Strong association between insufficient plasma exchange and fatal outcomes in Japanese patients with immune-mediated thrombotic thrombocytopenic purpura.

• Material Type: 博士論文
• Title: Strong association between insufficient plasma exchange and fatal outcomes in Japanese patients with immune-mediated thrombotic thrombocytopenic purpura.
• Author/Editor: Kayashima, Michinori; Sakai, Kazuya; Harada, Kazuki; Kanetake, Jun; Kubo, Masayuki; Hamada, Eriko; Hayakawa, Masaki; Hatakeyama, Kinta; Matsumoto, Masanori
• Author Heading: Kayashima, Michinori; Sakai, Kazuya; Harada, Kazuki; Kanetake, Jun; Kubo, Masayuki; Hamada, Eriko; Hayakawa, Masaki; Hatakeyama, Kinta; Matsumoto, Masanori
• Publication, Distribution, etc.: Springer Nature
• Publication Date: 2021-10
• Publication Date (W3CDTF): 2021-10
• Alternative Title: 日本人の免疫性血栓性血小板減少性紫斑病患者における不十分な血漿交換は致死的な転帰と強く相関する
• Periodical title: International journal of hematology
• No. or year of volume/issue: 114 4
• Volume: 114
• Issue: 4
• Pages: 415-423
• ISSN (Periodical Title): ISSN : 0925-5710
• Degree grantor/type: 奈良県立医科大学
• Date Granted: 2021-12-21
• Dissertation Number: 乙第1518号
• Degree Type: 博士（医学）
• Text Language Code: eng
• Subject Heading: Autopsy; Fatal outcome; Plasma exchange; Sudden death; Thrombotic thrombocytopenic purpura
• Target Audience: 一般
• Note (General): type:Thesis; Plasma exchange (PEX) using fresh frozen plasma has considerably reduced the mortality rate in patients with immune-mediated thrombotic thrombocytopenic purpura (iTTP). However, some patients still do not survive even with treatment, but little information is available regarding which treatment these patients received. This study was conducted to obtain this information in 240 patients who met the current iTTP diagnostic criteria and completed at least 30 days of follow-up except for deceased cases. These patients were divided into three groups: survivors (n = 195), TTP-related deaths (n = 32), and other cause of death (n = 13). In the TTP-related death group, 26 of 32 patients experienced sudden death, mostly following radical hypotension and bradycardia. The median follow-up time after admission was 5.0 days, and the median number of PEX sessions was 2.5. Nine patients underwent autopsy and had cardiac microvascular thrombi in arterioles. Levels of lactate dehydrogenase, total bilirubin, serum creatinine, and D-dimer were significantly higher in the TTP-related death group than in the survivors group. Frequent PEX (> 20 sessions) was not associated with TTP-related death. In the acute phase of iTTP, patients with substantial organ damage caused by microthrombi have a greater mortality risk, even after just a few PEX sessions.; 博士（医学）・乙第1518号・令和3年12月21日; © Japanese Society of Hematology 2021.; The version of record of this article, first published in International journal of hematology, is available online at Publisher’s website: http://dx.doi.org/10.1007/s12185-021-03197-5.; 発行元が定める登録猶予期間終了の後、本文を登録予定（2022.10）; identifier:International journal of hematology Vol.114 No.4 p.415-423 (2021 Oct); identifier:09255710; identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/3963; identifier:International journal of hematology, 114(4): 415-423
• Source: fulltext; http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/3963/1/01%e4%b9%991518%e6%9c%ac%e6%96%87%e3%81%ae%e8%a6%81%e6%97%a8.pdf; http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/3963/2/02%e4%b9%991518%e5%af%a9%e6%9f%bb%e8%a6%81%e6%97%a8.pdf; http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/3963/6/03%e4%b9%991518%e6%9c%ac%e6%96%87.pdf
• Access Restrictions: インターネット公開
• Related Material (DOI): 10.1007/s12185-021-03197-5
• Periodical Title (NCID): AA10797094; https://ci.nii.ac.jp/ncid/AA10797094
• Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）; https://irdb.nii.ac.jp
• Original Data Provider (Database): 奈良県立医科大学 : 奈良県立医科大学機関リポジトリ GINMU