Institute. Morelia, Michoacán, México
| | - Martha Eva Viveros Sandoval
- Laboratory of Haemostasis and Vascular Biology. Faculty of Medical and Biological Sciences "Dr. Ignacio Chavez". Michoacan University of San Nicolas de Hidalgo. Morelia, Michoacán, México
| | | | - Helios Eduardo Vega Gómez
- Department of Cardiology, Regional General Hospital No. 1. Mexican Social Security Institute. Morelia, Michoacán, México
| | - Sandra Edith López Castañeda
- Laboratory of Haemostasis and Vascular Biology. Faculty of Medical and Biological Sciences "Dr. Ignacio Chavez". Michoacan University of San Nicolas de Hidalgo. Morelia, Michoacán, México
| | - Anel Gómez García
- Biomedical Research Center of Michoacán, Mexican Social Security Institute. Morelia, Mich. México
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Kilercik M, Coskun A, Serteser M, Inan D, Unsal I. Biological variations of ADAMTS13 and von Willebrand factor in human adults. Biochem Med (Zagreb) 2014; 24:138-45. [PMID: 24627722 PMCID: PMC3936977 DOI: 10.11613/bm.2014.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/15/2014] [Indexed: 12/22/2022] Open
Abstract
Background: The ultra-large von Willebrand factor (vWF) multimers are very active and must be degraded by ADAMTS13 for optimal activity. A severe functional deficiency of ADAMTS13 has been associated with thrombotic thrombocytopenic purpura. The correct interpretation of patient vWF and ADAMTS13 plasma levels requires an understanding of the biological variation associated with these analytes. In the present paper, we aimed to determine the biological variation of ADAMTS13 and vWF in human adults. Materials and methods: Blood samples were collected weekly from 19 healthy subjects for 5 consecutive weeks. vWF activity and antigenicity were determined using aggregometric and immunoturbidimetric methods. ADAMTS13 antigenicity and activity were determined by ELISA. Results: The within-subject biological variations for vWF activity and antigenicity were 8.06% and 14.37%, respectively, while the between-subject biological variations were 18.5% and 22.59%, respectively. The index of individuality for vWF activity was 0.44, while vWF antigenicity was 0.64. Similarly, ADAMTS13 activity and antigenicity within-subject biological variations were 12.73% and 9.75%, respectively, while between-subject biological variations were 9.63% and 6.28%, respectively. The ADAMTS13 indexes of individuality were 1.32 and 1.55, respectively. Conclusion: We report high biological variation and individuality in vWF antigenicity and activity levels. However, ADAMTS13 antigenicity and activity displayed high biological variation, but low individuality. Thus, population-based reference intervals may be useful for monitoring ADAMTS13 antigenicity and activity, but not for vWF, which displays high individuality. These findings should be considered when determining the reference interval and other clinical variables associated with ADAMTS13 and vWF levels.
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Affiliation(s)
- Meltem Kilercik
- Acibadem University, School of Medicine, Department of Medical Biochemistry, Istanbul, Turkey
| | - Abdurrahman Coskun
- Acibadem University, School of Medicine, Department of Medical Biochemistry, Istanbul, Turkey
| | - Mustafa Serteser
- Acibadem University, School of Medicine, Department of Medical Biochemistry, Istanbul, Turkey
| | - Deniz Inan
- Marmara University, Arts and Science Faculty, Department of Statistics, Istanbul, Turkey
| | - Ibrahim Unsal
- Acibadem University, School of Medicine, Department of Medical Biochemistry, Istanbul, Turkey
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Ben Abdallah Chabchoub R, Boukedi A, Bensalah M, Maalej B, Gargour L, Turk F, Ben Halima N, Wolf M, Veyradier A, Mahfoudh A. [Atypical hemolytic and uremic syndrome associated with von Willebrand factor-cleaving protease (ADAMTS 13) deficiency in children]. Arch Pediatr 2013; 20:853-7. [PMID: 23827373 DOI: 10.1016/j.arcped.2013.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 12/27/2012] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
Hemolytic and uremic syndrome (HUS) is a classical form of thrombotic microangiopathies characterized by the association of hemolytic anemia with schizocytes, thrombocytopenia, and acute renal failure. Two forms of HUS have been described: the typical form that occurs after ingestion of a strain of bacteria, usually Escherichia coli types, which expresses verotoxin (also called shiga-like toxin), typically followed by bloody diarrhea, and atypical HUS, which is rare during childhood and can also be revealed by bloody diarrhea. We report a case of a 25-month-old infant who presented with hematuria and pallor after an episode of diarrhea. Biological tests revealed anemia, thrombocytopenia, and renal failure. The diagnosis of typical HUS was made, but the causal microorganism was not identified. Progression was favorable within 5 days of plasma transfusions. Two months later, the patient presented with the same symptoms and neurological impairment without any diarrhea. Von Willebrand factor-cleaving protease activity (ADAMTS 13) was low. Therefore, the diagnosis of atypical HUS by severe deficiency of ADAMTS 13 was suggested. The treatment was based on plasma transfusions resulting in remission. Atypical HUS associated with severe ADAMTS 13 deficiency rarely occurs in childhood. The prognosis, usually threatening, has been completely transformed thanks to a better understanding of the pathogenesis and to therapeutic progress.
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Affiliation(s)
- R Ben Abdallah Chabchoub
- Service de pédiatrie, urgences et réanimation pédiatriques, CHU Hédi Chaker, 3000 Sfax, Tunisie.
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Dierkes F, Andriopoulos N, Sucker C, Kuhr K, Hollenbeck M, Hetzel GR, Burst V, Teschner S, Rump LC, Benzing T, Grabensee B, Kurschat CE. Indicators of acute and persistent renal damage in adult thrombotic microangiopathy. PLoS One 2012; 7:e30886. [PMID: 22292070 PMCID: PMC3264649 DOI: 10.1371/journal.pone.0030886] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 12/28/2011] [Indexed: 11/29/2022] Open
Abstract
Background Thrombotic microangiopathies (TMA) in adults such as thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are life-threatening disorders if untreated. Clinical presentation is highly variable and prognostic factors for clinical course and outcome are not well established. Methods We performed a retrospective observational study of 62 patients with TMA, 22 males and 40 females aged 16 to 76 years, treated with plasma exchange at one center to identify clinical risk factors for the development of renal insufficiency. Results On admission, 39 of 62 patients (63%) had acute renal failure (ARF) with 32 patients (52%) requiring dialysis treatment. High systolic arterial pressure (SAP, p = 0.009) or mean arterial pressure (MAP, p = 0.027) on admission was associated with acute renal failure. Patients with SAP>140 mmHg on admission had a sevenfold increased risk of severe kidney disease (OR 7.464, CI 2.097–26.565). MAP>100 mmHg indicated a fourfold increased risk for acute renal failure (OR 4.261, CI 1.400–12.972). High SAP, diastolic arterial pressure (DAP), and MAP on admission were also independent risk factors for persistent renal insufficiency with the strongest correlation for high MAP. Moreover, a high C-reactive protein (CRP) level on admission correlated with renal failure in the course of the disease (p = 0.003). At discharge, renal function in 11 of 39 patients (28%) had fully recovered, 14 patients (23%) remained on dialysis, and 14 patients (23%) had non-dialysis-dependent chronic kidney disease. Seven patients (11%) died. We identified an older age as risk factor for death. Conclusions High blood pressure as well as high CRP serum levels on admission are associated with renal insufficiency in TMA. High blood pressure on admission is also a strong predictor of sustained renal insufficiency. Thus, adult TMA patients with high blood pressure may require special attention to prevent persistent renal failure.
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Affiliation(s)
- Firuseh Dierkes
- Department of Nephrology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Nikolaos Andriopoulos
- Renal Division, Department of Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Christoph Sucker
- Department of Hemostasis and Transfusion Medicine, Heinrich-Heine-University Medical Center, Düsseldorf, Germany
| | - Kathrin Kuhr
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Markus Hollenbeck
- Department of Nephrology and Rheumatology, Knappschaftskrankenhaus, Bottrop, Germany
| | - Gerd R. Hetzel
- Department of Nephrology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Volker Burst
- Renal Division, Department of Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Sven Teschner
- Renal Division, Department of Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Lars C. Rump
- Department of Nephrology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Thomas Benzing
- Renal Division, Department of Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - Bernd Grabensee
- Department of Nephrology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Christine E. Kurschat
- Renal Division, Department of Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
- * E-mail:
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Hermann R, Pfeil A, Busch M, Kettner C, Kretzschmar D, Hansch A, La Rosée P, Wolf G. [Very severe thrombotic thrombocytopenic purpura (TTP) after H1N1 vaccination]. ACTA ACUST UNITED AC 2010; 105:663-8. [PMID: 20878304 DOI: 10.1007/s00063-010-1107-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 07/12/2010] [Indexed: 12/01/2022]
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is a severe disease with microthrombi in various organs. The idopathic subtype is characterized by reduced ADAMTS13 activity mediated via autoantibodies against this protease. Induction of autoantibodies mechanistically is incompletely understood, but certain drugs can induce anti-ADAMTS13 antibodies through hapten mechanisms. CASE REPORT A 56-year-old man was admitted from an external hospital because of a rapidly worsening general condition, hemolytic anemia (hemoglobin 4.17 mmol/l, hematocrit 0.19), and thrombocytopenia (22 Gpt/l) for unknown reasons. Additionally, he was found to have an elevated lactate dehydrogenase (45.37 μmol/l/s). 13 days before hospitalization he had received vaccination against H1N1. Laboratory tests revealed an increased total bilirubin (126 μmol/l), and a decreased haptoglobin level (< 0.08 g/l). The blood smear showed 24% fragmentocytes. Direct and indirect Coombs test were negative. TPP was diagnosed based on the clinical presentation and the detection of ADAMTS13 antibodies. Despite daily plasma exchange via plasmapheresis and administration of corticosteroids, there was no significant rise in platelet counts. Immunosuppression with a total of four weekly doses of rituximab (375 mg/m(2) body surface area) was added. Over the next 5 weeks, the platelet count very slowly rose. After a total of 46 sessions, plasmapheresis was ended with complete remission of the disease. CONCLUSION This report emphasizes the immunologic susceptibility of TTP, and suggests the potential, but not proven role of H1N1 vaccination in the pathogenesis of TTP, because no serum before vaccination was available. Severe autoantibody TTP can be successfully treated by administering rituximab in addition to standard treatment with plasmapheresis and corticosteroids.
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Affiliation(s)
- Regina Hermann
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena, Germany.
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Schifferli A, von Vigier RO, Fontana M, Spartà G, Schmid H, Bianchetti MG, Rudin C. Hemolytic-uremic syndrome in Switzerland: a nationwide surveillance 1997-2003. Eur J Pediatr 2010; 169:591-8. [PMID: 19830454 DOI: 10.1007/s00431-009-1079-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 09/14/2009] [Accepted: 09/22/2009] [Indexed: 12/21/2022]
Abstract
Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in childhood. In its typical presentation, it is preceded by an episode of diarrhea mostly due to Shiga-toxin-producing Escherichia coli. There is important geographical variation of many aspects of this syndrome. Nationwide data on childhood HUS in Switzerland have not been available so far. In a prospective national study through the Swiss Pediatric Surveillance Unit 114 cases (median age 21 months, 50% boys) were reported between April 1997 and March 2003 by 38 pediatric units (annual incidence 1.42 per 10(5) children < or =16 years). Shiga-toxin-producing E. coli were isolated in 32 (60%) of tested stool samples, serotype O157:H7 in eight. Sixteen children presented with only minimal renal involvement, including three with underlying urinary tract infection. Six patients presented with atypical hemolytic-uremic syndrome, and six with HUS due to invasive Streptococcus pneumoniae infection. Mortality was 5.3%, including two out of six children with S. pneumoniae infection. The severity of thrombocytopenia and the presence of central nervous system involvement significantly correlated with mortality. In conclusion, childhood HUS is not rare in Switzerland. Contrasting other countries, E. coli O157:H7 play only a minor role in the etiology. Incomplete manifestation is not uncommon.
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Quéméneur T, Noel LH, Kyndt X, Droz D, Fleury D, Binaut R, Lemaitre V, Gobert P, Vanhille P. Thrombotic microangiopathy in adult Still's disease. Scand J Rheumatol 2009; 34:399-403. [PMID: 16234190 DOI: 10.1080/03009740510026689] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Adult Still's disease (ASD) is a rare systemic disorder characterized by fever, arthralgia, cutaneous rash, and lymphadenopathy, with high polymorphonuclear leucocytosis and low glycosylated ferritinaemia. Kidney involvement has been reported rarely. We present a patient with ASD who developed haemolytic uraemic syndrome (HUS). The 42-year-old patient was admitted for unexplained fever related to ASD according to Yamaguchi's classification criteria. As Still's disease was resistant to prednisone, high-dose intravenous immunoglobulins (IV Ig) were administered. During the follow-up the patient developed acute renal failure and non-immune haemolytic anaemia with high levels of antiphospholipid antibodies (IgG anticardiolipin antibodies and anti-beta2 glycoprotein 1 antibodies). Renal biopsy disclosed thrombotic microangiopathy (TMA) with arteriolar and glomerular involvement. Treatment with steroids and intravenous IV Ig was reinitiated but renal function worsened towards end-stage renal failure. In this case, we suggest that antiphospholipid antibodies could have promoted arteriolar and glomerular TMA. HUS may be the cause of acute renal failure in Still's disease.
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Affiliation(s)
- T Quéméneur
- Department of Nephrology and Internal Medicine, Valenciennes Hospital, Valenciennes, France
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Abstract
Thrombotic microangiopathies (TMA) are microvascular occlusive disorders characterized by hemolytic anemia caused by fragmentation of erythrocytes and thrombocytopenia due to increased platelet aggregation and thrombus formation, eventually leading to disturbed microcirculation with reduced organ perfusion. Although several disease states may manifest as TMA, the two most relevant conditions associated with TMA are thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), characterized by prominent brain or renal lesions, respectively. However, occasionally the clinical distinction between these two conditions can be difficult. In this review, we focus on the epidemiologic and diagnostic criteria as well as on the most recent insights into the pathophysiology and treatment of these two conditions.
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Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Trasfusione, Azienda Ospedaliera di Verona, Verona, Italy.
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Franchini M, Zaffanello M, Veneri D. Advances in the pathogenesis, diagnosis and treatment of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Thromb Res 2006; 118:177-84. [PMID: 16126255 DOI: 10.1016/j.thromres.2005.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 06/30/2005] [Accepted: 07/21/2005] [Indexed: 11/27/2022]
Abstract
The thrombotic microangiopathies are microvascular occlusive disorders characterized by hemolytic anemia caused by fragmentation of erythrocytes and thrombocytopenia due to increased platelet aggregation and thrombus formation, eventually leading to disturbed microcirculation with reduced organ perfusion. Depending on whether brain or renal lesions prevail, two different entities have been described: thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). However, not rarely the clinical distinctions between these two conditions remain questionable. Recent studies have contributed greatly to our current understanding of the molecular mechanisms leading to TTP and HUS. In this review, we briefly focus on the most important advances in the pathophysiology, diagnosis and treatment of these two thrombotic microangiopathies.
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Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Trasfusione, Ospedale Policlinico, Piazzale L. Scuro Azienda Ospedaliera di Verona, Italy.
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