Symptoms of anxiety and depression, deteriorated memory and attention functions, and inferior quality of life may persist in patients with acute thrombotic thrombocytopenic purpura (TTP) in hematologic remission, according to results published in Haematologica.

Neurologic symptoms of microthrombosis characterize acute manifestations of acquired TTP, and even in hematologic remission, persistent neurologic impairment can plague patients and affect their quality of life.

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Researchers evaluated the long-term neuropsychologic outcomes of 35 patients with acute TTP at an outpatient clinic in Italy. In total, 77% of patients were female, and median age at onset was 41 years (interquartile range [IQR], 35-48). These patients were regularly followed at the clinic for microangiopathies between December 2015 and October 2016.

Patients underwent psychologic assessments for memory and attention functions, health-related quality of life, and emotional well-being at least 3 months after their last acute TTP event, with psychologic follow-up occurring a median of 36 months (IQR, 17-54) following the event.

Persistent subjective neurologic deficiencies during a period of hematologic remission were reported by 17 patients. Patient-reported symptoms included headache, dizziness, loss of balance, diplopia, disorientation, and lack of concentration.

Compared with the general Italian population, these patients scored lower on  neuropsychologic evaluations of direct, indirect, and deferred memory.

In patients with neurologic involvement at the presentation of the initial TTP event, a higher degree of impaired memory function persisted at follow-up compared with patients without neurologic involvement at presentation of the initial TTP event.

Symptoms of anxiety and depression were found in 7 and 15 patients, respectively. Health-related quality of life was lower in patients with acute TTP at follow-up compared with the general Italian population. In addition, mental health domains were more affected than physical health domains, with a mean difference of 58.43 between the mental and physical components of the Short Form (36) Health Status Questionnaire.

The authors concluded that despite successful treatment of acute TTP with immunosuppressive therapy and plasma exchange, many patients still suffer from long-term neuropsychologic sequalae for years after the acute phase of the disease. Patients with neuropsychologic manifestations at first presentation of the disease appeared to be particularly susceptible to long-term deleterious mental health effects.

Reference

1.     Riva S, Mancini I, Maino A, et al. Long-term neuropsychological sequelae, emotional wellbeing and quality of life in patients with acquired thrombotic thrombocytopenic purpura [published online September 26, 2019]. Haematologica. doi:10.3324/haematol.2019.226423