Diagnostic uncertainty presented barriers to the timely management of acute thrombotic thrombocytopenic purpura in the United Kingdom between 2014 and 2019

Background Acute thrombotic thrombocytopenic purpura (TTP) is a life‐threatening emergency and plasma exchange (PEX) is the initial treatment shown to reduce acute mortality. Objectives To compare current practice in the United Kingdom (UK) against the standards set out in the 2012 British Society o...

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Published in:	Journal of thrombosis and haemostasis Vol. 20; no. 6; pp. 1428 - 1436
Main Authors:	Bull, Tom P., Nicolson, Phillip L. R., Doyle, Andrew J., Langridge, Alexander, Pettit, Michala, Perry, Rita, Thomas, William, Page, Catherine, Whalley, Ioana, Dutt, Tina, Garth, Louise, Lester, Will, Buka, Richard J., Subhan, Mary, Ware, Victoria, Etherington, Astrid, Carter‐Brzezinski, Luke, Corrigan, Claire, Benson, Gary, Zhao, Rui, Douglas, Kenneth, Smith, Sophie, Wolf, Julia, Todd, Sophie A., McDonald, Vickie, Rampotas, Alexandros, Dean, Christopher, Sangha, Gavinda, Pavord, Sue, Denny, Nicholas, Jaafar, Sarah, McLaughlin, David P. T., Ross, Jennifer E., Karanth, Mamatha, Beverstock, Sarah L., Mansonso, Lynn, Tauro, Sudhir, Shenouda, Amir, Bailiff, Benjamin M., Kajita, Daniel, Alford, Sarah, Pickard, Keir, Greystoke, Brigit, Abdussalam, Asmaa, Roberts, Lara N, Young, Jennifer, Maddox, Jamie, Wheeldon, Sarah L., Tahhan, Molham, Vickers, Mark, Hill, Quentin, Mustafa, Nadreen, Almaremi, Azza, Hughes, Emily, Loizou, Eleana, James, Izabela, Farmer, Isabel, Thanigaikumar, Murugaiyan, Kerr, Paul, Gooding, Richard, Thornton, Kathryn, Dixon, Kiri I., Crowe, Josephine, De Lord, Corinne, Sud, Amit, Bailey, Chris, Hall, Rachel, Gray, Benjamin, Chauhan, Salena R., Gudger, Amy, Horgan, Claire, Venkatadasari, Indrani, Kaddam, Israa, Mapplebeck, Claire L., Van Veen, Joost, Raj, Maya, De Abrew, Kanchana, Belsham, Edward, Gyansah, Cecilia, Sadullah, Shalal, Salhan, Beena, Murrin, Richard, Williams, Rhys L., Stewart, Andrew, Cornish, Naomi, Ackroyd, Sam, Chen, Lucia Y., Pemberton, Nicholas, Rawi, Emanal, Yong, Jun, Davies, David, Peck, Rachel C., Cahalin, Paul, Prodger, Catherine, Dutton, David A., Sternberg, Alexander J., Chengal, Rajani, Polzella, Paolo, Scully, Marie
Format:	Journal Article
Language:	English
Published:	England Elsevier Limited 01-06-2022 John Wiley and Sons Inc
Subjects:	Apheresis Hospitals immune thrombotic thrombocytopenic purpura Mortality Original Patients plasma exchange PLATELETS Purpura quality improvement service evaluation Thrombocytopenia Thrombocytopenic purpura Thrombotic thrombocytopenic purpura United Kingdom > UK immune thrombotic thrombocytopenic purpura plasma exchange thrombocytopenia quality improvement service evaluation
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Summary:	Background Acute thrombotic thrombocytopenic purpura (TTP) is a life‐threatening emergency and plasma exchange (PEX) is the initial treatment shown to reduce acute mortality. Objectives To compare current practice in the United Kingdom (UK) against the standards set out in the 2012 British Society of Haematology guideline, and to better understand the issues affecting prompt initiation of PEX. Patients/Methods The trainee research network HaemSTAR conducted a retrospective nationwide review of adults presenting to UK hospitals with a first episode of acute TTP. Results Data on 148 patients treated at 80 UK hospitals between 2014 and 2019 demonstrated that 64.8% of patients received PEX within 24 h. Diagnostic uncertainty was the most commonly cited reason for delayed treatment. Conversely, a shorter time to PEX occurred in patients who had red cell fragments or severe thrombocytopenia identified on their first complete blood count. Availability of on‐site PEX was associated with a greater proportion of patients receiving PEX within 8 h compared to patients transferred, but by 24 h there was no difference between the two groups and two‐thirds of all patients had received their first PEX. The mortality rate for patients that received PEX was 9.2%, with 27.8% of deaths linked to delayed treatment initiation. Conclusions This is the first multi‐center evaluation of treatment delays in acute TTP and it will inform targeted pathways to improve prompt access to life‐saving intervention.
Bibliography:	Final decision: David Lillicrap, 16 February 2022 Manuscript handled by: David Lillicrap The HaemSTAR Collaborators are listed in supporting information. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1538-7933 1538-7836 1538-7836
DOI:	10.1111/jth.15681