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Acquired ADAMTS-13 deficiency in pediatric patients with severe sepsis

From the Department of Pediatrics (TCN, KA); Thrombosis Research Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA (AL, LL, CB, HC, WSM, ALB, J-fD)

Correspondence: Jing-fei Dong, Thrombosis Research Section, Department of Medicine, BCM286, N1319, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA. E-mail: jfdong{at}bcm.tmc.edu

We studied the state of ultralarge von Willebrand factor (ULVWF) proteolysis in 21 pediatric patients with severe sepsis and found that the overall group of patients had moderately reduced ADAMTS-13 activity, but 31% had severe enzymatic deficiency. The severe deficiency correlated with greater adhesion activity of von Willebrand factor, severity of thrombocytopenia and plasma levels of interleukin-6. It also correlated clinically with severity of illness and organ dysfunction. These results suggest that ULVWF proteolysis is insufficient in septic patients and severely deficient in a subgroup of patients. The deficiency may contribute to the development of thrombocytopenia and ischemic organ failure associated with sepsis.

Key words: sepsis, ADAMTS-13, ULWF, thrombotic microangiopathy.

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