Deleterious neurological impact of diagnostic delay in immune-mediated thrombotic thrombocytopenic purpura Article Swipe
A. Renaud
,
A. Caristan
,
Amélie Seguin
,
C. Agard
,
Gauthier Blonz
,
Emmanuel Canet
,
Marion Eveillard
,
Pascal Godmer
,
J. Graveleau
,
M. Lecouffe-Desprets
,
Hervé Maisonneuve
,
F. Perrin
,
M. Hamidou
,
A. Néel
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0260196
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0260196
Background Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare life-threatening thrombotic microangiopathy requiring urgent therapeutic plasma exchange (TPE). However, the exact impact of a slight delay in TPE initiation on the subsequent patients’ outcome is still controversial. Aim We aimed to study the frequency, short-term neurological consequences, and determinants of diagnostic delay in iTTP. Methods We conducted a retrospective monocentric study including patients with a first acute episode of iTTP (2005–2020) classified into 2 groups: delayed (>24h from first hospital visit, group 1) and immediate diagnosis (≤24h, group 2). Results Among 42 evaluated patients, 38 were included. Eighteen cases (47%) had a delayed diagnosis (median: 5 days). The main misdiagnosis was immune thrombocytopenia (67%). The mortality rate was 5% (1 death in each group). Neurological events (stroke/TIA, seizure, altered mental status) occurred in 67% vs 30% patients in group 1 and 2, respectively (p = 0.04). Two patients in group 1 exhibited neurological sequelae. The hospital length of stay was longer in group 1 (p = 0.02). At the first hospital evaluation, potential alternative causes of thrombocytopenia were more prevalent in group 1 (33% vs 5%, p = 0.04). Anemia was less frequent in group 1 (67% vs 95%, p = 0.04). All patients had undetectable haptoglobin levels. By contrast, 26% of schistocytes counts were <1%, mostly in group 1 (62% vs 11%, p = 0.01). Conclusion Diagnostic delay is highly prevalent in iTTP, with a significant impact on short-term neurological outcome. In patients with profound thrombocytopenia, the thorough search for signs of incipient organ dysfunction, systematic hemolysis workup, and proper interpretation of schistocytes count are the key elements of early diagnosis of TTP.
Related Topics
Concepts
Medicine
Thrombotic thrombocytopenic purpura
Thrombotic microangiopathy
Stroke (engine)
Internal medicine
Schistocyte
Pediatrics
Microangiopathy
Anemia
Microangiopathic hemolytic anemia
Retrospective cohort study
Gastroenterology
Diabetes mellitus
Platelet
Disease
Engineering
Mechanical engineering
Endocrinology
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1371/journal.pone.0260196
- https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0260196&type=printable
- OA Status
- gold
- Cited By
- 6
- References
- 33
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3211911447
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W3211911447Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1371/journal.pone.0260196Digital Object Identifier
- Title
-
Deleterious neurological impact of diagnostic delay in immune-mediated thrombotic thrombocytopenic purpuraWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2021Year of publication
- Publication date
-
2021-11-19Full publication date if available
- Authors
-
A. Renaud, A. Caristan, Amélie Seguin, C. Agard, Gauthier Blonz, Emmanuel Canet, Marion Eveillard, Pascal Godmer, J. Graveleau, M. Lecouffe-Desprets, Hervé Maisonneuve, F. Perrin, M. Hamidou, A. NéelList of authors in order
- Landing page
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https://doi.org/10.1371/journal.pone.0260196Publisher landing page
- PDF URL
-
https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0260196&type=printableDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0260196&type=printableDirect OA link when available
- Concepts
-
Medicine, Thrombotic thrombocytopenic purpura, Thrombotic microangiopathy, Stroke (engine), Internal medicine, Schistocyte, Pediatrics, Microangiopathy, Anemia, Microangiopathic hemolytic anemia, Retrospective cohort study, Gastroenterology, Diabetes mellitus, Platelet, Disease, Engineering, Mechanical engineering, EndocrinologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
6Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 1, 2024: 1, 2023: 3Per-year citation counts (last 5 years)
- References (count)
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33Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| referenced_works | https://openalex.org/W2604565584, https://openalex.org/W2557184605, https://openalex.org/W2109793252, https://openalex.org/W2920870186, https://openalex.org/W2340762935, https://openalex.org/W2043896622, https://openalex.org/W2605728624, https://openalex.org/W2910737538, https://openalex.org/W2015465267, https://openalex.org/W2978815870, https://openalex.org/W3032191289, https://openalex.org/W2582683896, https://openalex.org/W2031109264, https://openalex.org/W2340760838, https://openalex.org/W2101061562, https://openalex.org/W2315229770, https://openalex.org/W2010802708, https://openalex.org/W2139129249, https://openalex.org/W3042682193, https://openalex.org/W2163744485, https://openalex.org/W2600826833, https://openalex.org/W2976604838, https://openalex.org/W3093859471, https://openalex.org/W2593388942, https://openalex.org/W2910585634, https://openalex.org/W2049115072, https://openalex.org/W2148765840, https://openalex.org/W1975343288, https://openalex.org/W2154622864, https://openalex.org/W2104756521, https://openalex.org/W2151160622, https://openalex.org/W2608854612, https://openalex.org/W3151407768 |
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| abstract_inverted_index.2 | 73 |
| abstract_inverted_index.5 | 105 |
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| abstract_inverted_index.iTTP. | 53 |
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| abstract_inverted_index.signs | 251 |
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| abstract_inverted_index.0.04). | 145, 188, 201 |
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| abstract_inverted_index.delayed | 75, 102 |
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| abstract_inverted_index.group). | 123 |
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| corresponding_author_ids | https://openalex.org/A5045779109, https://openalex.org/A5067988271, https://openalex.org/A5014805827, https://openalex.org/A5054350853, https://openalex.org/A5044689587, https://openalex.org/A5003323667, https://openalex.org/A5051632559, https://openalex.org/A5064820449, https://openalex.org/A5087815998, https://openalex.org/A5022025860, https://openalex.org/A5114377375, https://openalex.org/A5027363677, https://openalex.org/A5019790026, https://openalex.org/A5055624183 |
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| corresponding_institution_ids | https://openalex.org/I4210106350, https://openalex.org/I4210107416, https://openalex.org/I4210110902, https://openalex.org/I4210146871, https://openalex.org/I4210162598, https://openalex.org/I97188460 |
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