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Prepublished online as a Blood First Edition Paper on April 17, 2002; DOI 10.1182/blood-2002-02-0344.
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Blood, 15 July 2002, Vol. 100, No. 2, pp. 710-713
BRIEF REPORT
Von Willebrand factor-cleaving protease (ADAMTS13) in
thrombocytopenic disorders: a severely deficient activity is specific
for thrombotic thrombocytopenic purpura
Valentina Bianchi,
Rodolfo Robles,
Lorenzo Alberio,
Miha Furlan, and
Bernhard Lämmle
From the Central Hematology Laboratory, University
Hospital, Inselspital, Bern, Switzerland.
A severe deficiency in von Willebrand factor-cleaving protease
(ADAMTS13) activity (< 5% that in normal plasma) has been observed in
most patients with a diagnosis of thrombotic thrombocytopenic purpura
(TTP) but not in those with a diagnosis of hemolytic uremic syndrome.
However, ADAMTS13 deficiency has been claimed not to be specific for
TTP, since it was observed in various thrombocytopenic and other
conditions. We studied 68 patients with thrombocytopenia due to severe
sepsis or septic shock (n = 17), heparin-induced thrombocytopenia (n = 16), idiopathic thrombocytopenic purpura (n = 10), or other hematologic (n = 15) or miscellaneous conditions (n = 10). Twelve of the 68 patients had subnormal levels of ADAMTS13 activity ( 30%), but none had less than 10%. Thus, the study showed
that ADAMTS13 activity is decreased in a substantial proportion of
patients with thrombocytopenia of various causes. A severe deficiency
of ADAMTS13 (< 5%), identified in more than 120 patients during 1996 to 2001 in our laboratory, is specific for a thrombotic microangiopathy
commonly labeled TTP.

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