{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T23:23:58Z","timestamp":1750202638662,"version":"3.37.3"},"reference-count":10,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,12,22]],"date-time":"2017-12-22T00:00:00Z","timestamp":1513900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:p>Thrombotic thrombocytopenic purpura (TTP) is an acute, life\u2010threatening illness with disseminated platelet\u2010rich thromboses of small vessels that variably presents with the classic clinical \u201cpentad\u201d of microangiopathic hemolytic anemia, thrombocytopenia, fever, altered mental status, and acute kidney injury. Most cases are caused by an acquired autoantibody to ADAMTS13, a metalloproteinase that cleaves large von Willebrand Factor (vWF) multimers. The mainstay of treatment is daily therapeutic plasma exchange (TPE), sometimes with adjunctive pharmacologic immunosuppression. TPE is generally continued until the platelet count is greater than 150 \u00d7 10<jats:sup>3<\/jats:sup>\/\u00b5L and the lactate dehydrogenase is near normal for 2\u20103 consecutive days. Unfortunately, there is no clear guidance for when thrombocytopenia is refractory for a prolonged period of time. The following case describes such a scenario in which consecutive ADAMTS13 activity and inhibitor levels were used to guide the decision to stop treatment with TPE in a patient who failed to recover their platelet count.<\/jats:p>","DOI":"10.1002\/jca.21612","type":"journal-article","created":{"date-parts":[[2017,12,24]],"date-time":"2017-12-24T07:35:43Z","timestamp":1514100943000},"page":"436-438","source":"Crossref","is-referenced-by-count":4,"title":["Therapeutic plasma exchange for thrombotic thrombocytopenic purpura with refractory thrombocytopenia"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4088-6497","authenticated-orcid":false,"given":"Nolan","family":"Maloney","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Dartmouth Hitchcock Medical Center Lebanon New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Dartmouth Hitchcock Medical Center Lebanon New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zbigniew M.","family":"Szczepiorkowski","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Dartmouth Hitchcock Medical Center Lebanon New Hampshire"},{"name":"Department of Medicine Dartmouth Hitchcock Medical Center Lebanon New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy M.","family":"Dunbar","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Dartmouth Hitchcock Medical Center Lebanon New Hampshire"},{"name":"Department of Medicine Dartmouth Hitchcock Medical Center Lebanon New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,12,22]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-196603000-00003"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198212023072306"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V89.9.3097"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.21470_c"},{"key":"e_1_2_4_6_1","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1182\/blood.V128.22.133.133","article-title":"A prospective, randomized study of cyclosporine or corticosteroids as an adjunct to plasma exchange for the treatment of thrombotic thrombocytopenic purpura","volume":"128","author":"Cataland S","year":"2016","journal-title":"Blood"},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-03-703827"},{"key":"e_1_2_4_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13993"},{"key":"e_1_2_4_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2004.05188.x"},{"key":"e_1_2_4_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030288"},{"key":"e_1_2_4_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-03-1173"}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjca.21612","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.21612","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T23:33:00Z","timestamp":1694993580000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.21612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,22]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1002\/jca.21612"],"URL":"https:\/\/doi.org\/10.1002\/jca.21612","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"type":"print","value":"0733-2459"},{"type":"electronic","value":"1098-1101"}],"subject":[],"published":{"date-parts":[[2017,12,22]]}}}