Abstract
Introduction
Literature on epidemiology of thrombotic thrombocytopenic purpura (TTP) in the Middle
East is scarce.
Materials and methods
We prospectively examined the association between infection and clinical outcomes
in 44 patients with idiopathic TTP, with severely deficient ADAMTS13. We also investigated
seasonality of the disease, hoping to better understand the epidemiology of idiopathic
TTP.
Results
Summer demonstrated significantly lower incidence for idiopathic TTP, compared with
other seasons P = 0.0003. Fourteen patients had 15 episodes with a suspected concomitant
infection. Five initial episodes were triggered by an infection (33.3 %), all presenting
in winter, six episodes were associated with an exacerbation (40 %) and infection
triggered a relapse in the other four episodes (26.7 %), with 2 episodes presenting
in winter.
TTP associated infections included: central line infection, urinary tract infection
and post-operative infection. One patient had respiratory tract infection, on both
his initial and relapsing episodes. Refractoriness to treatment was demonstrated in
4 patients (28.6 %) and it was associated with dental abscess (one patient), septic
shock (one patient) and Mycoplasma pneumonia (2 patients). All 4 patients had markedly
elevated CRP values with a median of 335 mg/L.
Conclusion
Most of the infection associated episodes developed in winter (77.8 %).
In patients with idiopathic TTP refractory to conventional treatment, infection should
be seriously considered as an additional contributing factor for their initial and
/or recurrent episodes, particularly when CRP is markedly elevated.
Keywords
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Article info
Publication history
Published online: August 25, 2020
Accepted:
August 3,
2020
Received in revised form:
July 18,
2020
Received:
February 24,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
