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Clinical Characteristics and Treatment Courses of Trauma-Induced Thrombotic Microangiopathy: A Retrospective Study.

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  • المؤلفون: Hwang S;Hwang S; Kim GW; Kim GW; Cho SH; Cho SH; Lim KH; Lim KH
  • المصدر:
    Journal of clinical medicine [J Clin Med] 2024 Oct 30; Vol. 13 (21). Date of Electronic Publication: 2024 Oct 30.
  • نوع النشر :
    Journal Article
  • اللغة:
    English
  • معلومة اضافية
    • المصدر:
      Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101606588 Publication Model: Electronic Cited Medium: Print ISSN: 2077-0383 (Print) Linking ISSN: 20770383 NLM ISO Abbreviation: J Clin Med Subsets: PubMed not MEDLINE
    • بيانات النشر:
      Original Publication: Basel, Switzerland : MDPI AG, [2012]-
    • نبذة مختصرة :
      Introduction: Thrombotic microangiopathy (TMA), defined by thrombocytopenia, microangiopathic hemolytic anemia, and organ injury, is not widely recognized as being trauma-related. This study aimed to describe the clinical features and outcomes of trauma-induced TMA (t-TMA) to assist in early diagnosis and management. Methods: A retrospective review was conducted on 30 trauma patients diagnosed with t-TMA between 2014 and 2019. Demographic, clinical, and laboratory data, as well as treatment methods, were analyzed. Results: Thrombocytopenia (<50,000/µL) occurred, on average, 2.9 days post-trauma, with diagnosis following 3.6 days later. Patients had a mean age of 67.6 years, and 63.3% were male. Clinical presentations included acute kidney injury (AKI) requiring renal replacement therapy (86.7%), altered mental status (53.3%), non-infectious fever (50%), and digital necrosis (43.3%). Eighteen patients were treated with therapeutic plasma exchange (TPE) alone, nine with TPE and methylprednisolone, and three with methylprednisolone alone. Remission was achieved in 96.7% of all cases. The mean TPE duration was 6.1 days, prolonged by prior platelet transfusions. The mortality rate was 26.7% (8/30), with sepsis being the most common cause of death (five patients), particularly for those treated with TPE and methylprednisolone. Conclusions: Trauma-induced TMA should be suspected in trauma patients presenting with unexplained thrombocytopenia, AKI, and elevated LDH. Early diagnosis and prompt treatment are crucial, while unnecessary platelet transfusions should be avoided. Careful infection management is critical to improving patient outcomes, particularly if patients are treated with TPE and methylprednisolone.
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    • Grant Information:
      2021 Kyungpook National University Research Fund, 2021.
    • Contributed Indexing:
      Keywords: acute renal failure; sepsis; therapeutic plasma exchange; thrombotic microangiopathy; trauma
    • الموضوع:
      Date Created: 20241109 Latest Revision: 20241116
    • الموضوع:
      20250114
    • الرقم المعرف:
      PMC11547120
    • الرقم المعرف:
      10.3390/jcm13216527
    • الرقم المعرف:
      39518668