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    Poster Networking

    Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies

    Poster Networking Session

    PB0333 - Therapeutic Plasma Exchange-Related Complications in Patients with Immune-Mediated Thrombotic Thrombocytopenic Purpura

    Sunday, June 25, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Presenting Author(s)

    • Pasquale Agosti, MD, PhD

      Università degli Studi di Milano, Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Milan, Italy
      Milano, Lombardia, Italy

      • Co-Author(s)

    • CC

      Chiara Cardone

      nurse
      Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
      Milano, Lombardia, Italy

    • IM

      Ilaria Mancini, PhD

      Post-Doc Research Fellow
      Università degli Studi di Milano, Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Milan, Italy
      Milan, Lombardia, Italy

    • PD

      Pasqualina De Leo

      Biologist
      Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
      Milan, Lombardia, Italy

    • CB

      Christian Bichard

      MD
      Università degli Studi di Milano, Department of Pathophysiology and Transplantation
      Milano, Lombardia, Italy

    • Andrea Artoni, MD

      MD
      Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
      Milano, Lombardia, Italy

    • BF

      Barbara Ferrari

      MD
      Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
      Milan, Lombardia, Italy

    • Juri Alessandro Giannotta, MD

      Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
      Milano, Lombardia, Italy

    • NF

      Norma Nadia Fantini

      MD
      Transfusion Medicine and Cell Therapy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
      Milano, Lombardia, Italy

    • MM

      Maria Cristina Mocellin

      MD
      Transfusion Medicine and Cell Therapy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
      Milano, Lombardia, Italy

    • Flora Peyvandi, MD, PhD (she/her/hers)

      Director
      IRCCS Ca' Granda Maggiore Hospital Foundation, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milano, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milano, Italy
      Milano, Lombardia, Italy

    Background: Daily therapeutic plasma exchange (TPE) is the cornerstone of treatment for immune-mediated thrombotic thrombocytopenic purpura (iTTP). However, TPE is not a risk-free procedure and there is scarce evidence regarding its safety in iTTP.

    Aims: This study aims to describe the TPE-related clinical complications occurred in a cohort of patients hospitalized for an acute iTTP episode.

    Methods: In this cross-sectional study, patients hospitalized for an acute iTTP episode at the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico (Milan) between January 2016 and April 2022 undergoing a central venous catheter (CVC) placement to start TPE were enrolled. We distinguished between CVC- and TPE-related complications. Age, sex, clinical manifestations, laboratory parameters, chronic diseases and treatments, episode management and outcomes were collected.

    Results: Thirty-three iTTP episodes from 32 patients were included, 20 (61%) first episodes and 2 (6%) complicated with acute exacerbations. The majority of CVCs were placed in a common femoral vein. Among major CVC-related complications, 5 were venous thromboses (VTs) requiring heparin and CVC removal, and 3 infections (2 systemic) requiring systemic antibiotic treatment with CVC removal. The 19 CVC-related bleeds (in 16 episodes) required local hemostatic medications. Among major TPE-related complications, the most common were allergic reactions (49%), mostly urticarial rashes requiring systemic steroids and antihistamines (Table 1).
    The episodes complicated with CVC-related VT or infection required a longer hospitalization, those complicated with CVC-related infection required also a higher number of TPE to achieve clinical response. No other major differences were observed among episodes with and without CVC-related complications (Table 2).

    Conclusion(s): TPE was well tolerated in our cohort of acute iTTP patients, with CVC-related minor bleeds and allergic reactions being the most common complications (48.5%). The occurrence of CVC-related major complications, as VT or infections, may lead to a longer hospitalization, also independently of patients’ characteristics and disease severity.