Table 7.
Death and major complications attributed to PEX treatment in patients with their initial episode of TTP from 1996 to 2014
| Description of complications | Diagnosis of TTP supported (n = 68) | Diagnosis of TTP not supported (n = 274) | ||
|---|---|---|---|---|
| No. | % | No. | % | |
| Deaths (catheter-related) | 3 | 4.4 | 4 | 1.5 |
| Pulmonary hemorrhage caused by central venous catheter insertion for PEX | 1 | 3 | ||
| Systemic infection | 2 | 1 | ||
| Nonfatal major complications | 36 | 53 | 55 | 20 |
| Catheter-related complications | 28 | 41 | 41 | 15 |
| Systemic infection, documented bacteremia | 12 | 19 | ||
| Systemic infection, suspected bacteremia* | 2 | 2 | ||
| Localized infection at catheter insertion site† | 2 | 1 | ||
| Catheter obstruction‡ | 6 | 11 | ||
| Venous thrombosis requiring systemic anticoagulation | 3 | 4 | ||
| Catheter insertion site hemorrhage§ | 1 | 3 | ||
| Pneumothorax|| | 1 | 1 | ||
| Insertion of incorrect catheter‡ | 1 | 0 | ||
| Plasma-related complications | 8 | 12 | 14 | 5 |
| Anaphylaxis with cardiac arrest | 1 | 0 | ||
| Hypotension requiring vasopressor treatment | 3 | 6 | ||
| Hypoxia¶ | 1 | 8 | ||
| Hypocalcaemia, arrhythmia¶ | 1 | 0 | ||
| Serum sickness after PEX | 2 | 0 | ||
Registry patients with a supported diagnosis of TTP (ADAMTS13 <10% supported by clinical criteria) were compared with Registry patients whose initial suspected diagnosis of TTP was not supported by ADAMTS13 activity <10%. These data are derived from our previous analyses from 1996 to 2014.17 Major complications were previously defined.16 Ten of the 78 patients with TTP are not included in this comparison. One patient died before a catheter was inserted and PEX began (death caused by TTP, documented by autopsy). One patient died soon after her first PEX began (death caused by TTP, documented by autopsy).Two patients were diagnosed before active surveillance for PEX complications began in June 1996 (both had major complications: 1 had systemic infection with bacteremia; 1 had local infection at the catheter site requiring systemic antibiotics). Six patients were enrolled in 2014-2015 after our previous analysis of all patients treated with PEX had been completed in June 2014.17 Four of these 6 patients had no major complications; 2 had major complications: 1 had systemic infection with bacteremia; 1 had plasma allergic reaction with chest pain and dyspnea that required stopping PEX. Therefore, 40 (52%) of all 77 TTP patients treated with PEX had major nonfatal complications. The frequency of deaths (P = .144) and plasma-related major complications (P = .055) were not different between patients who had TTP and those who did not. The frequency of all major complications (P < .001), catheter-related major complications (P < .001), and systemic infections with documented bacteremia (P < .010) was significantly different between the 2 patient cohorts.
Blood cultures were negative but patient was treated with a full course of parenteral antibiotics for presumed sepsis.
Required hospitalization and systemic antibiotics.
Required removal of the catheter and placement of a new catheter.
Required red blood cell transfusion.
Required placement of a chest tube.
Required stopping PEX.