Contributions
Abstract: PB2101
Type: Publication Only
Background
Thrombotic thrombocytopenic purpura (TTP) has a high mortality rate. The cornerstone of management is plasma exchange (PE) which usually requires urgent insertion of a central venous catheter. Patients often have a platelet count of <50x109/L at presentation however, National BCSH Guidance advises against platelet transfusion in TTP due to the perceived high aggregability state and reports of associated fatal thrombosis. The risk of thrombocytopaenia related haemorrhage however creates anxiety and dilemma for the team responsible for line insertion and may lead to delays or unnecessary platelet transfusion.
Aims
The aim of the study is determine the average platelet count at time of line insertion and to see if any bleeding complications are observed.
Methods
We retrospectively reviewed all central venous catheter lines inserted in patients presenting to a regional TTP Centre over a 4-year period from 2012-2016.
Results
A total of 48 patients confirmed to have TTP with an ADAMTS13 <5% underwent line insertion: 94 central venous catheter lines were inserted: 40% femoral, 60%–internal jugular vein. The median number of lines inserted per patient episode was 3, with a range of 1-5. Median presenting platelet count for first line insertion was 25x109/L (IQR 9-26 x109/L). 70% of lines were inserted by critical care and the remaining 30% by interventional radiology. Platelet transfusion was not administered pre line insertion in any case. No significant bleeding complications were documented during or after line insertion. 5 patients had ‘excessive oozing at the insertion site’ documented, within the first 24 hours of insertion, for which no intervention was required. There were no deaths related to line insertion.
Conclusion
In conclusion, this study shows no significant bleeding risk associated with central venous catheter insertion in thrombocytopenic patients presenting with TTP. The results support guidance against prophylactic platelet transfusion in this setting and provide reassurance for teams tasked with central line insertion in this critically unwell patient group.
Session topic: 32. Platelets disorders
Keyword(s): TTP, Platelet transfusion
Abstract: PB2101
Type: Publication Only
Background
Thrombotic thrombocytopenic purpura (TTP) has a high mortality rate. The cornerstone of management is plasma exchange (PE) which usually requires urgent insertion of a central venous catheter. Patients often have a platelet count of <50x109/L at presentation however, National BCSH Guidance advises against platelet transfusion in TTP due to the perceived high aggregability state and reports of associated fatal thrombosis. The risk of thrombocytopaenia related haemorrhage however creates anxiety and dilemma for the team responsible for line insertion and may lead to delays or unnecessary platelet transfusion.
Aims
The aim of the study is determine the average platelet count at time of line insertion and to see if any bleeding complications are observed.
Methods
We retrospectively reviewed all central venous catheter lines inserted in patients presenting to a regional TTP Centre over a 4-year period from 2012-2016.
Results
A total of 48 patients confirmed to have TTP with an ADAMTS13 <5% underwent line insertion: 94 central venous catheter lines were inserted: 40% femoral, 60%–internal jugular vein. The median number of lines inserted per patient episode was 3, with a range of 1-5. Median presenting platelet count for first line insertion was 25x109/L (IQR 9-26 x109/L). 70% of lines were inserted by critical care and the remaining 30% by interventional radiology. Platelet transfusion was not administered pre line insertion in any case. No significant bleeding complications were documented during or after line insertion. 5 patients had ‘excessive oozing at the insertion site’ documented, within the first 24 hours of insertion, for which no intervention was required. There were no deaths related to line insertion.
Conclusion
In conclusion, this study shows no significant bleeding risk associated with central venous catheter insertion in thrombocytopenic patients presenting with TTP. The results support guidance against prophylactic platelet transfusion in this setting and provide reassurance for teams tasked with central line insertion in this critically unwell patient group.
Session topic: 32. Platelets disorders
Keyword(s): TTP, Platelet transfusion