Affiliations 

  • 1 Perth Blood Institute, Perth, Australia
  • 2 Haematology, Hospital Ampang, Malaysia
  • 3 Centre for Clinical Trials, Hospital Ampang, Selangor, Malaysia
  • 4 Haematology, Northern Cancer Service, Tasmania, Australia
  • 5 Haematology, The Alfred Hospital, Melbourne,Australia
  • 6 Haematology, Westmead Hospital, New South Wales, Australia
  • 7 Haematology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • 8 Haematology, The Canberra Hospital, Canberra, Australia
  • 9 Haematology and Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 10 Haematology, Singapore General Hospital, Singapore
  • 11 Haematology, KK Women's and Children's Hospital, Singapore
  • 12 Internal Medicine, Cha Bundang Medical Centre, Cha University, Seongnam, Korea
  • 13 Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 14 Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 15 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
  • 16 Haematology, Canterbury District Health Board, Christchurch, Auckland, New Zealand
  • 17 Haematology, North Shore Hospital, Auckland, New Zealand
  • 18 Calvery Mater Hospital Newcastle, Waratah, New South Wales, Australia
Blood Res, 2023 Mar 31;58(1):36-41.
PMID: 36632683 DOI: 10.5045/br.2023.2022133

Abstract

BACKGROUND: The PLASMIC score is a convenient tool for predicting ADAMTS13 activity of <10%. Lactate dehydrogenase (LDH) is widely used as a marker of haemolysis in thrombotic thrombocytopenic purpura (TTP) monitoring, and could be used as a replacement marker for lysis. We aimed to validate the PLASMIC score in a multi-centre Asia Pacific region, and to explore whether LDH could be used as a replacement marker for lysis.

METHODS: Records of patients with thrombotic microangiopathy (TMA) were reviewed. Patients' ADAMTS13 activity levels were obtained, along with clinical/laboratory findings relevant to the PLASMIC score. Both PLASMIC scores and PLASMIC-LDH scores, in which LDH replaced traditional lysis markers, were calculated. We generated a receiver operator characteristics (ROC) curve and compared the area under the curve values (AUC) to determine the predictive ability of each score.

RESULTS: 46 patients fulfilled the inclusion criteria, of which 34 had ADAMTS13 activity levels of <10%. When the patients were divided into intermediate-to-high risk (scores 5‒7) and low risk (scores 0‒4), the PLASMIC score showed a sensitivity of 97.1% and specificity of 58.3%, with a positive predictive value (PPV) of 86.8% and negative predictive value (NPV) of 87.5%. The PLASMIC-LDH score had a sensitivity of 97.1% and specificity of 33.3%, with a PPV of 80.5% and NPV of 80.0%.

CONCLUSION: Our study validated the utility of the PLASMIC score, and demonstrated PLASMIC-LDH as a reasonable alternative in the absence of traditional lysis markers, to help identify high-risk patients for treatment via plasma exchange.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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