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June 8, 2005

Cocaine-Induced Acute Hepatitis and Thrombotic Microangiopathy—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(22):2715-2716. doi:10.1001/jama.293.22.2715-b

In Reply: Drs El-Rahman and Ammar suggest an equivalence between TMA and TTP, and advocate for plasma exchange with fresh-frozen plasma. Thrombotic microangiopathy represents a syndrome that may result from different conditions, which include TTP, hemolytic-uremic syndrome, acute postpartum and contraceptive-associated renal failure, malignant hypertension, HELLP (hemolysis, elevated liver enzymes, and low platelet count in association with eclampsia) syndrome, cancer, immunosuppressive therapy, and catastrophic antiphospholipid syndrome.1,2 Not all share the severe deficiency of, or the inhibitory activity against, the von Willebrand factor–cleaving protease ADAMTS-13, which is present in TTP, leaving unclear the role of plasma exchange in the treatment of (for example) adult patients with hemolytic-uremic syndrome.3

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