The Clinical Significance Of TTP And APS PLASMIC Score

?Objective and Background?Thrombotic microangiopathy(TMA)is a group of extremely acute acute clinical syndromes with microangiopathic hemolytic anemia,thrombocytopenia,and multiple organ microembolism.Recent studies have shown that early recognition delays in TMA are leading to high lethality,as plasma exchange(PE)within 24 hours can reduce mortality by 90% to 20%;however,early diagnosis of this syndrome is difficult,even if ADAMTS13 is later found to be lower than 10% improves the specificity of the diagnosis of thrombotic thrombocytopenic purpura(TTP),but laboratory reports often take several days.We are concerned that the newly published PLASMIC scoring system validated among Caucasians can be used to distinguish between severe ADAMTS13 deficiency and early recognition of TTP,but it is not clear whether it is suitable for Chinese patients.Therefore,this study adopts this scoring system to verify the retrospective study of TTP cases admitted in our hospital in the past six years.At the same time,we can further learn from the scoring system to explore the possibility of APS prediction,and add the cell enzyme index that can be urgently checked at any time in clinical practice.And coagulation indicators were comprehensively evaluated to explore the clinical significance of the PLASMIC scoring system for TTP and APS.?Methods?The cases were selected from December 2012 to December 2018 in the Second Affiliated Hospital of Fujian Medical University,and patients diagnosed with TTP and APS were discharged.TTP uses the 2012 TTP China Expert Consensus.APS uses the revised classification criteria of the 2006 Sydney International APS Conference.The records include the patient's main clinical signs and symptoms,laboratory tests,treatment options,and outcomes.A total of 22 patients with TTP diagnosed and discharged were excluded.A total of 15 patients with effective TTP were enrolled after repeated hospitalization and incomplete data.A total of 95 patients with atrial diagnosis of APS were excluded,and cases of repeated hospitalization and lack of data were excluded.A total of 44 patients with effective APS were enrolled.All patients with TTP and APS were scored in conjunction with the PLASMIC scoring system and related literature to explore their clinical value.?Results?1.Among the 15 patients with TTP,6 were male and 9 were female.All patients had hemolytic anemia and thrombocytopenia.Among them,10 had renal damage,8 had neuropsychiatric symptoms,9 had fever,and 15 had TTP patients.The PLASMIC scores were moderately risky and above,of which 14 patients reached a high risk level;9 of the 15 TTP patients were tested for ADAMTS13 activity,all with severe reduction(<10%),and 8 of them had severe severe reduction(<5%)Of the 9 TTP patients who underwent ADAMTS13 activity testing,8 had a high risk of PLASMIC scores,and only 1 had a moderate risk level.13 cases of peripheral blood smear showed broken red blood cells;all patients were given hormone therapy,5 cases combined with other drugs(3 cases with rituximab,3 combined with immunosuppressive agents);6 cases of TTP patients improved,8 cases There was no remission or automatic discharge,and 1 patient died;9 of them underwent plasma exchange therapy,5 of which were improved;5 of 6 patients who were not treated with plasmapheres were rapidly aggravated.2.1 Of the 44 APS patients,14 were male and 30 were female.All patients had no history of solid organ or stem cell transplantation,and there was no active cancer.9 of the PLASMIC scores were low-risk,31 were moderate,and 4 were High risk levels were achieved;platelet counts(AUC 0.98;p < 0.001),percentage of reticulocytes(AUC 0.851;p < 0.001),and indirect bilirubin(AUC 0.894;p < 0.001)in the PLASMIC scoring system in the PLASMIC scoring system Some indicators have predictive value for APS.2.2 Among the cell enzymes that can be urgently examined at any time,lactate dehydrogenase(AUC value 0.970;p <0.001),aspartate aminotransferase(AUC value 0.839;p <0.001)and coagulation index D-Dimer(AUC value 0.877;p <0.001),suggesting a good predictive value in APS.?Conclusion?The PLASMIC scoring system helps to assess the risk of rapid ADAMTS13 severe defects in patients with suspected TTP,benefiting early diagnosis and timely intervention to improve prognosis;the improved PLASMIC± scoring system in this study(added to some cellular enzymes and coagulation Indicators)show a certain predictive value in APS.