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Critical Care |

Pulmonary Manifestations in Patients With Thrombotic Thrombocytopenic Purpura at a Community Hospital Setting

Huimin Wu, MD; Michael Kiel, PhD; Qi Shi, MD
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Internal Medicine Residency Program, The Wright Center for Graduate Medical Education, Scranton, PA


Chest. 2013;144(4_MeetingAbstracts):365A. doi:10.1378/chest.1703532
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Abstract

SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Thrombotic thrombocytopenic purpura (TTP) is a critical, frequently life-threatening disease that is characterized by the pentad of thrombocytopenia, microangiopathic hemolytic anemia, neurological changes, renal dysfunction and fever that classically spares lung tissues. The hypothesis for our project is that pulmonary complications may occur in patients with TTP due to pulmonary microthrombi, immunosuppressive therapy, plasma exchange, or prolonged ICU stays. The aim of our study is to describe the pulmonary manifestations and provide the clinical evidence in this group of patients.

METHODS: We did a retrospective chart review of patients with the diagnosis of TTP from 2004 to 2012 at a community hospital. The patients with a primary diagnosis of TTP were identified. The medical records of the first admission were reviewed. Clinical, laboratory, and other pertinent data were collected and the clinical outcome was documented.

RESULTS: A total of 14 patients with an established primary diagnosis of TTP were included in the analysis (age: 27-83 years; 64% females). While 1 patient had obstructive sleep apnea, others had no history of respiratory disease. Dyspnea was the most common respiratory symptom (64%). Other respiratory symptoms included cough (21%), sputum (7%) and hemoptysis (7%). Seven patients (50%) had abnormal findings on auscultation of the lung, including crackles or diminished breath sounds. Eleven patients (79%) had abnormal chest radiograph findings, including diffuse or local infiltrate, pleural effusion or atelectasis. Of the 13 patients (93%) who needed intensive care unit management, 6 patients required invasive mechanical ventilation, in which 3 patients (50%) died and 1 patient was transferred to a tertiary medical center.

CONCLUSIONS: Our data suggest that pulmonary abnormalities are common in patients with TTP at our community hospital and may predict worse clinical outcomes.

CLINICAL IMPLICATIONS: Pulmonary involvement is not as rare as once was thought. Pulmonary manifestations should be carefully evaluated in patients with TTP. Further studies are needed to better define the pathophysiology and risk factors of developing pulmonary abnormalities in TTP patients.

DISCLOSURE: The following authors have nothing to disclose: Huimin Wu, Michael Kiel, Qi Shi

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