Microangiopathic hemolytic anemia medical therapy: Difference between revisions
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* Patients should be given [[folic acid|folic acid (oral]] as [[patient]]s can develop [[folate]] deficiency due to ongoing [[hemolysis]] <ref name="pmid22624596">{{cite journal| author=Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F | display-authors=etal| title=Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. | journal=Br J Haematol | year= 2012 | volume= 158 | issue= 3 | pages= 323-35 | pmid=22624596 | doi=10.1111/j.1365-2141.2012.09167.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22624596 }} </ref>. | * Patients should be given [[folic acid|folic acid (oral]] as [[patient]]s can develop [[folate]] deficiency due to ongoing [[hemolysis]] <ref name="pmid22624596">{{cite journal| author=Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F | display-authors=etal| title=Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. | journal=Br J Haematol | year= 2012 | volume= 158 | issue= 3 | pages= 323-35 | pmid=22624596 | doi=10.1111/j.1365-2141.2012.09167.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22624596 }} </ref>. | ||
* [[Platelet]]s [[transfusion]] is indicated for [[patients]] with serious [[internal bleeding]], [[hemorrhage]] or [[neurological]] complications as there is a high incidence of [[thrombosis]] with [[platelet]] [[transfusion]] <ref name="pmid19210323">{{cite journal| author=Swisher KK, Terrell DR, Vesely SK, Kremer Hovinga JA, Lämmle B, George JN| title=Clinical outcomes after platelet transfusions in patients with thrombotic thrombocytopenic purpura. | journal=Transfusion | year= 2009 | volume= 49 | issue= 5 | pages= 873-87 | pmid=19210323 | doi=10.1111/j.1537-2995.2008.02082.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19210323 }} </ref> <ref name="pmid25588677">{{cite journal| author=Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE, Tobian AA| title=Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. | journal=Blood | year= 2015 | volume= 125 | issue= 9 | pages= 1470-6 | pmid=25588677 | doi=10.1182/blood-2014-10-605493 | pmc=4342358 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25588677 }} </ref>. | * [[Platelet]]s [[transfusion]] is indicated for [[patients]] with serious [[internal bleeding]], [[hemorrhage]] or [[neurological]] complications as there is a high incidence of [[thrombosis]] with [[platelet]] [[transfusion]] <ref name="pmid19210323">{{cite journal| author=Swisher KK, Terrell DR, Vesely SK, Kremer Hovinga JA, Lämmle B, George JN| title=Clinical outcomes after platelet transfusions in patients with thrombotic thrombocytopenic purpura. | journal=Transfusion | year= 2009 | volume= 49 | issue= 5 | pages= 873-87 | pmid=19210323 | doi=10.1111/j.1537-2995.2008.02082.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19210323 }} </ref> <ref name="pmid25588677">{{cite journal| author=Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE, Tobian AA| title=Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. | journal=Blood | year= 2015 | volume= 125 | issue= 9 | pages= 1470-6 | pmid=25588677 | doi=10.1182/blood-2014-10-605493 | pmc=4342358 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25588677 }} </ref>. | ||
* | * [[Patients]] are given adjunct [[corticosteroid]]s along with therapeutic [[plasmapheresis]]. The dose of [[prednisolone (oral)]] depends upon severity of clinical symptoms with higher doses for clinically more severe [[disease]]. The staring dose of [[prednisolone (oral)]] is 1mg/kg. This dose is maintained until [[platelet]] count comes back to normal range. Then the dose is rapidly tapered over a period of three to four weeks<ref name="pmid20686117">{{cite journal| author=George JN| title=How I treat patients with thrombotic thrombocytopenic purpura: 2010. | journal=Blood | year= 2010 | volume= 116 | issue= 20 | pages= 4060-9 | pmid=20686117 | doi=10.1182/blood-2010-07-271445 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20686117 }} </ref>. | ||
==References== | ==References== | ||
Revision as of 11:15, 30 January 2021
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Associate Editor(s)-in-Chief: Mydah Sajid, MD[1]
- Microangiopathic hemolytic anemia is a medical emergency and requires prompt treatment.
- Therapeutic plasmapheresis is the treatment of choice. It should be instituted immediately in patients with high clinical suspicion of microangiopathic hemolytic anemic before the results of confirmatory diagnostic tests like ADAM TS13 assay[1].
- If plasmapheresis is unavailable, patients can be administered large volume plasma or FFPs. This treatment is not as efficacious as plasmapheresis, but it can be suitable alternative[2] .
- Patients should be given folic acid (oral as patients can develop folate deficiency due to ongoing hemolysis [3].
- Platelets transfusion is indicated for patients with serious internal bleeding, hemorrhage or neurological complications as there is a high incidence of thrombosis with platelet transfusion [4] [5].
- Patients are given adjunct corticosteroids along with therapeutic plasmapheresis. The dose of prednisolone (oral) depends upon severity of clinical symptoms with higher doses for clinically more severe disease. The staring dose of prednisolone (oral) is 1mg/kg. This dose is maintained until platelet count comes back to normal range. Then the dose is rapidly tapered over a period of three to four weeks[6].
References
- ↑ Arnold DM, Patriquin CJ, Nazy I (2017). "Thrombotic microangiopathies: a general approach to diagnosis and management". CMAJ. 189 (4): E153–E159. doi:10.1503/cmaj.160142. PMC 5266569. PMID 27754896.
- ↑ Rock GA, Shumak KH, Buskard NA, Blanchette VS, Kelton JG, Nair RC; et al. (1991). "Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group". N Engl J Med. 325 (6): 393–7. doi:10.1056/NEJM199108083250604. PMID 2062330.
- ↑ Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F; et al. (2012). "Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies". Br J Haematol. 158 (3): 323–35. doi:10.1111/j.1365-2141.2012.09167.x. PMID 22624596.
- ↑ Swisher KK, Terrell DR, Vesely SK, Kremer Hovinga JA, Lämmle B, George JN (2009). "Clinical outcomes after platelet transfusions in patients with thrombotic thrombocytopenic purpura". Transfusion. 49 (5): 873–87. doi:10.1111/j.1537-2995.2008.02082.x. PMID 19210323.
- ↑ Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE, Tobian AA (2015). "Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality". Blood. 125 (9): 1470–6. doi:10.1182/blood-2014-10-605493. PMC 4342358. PMID 25588677.
- ↑ George JN (2010). "How I treat patients with thrombotic thrombocytopenic purpura: 2010". Blood. 116 (20): 4060–9. doi:10.1182/blood-2010-07-271445. PMID 20686117.