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CC BY 4.0 · TH Open 2021; 05(01): e1-e7
DOI: 10.1055/s-0040-1722610
Original Article

Cerebral Infarction in Immune Thrombotic Thrombocytopenic Purpura Is Associated with Old Age, Hypertension, Smoking, and Anti-ADAMTS13 Ig, But Not with Mortality

Raima Memon
1   Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Jingrui Sui
1   Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Chen Lin
2   Department of Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
,
X. Long Zheng 
1   Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
3   Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States
› Author Affiliations Funding The study is supported in part by grants from NHLBI (HL126724 to XLZ).
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Abstract

Background Neurological involvement is common in patients with immune thrombotic thrombocytopenic purpura (iTTP), but the frequency, risk factors, and outcomes of these with imaging-confirmed stroke in iTTP are not known.

Methods We selected 66 out of 109 iTTP patients with neurological signs and symptoms and reviewed their CT/MRI (computed tomography/magnetic resonance imaging) findings for the evidence of stroke and other clinical information in Alabama TTP Registry.

Results Of these, 52 (78.8%) had their CT/MRI done on admission in whom 22 (42.3%) were positive for multiple acute or chronic infarcts. The patients with image-confirmed ischemic stroke were older, and appeared to be associated with a history of hypertension and smoking. Additionally, patients with imaging-confirmed stroke showed higher plasma concentrations of anti-ADAMTS13 IgG than those without stroke. More interestingly, there was no statistically significant difference in the rate of exacerbation and 60-day mortality between those with and without stroke.

Conclusion Ischemic cerebral infarcts are common findings in brain imaging studies of patients with acute iTTP; old age, chronic hypertension, and smoking, as well as high plasma concentrations of anti-ADAMTS13 IgG may be the potential risk factors for cerebral infarction in these patients. The presence of image-confirmed ischemic stroke, however, does not predict exacerbation and 60-day mortality, although the long-term effect of such ischemic brain damage on cognitive function and quality of life remains to be determined.

Keywords

thrombotic thrombocytopenic purpura - inflammatory mediators - ADAMS/ADAMTS13 - von Willebrand factor - cerebrovascular disease - autoimmune diseases - autoantibodies

Authors' Contributions

R.M., C.L., J.S., and X.L.Z. designed research, performed experiments, and analyzed the results, as well as wrote the manuscript. All other nonauthors in the acknowledgment contribute to patient recruitment, informed consents, and sample collections. All authors have reviewed and approved the final version of the manuscript for submission.




Publication History

Received: 17 November 2020

Accepted: 30 November 2020

Article published online:
13 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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