Document Detail

Is it quinine TTP/HUS or quinine TMA? ADAMTS13 levels and implications for therapy.
MedLine Citation:
PMID:  19260037     Owner:  NLM     Status:  MEDLINE    
Thrombocytopenia with or without microangiopathy following quinine is often referred to as quinine "hypersensitivity." When schistocytes are present it is frequently termed "quinine-associated TTP/HUS." A severe deficiency of the vWF-cleaving protease, ADAMTS13, is associated with idiopathic TTP. A previous study of patients with "quinine-associated TTP/HUS" found that ADAMTS13 activities were not abnormal in 12/12 patients. A retrospective review of TTP patients with quinine-associated thrombotic microangiopathy (TMA) for whom ADAMTS13 was measured before plasma exchange was performed. Six patients were identified. All were females (age range: 43 to 73, mean = 61.7 years) and had taken quinine for leg cramps. Four of the six experienced renal failure requiring dialysis. Five of the patients had D-Dimers levels measured, all were elevated. In four patients the levels were > or = 18 times the upper limit of normal. ADAMTS13 was normal in four patients and mildly decreased in two patients. We conclude that while thrombocytopenia and schistocytosis can be seen in quinine-associated TTP/HUS, the pathophysiology seems to be distinct from that seen in most cases of idiopathic TTP (i.e., severely decreased ADAMTS13 with an inhibitor). We recommend that a TMA in association with quinine be consistently referred to as quinine-associated thrombotic microangiopathy (quinine-TMA) to better distinguish this entity from idiopathic TTP. The use of plasma exchange in quinine-TMA is called into question.
Yara A Park; Shauna N Hay; Karen E King; Karen Matevosyan; Jessica Poisson; Amy Powers; Ravindra Sarode; Beth Shaz; Mark E Brecher
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of clinical apheresis     Volume:  24     ISSN:  1098-1101     ISO Abbreviation:  J Clin Apher     Publication Date:  2009  
Date Detail:
Created Date:  2009-06-11     Completed Date:  2009-08-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8216305     Medline TA:  J Clin Apher     Country:  United States    
Other Details:
Languages:  eng     Pagination:  115-9     Citation Subset:  IM    
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
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MeSH Terms
ADAM Proteins / blood*
Aged, 80 and over
Fibrin Fibrinogen Degradation Products
Kidney Failure / blood,  chemically induced,  therapy
Middle Aged
Muscle Cramp / blood,  drug therapy
Muscle Relaxants, Central / administration & dosage,  adverse effects*
Plasma Exchange*
Purpura, Thrombocytopenic, Idiopathic / blood*,  chemically induced*,  therapy*
Quinine / administration & dosage,  adverse effects*
Renal Dialysis
Retrospective Studies
Reg. No./Substance:
0/Fibrin Fibrinogen Degradation Products; 0/Muscle Relaxants, Central; 0/fibrin fragment D; 130-95-0/Quinine; EC 3.4.24.-/ADAM Proteins; EC 3.4.24.-/ADAMTS13 protein, human

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