Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 33
Filter
1.
J Clin Apher ; 36(4): 628-633, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1748739

ABSTRACT

BACKGROUND: Criteria for selection of FFP blood type has not been clearly established and use of group AB plasma is preferred by numerous transplantation protocols. AIMS: This study assesses the safety and efficacy of alternative group A or B plasma in ABO incompatible solid organ transplantation. MATERIALS & METHODS: Alternative use of group A or B plasma (incompatible plasma) was inevitable during the shortage of group AB plasma. Experience from select number of patients during the period of extreme group AB plasma shortage is described. RESULTS: The result of alternative use of group A or B plasma was within expectation, showing effective reduction of isoagglutinin titers for pre-operative desensitization and efficacy for treatment of post-operative patients. No immediate hemolytic transfusion reaction was reported. DISCUSSION: While validation in a larger cohort of patients is necessary, our limited experience have shown satisfactory clinical outcomes without adverse events. CONCLUSIONS: Use of incompatible group A or B plasma is a viable option when group AB plasma is limited.


Subject(s)
ABO Blood-Group System , Blood Group Incompatibility/therapy , Plasma Exchange/methods , Transplantation/methods , Agglutinins/chemistry , Blood Banks/supply & distribution , Graft Survival , Hemolysis , Humans , Kidney Transplantation/adverse effects , Patient Safety , Plasma/immunology , Plasmapheresis , Transfusion Reaction , Treatment Outcome
2.
Blood Purif ; 50(3): 290-297, 2021.
Article in English | MEDLINE | ID: covidwho-1533118

ABSTRACT

The principles and use of plasmapheresis are often little understood by intensivists. We propose to review the principles, the main indications, and the methods of using this technique.


Subject(s)
Critical Care/methods , Plasma Exchange/methods , Animals , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/therapy , COVID-19/therapy , Equipment Design , Guillain-Barre Syndrome/therapy , Humans , Liver Failure, Acute/therapy , Membranes, Artificial , Plasma Exchange/instrumentation , Purpura, Thrombotic Thrombocytopenic/therapy
3.
J Clin Apher ; 36(6): 849-863, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1479409

ABSTRACT

INTRODUCTION: Therapeutic plasma exchange (TPE) for neuroimmunological disorders has played an increasingly important role within the Southeast Asian (SEA) region. The South East Asian Therapeutic Plasma exchange Consortium (SEATPEC) was formed in 2018 to promote education and research on TPE within the region. The advent of the Covid-19 pandemic has produced challenges for the development and expansion of this service. METHODOLOGY: A qualitative and semi-quantitative questionnaire-based survey was conducted by SEATPEC member countries from January to June 2020 (Phase 1) and then from July 2020 to January 2021 in (Phase 2) to assess the impact of Covid-19 on regional TPE. OBJECTIVES: The study's main objectives were to explore the challenges experienced and adaptations/adjustments taken by SEATPEC countries in order to continue safe and efficient TPE during the Covid-19 pandemic. RESULTS: The pandemic was found to disrupt the delivery of TPE services in all SEATPEC countries. Contributing factors were multifactorial due to overstretched medical services, staff shortages, quarantines and redeployments, fear of acquiring Covid-19, movement restriction orders, and patient's psychological fear of attending hospitals/testing for Covid-19. All SEATPEC countries practiced careful stratification of cases for TPE (electives vs emergencies, Covid-19 vs non-Covid-19 cases). SEATPEC countries had to modify TPE treatment protocols to include careful preprocedure screening of patient's for Covid-19, use of personal protective equipment (PPE) and post-TPE sanitization of machines and TPE suites. CONCLUSION: Based on the responses of the survey, SEATPEC countries produced a consensus statement with five recommendations for safe and effective TPE within the region.


Subject(s)
COVID-19 , Plasma Exchange , Asia, Southeastern/epidemiology , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Consensus , Humans , Nervous System Diseases/complications , Nervous System Diseases/therapy , Neurologists , Pandemics , Plasma Exchange/methods , Plasma Exchange/statistics & numerical data , SARS-CoV-2 , Surveys and Questionnaires
4.
J Clin Apher ; 37(1): 117-121, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1473857

ABSTRACT

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a newly described hematologic disorder, which presents as acute thrombocytopenia and thrombosis after administration of the ChAdOx1 nCov-19 (AstraZeneca) and Ad26.COV2.S (Johnson & Johnson) adenovirus-based vaccines against COVID-19. Due to positive assays for antibodies against platelet factor 4 (PF4), VITT is managed similarly to autoimmune heparin-induced thrombocytopenia (HIT) with intravenous immunoglobulin (IVIG) and non-heparin anticoagulation. We describe a case of VITT in a 50-year-old man with antecedent alcoholic cirrhosis who presented with platelets of 7 × 103 /µL and portal vein thrombosis 21 days following administration of the Ad26.COV2.S COVID-19 vaccine. The patient developed progressive thrombosis and persistent severe thrombocytopenia despite IVIG, rituximab and high-dose steroids and had persistent anti-PF4 antibodies over 30 days after his initial presentation. As such, delayed therapeutic plasma exchange (TPE) was pursued on day 32 of admission as salvage therapy, with a sustained improvement in his platelet count. Our case serves as proof-of-concept of the efficacy of TPE in VITT.


Subject(s)
/adverse effects , Plasma Exchange/methods , Purpura, Thrombocytopenic, Idiopathic/therapy , Vaccination/adverse effects , Humans , Male , Middle Aged , Platelet Count , Platelet Factor 4/immunology , Purpura, Thrombocytopenic, Idiopathic/etiology
5.
Transfus Apher Sci ; 61(1): 103292, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1466939

ABSTRACT

The psychosocial consequences of the COVID-19 pandemic caused multifaceted challenges in clinical and therapeutic practices. This was the case at the Therapeutic Apheresis Unit of the Padua University Hospital too. Several published reports describe the increase in alcohol and food addiction diseases. In this context, during the last months, the Padua Therapeutic Apheresis Unit treated many more patients with acute pancreatitis due to severe hypertriglyceridemia with therapeutic plasma exchange than in the previous ten years. Furthermore, retrospective cohort studies have been recently published describing the onset of acute pancreatitis during the COVID-19 infection even if, to date, there is still insufficient evidence to estabilish a direct causality. Anyway, the COVID-19 pandemic translated into changes of the overall disease prevalence scenario and therefore the Padua Therapeutic Apheresis Unit will need to reorganise its Therapeutic Apheresis activity.


Subject(s)
Hypertriglyceridemia/complications , Pancreatitis/etiology , Pancreatitis/physiopathology , Pancreatitis/therapy , Plasma Exchange/methods , Adult , COVID-19 , Female , Humans , Hypertriglyceridemia/physiopathology , Male , Middle Aged , SARS-CoV-2
6.
Neurologist ; 26(5): 196-224, 2021 Sep 07.
Article in English | MEDLINE | ID: covidwho-1398198

ABSTRACT

BACKGROUND: Central nervous system complications are reported in an increasing number of patients with Coronavirus Disease 2019 (COVID-19). COVID-19-related Guillain-Barré syndrome (GBS) is of particular importance given its association with higher mortality rates and prolonged respiratory failure. REVIEW SUMMARY: We conducted a systematic review of published cases for COVID-19-related GBS, and provide a summary of clinical management strategies for these cases. Sixty-three studies, including 86 patients, were included. Seventy-six cases with reported outcome data were eligible for the outcome analysis. Ninety-nine percent of patients were diagnosed with COVID-19 before diagnosis of GBS (median: 14 d prior, interquartile range: 7 to 20). Intravenous immunotherapy (intravenous immunoglobulin: 0.4 g/kg/d for 5 d) was the most frequently used treatment approach. The review indicated that the outcome was not favorable in 26% of cases (persistent neurological deficits). A mortality rate of 3.5% was observed in patients with COVID-19-related GBS. CONCLUSIONS: Although evidence to support specific treatments is lacking, clinicians should consider the benefits of immunotherapy and plasma exchange in addition to the standard antimicrobial and supportive therapies for patients who meet the diagnostic criteria for acute sensory and motor polyradiculoneuritis. Intravenous immunoglobulin treatment alone is not shown to result in improved outcomes or mortality. More extensive studies aimed at exploring the neurological manifestations and complications of COVID-19 and distinctive treatment options for COVID-19-related GBS are warranted.


Subject(s)
COVID-19/drug therapy , Guillain-Barre Syndrome/drug therapy , Immunoglobulins, Intravenous/therapeutic use , SARS-CoV-2/drug effects , Thyroid Neoplasms/drug therapy , Guillain-Barre Syndrome/diagnosis , Humans , Plasma Exchange/methods , Plasmapheresis/adverse effects , Plasmapheresis/methods
7.
JAMA Cardiol ; 6(12): 1451-1460, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1349213

ABSTRACT

Importance: The COVID-19 pandemic saw one of the fastest developments of vaccines in an effort to combat an out-of-control pandemic. The 2 most common COVID-19 vaccine platforms currently in use, messenger RNA (mRNA) and adenovirus vector, were developed on the basis of previous research in use of this technology. Postauthorization surveillance of COVID-19 vaccines has identified safety signals, including unusual cases of thrombocytopenia with thrombosis reported in recipients of adenoviral vector vaccines. One of the devastating manifestations of this syndrome, termed vaccine-induced immune thrombotic thrombocytopenia (VITT), is cerebral venous sinus thrombosis (CVST). This review summarizes the current evidence and indications regarding biology, clinical characteristics, and pharmacological management of VITT with CVST. Observations: VITT appears to be similar to heparin-induced thrombocytopenia (HIT), with both disorders associated with thrombocytopenia, thrombosis, and presence of autoantibodies to platelet factor 4 (PF4). Unlike VITT, HIT is triggered by recent exposure to heparin. Owing to similarities between these 2 conditions and lack of high-quality evidence, interim recommendations suggest avoiding heparin and heparin analogues in patients with VITT. Based on initial reports, female sex and age younger than 60 years were identified as possible risk factors for VITT. Treatment consists of therapeutic anticoagulation with nonheparin anticoagulants and prevention of formation of autoantibody-PF4 complexes, the latter being achieved by administration of high-dose intravenous immunoglobin (IVIG). Steroids, which can theoretically inhibit the production of new antibodies, have been used in combination with IVIG. In severe cases, plasma exchange should be used for clearing autoantibodies. Monoclonal antibodies, such as rituximab and eculizumab, can be considered when other therapies fail. Routine platelet transfusions, aspirin, and warfarin should be avoided because of the possibility of worsening thrombosis and magnifying bleeding risk. Conclusions and Relevance: Adverse events like VITT, while uncommon, have been described despite vaccination remaining the most essential component in the fight against the COVID-19 pandemic. While it seems logical to consider the use of types of vaccines (eg, mRNA-based administration) in individuals at high risk, treatment should consist of therapeutic anticoagulation mostly with nonheparin products and IVIG.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Purpura, Thrombotic Thrombocytopenic/etiology , Sinus Thrombosis, Intracranial/complications , Adult , Age Factors , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/therapeutic use , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Autoantibodies/immunology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/immunology , Combined Modality Therapy/methods , Female , Humans , Immunoglobulins, Intravenous/administration & dosage , Immunoglobulins, Intravenous/therapeutic use , Male , Middle Aged , Plasma Exchange/methods , Platelet Factor 4/immunology , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/drug therapy , Purpura, Thrombotic Thrombocytopenic/physiopathology , Risk Factors , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Safety , Sex Characteristics , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/physiopathology , Steroids/administration & dosage , Steroids/therapeutic use
8.
Clin Neurol Neurosurg ; 207: 106775, 2021 08.
Article in English | MEDLINE | ID: covidwho-1338371

ABSTRACT

Post-infectious/immune mediated effects of COVID-19 infection include descriptions of Guillain-Barré syndrome (GBS) in patients usually with respiratory failure and after 1-2 weeks from the onset of viral illness. Asymptomatic cases for COVID-19 infection were rarely described. Herein, we studied a 62-year-old patient with progressive weakness of lower extremities, rapidly evolving to a severe, flaccid tetraplegia and dysphagia. Neurological symptoms weren't preceded by fever or pulmonary symptoms. Because of laboratory test abnormalities (thrombocytopenia, lymphocytopenia, high inflammation indexes), the patient underwent to nasopharyngeal swab, resulted positive for SARS-CoV-2 on RT-PCR assay; cerebrospinal fluid (CSF) was negative for SARS-CoV-2. The clinical (severe symmetric distal upper and lower limbs weakness, grade 0/5; decreased proprioceptive sensitivity and hypoesthesia involving the four limbs; loss of deep tendon reflexes), electrophysiological (prevailing axonal polyradiculoneuritis) and CSF features (albumino-cytological dissociation) disclosed the GBS diagnosis (level 1 of diagnostic certainty according to the Brighton criteria). The patient received plasma exchange and immunoglobulin, and, at 4 weeks after treatment and physical therapy, the patient had moderate improvement (weakness at lower and upper extremities was grade 2/5 and 3/5, respectively). Neurologists and clinicians should be aware of the possible link between neurological symptoms and COVID-19 infection, not only after viral prodrome and pulmonary symptoms, but also without COVID-19 symptoms.


Subject(s)
COVID-19/complications , COVID-19/diagnostic imaging , Guillain-Barre Syndrome/diagnostic imaging , Guillain-Barre Syndrome/etiology , COVID-19/therapy , Guillain-Barre Syndrome/therapy , Humans , Male , Middle Aged , Plasma Exchange/methods
9.
Transfus Apher Sci ; 60(4): 103174, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1251570

ABSTRACT

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is associated with high titers of immunoglobulin G class antibodies directed against the cationic platelet chemokine platelet factor 4 (PF4). These antibodies activate platelets via FcγIIa receptors. VITT closely resembles heparin-induced thrombocytopenia. Inflammation and tissue trauma substantially increase the risk for forming pathogenic PF4 antibodies. We therefore propose the use of therapeutic plasma exchange as rescue therapy in VITT to deplete antibodies plus factors promoting inflammation such as excess cytokines in the circulation as well as extracellular vesicles derived from activated platelets.


Subject(s)
COVID-19 Vaccines/adverse effects , Plasma Exchange , Platelet Factor 4/immunology , Purpura, Thrombotic Thrombocytopenic/therapy , Salvage Therapy , Albumins , Antibody Specificity , Anticoagulants , Autoantibodies/immunology , COVID-19 Vaccines/pharmacology , Citrates , Contraindications, Procedure , Cytokines/blood , Extracellular Vesicles , Humans , Immunoglobulin G/immunology , Inflammation , Plasma Exchange/adverse effects , Plasma Exchange/methods , Platelet Activation , Platelet Transfusion/adverse effects , Purpura, Thrombotic Thrombocytopenic/etiology , Purpura, Thrombotic Thrombocytopenic/immunology , Registries , Thrombocytopenia/etiology , Thrombosis/etiology
10.
Int J Antimicrob Agents ; 57(5): 106334, 2021 May.
Article in English | MEDLINE | ID: covidwho-1213262

ABSTRACT

Assessment of efficacy of therapeutic plasma exchange (TPE) following life-threatening COVID-19. This was an open-label, randomised clinical trial of ICU patients with life-threatening COVID-19 (positive RT-qPCR plus ARDS, sepsis, organ failure, hyperinflammation). Study was terminated after 87/120 patients enrolled. Standard treatment plus TPE (n = 43) versus standard treatment (n = 44), and stratified by PaO2/FiO2 ratio (>150 vs. ≤150), were compared. Primary outcomes were 35-day mortality and TPE safety. Secondary outcomes were association between TPE and mortality, improvement in SOFA score, change in inflammatory biomarkers, days on mechanical ventilation (MV), and ICU length of stay (LOS). Eighty-seven patients [median age 49 (IQR 34-63) years; 82.8% male] were randomised (44 standard care; 43 standard care plus TPE). Days on MV (P = 0.007) and ICU LOS (P = 0.02) were lower in the TPE group. 35-Day mortality was non-significantly lower in the TPE group (20.9% vs. 34.1%; Kaplan-Meier, P = 0.582). TPE was associated with increased lymphocytes and ADAMTS-13 activity and decreased serum lactate, lactate dehydrogenase, ferritin, d-dimers and interleukin-6. Multivariable regression analysis provided several predictors of 35-day mortality: PaO2/FiO2 ratio (HR, 0.98, 95% CI 0.96-1.00; P = 0.02]; ADAMTS-13 activity (HR, 0.89, 95% CI 0.82-0.98; P = 0.01); pulmonary embolism (HR, 3.57, 95% CI 1.43-8.92; P = 0.007). Post-hoc analysis revealed a significant reduction in SOFA score for TPE patients (P < 0.05). In critically-ill COVID-19 patients, addition of TPE to standard ICU therapy was associated with faster clinical recovery and no increased 35-day mortality.


Subject(s)
COVID-19/drug therapy , COVID-19/etiology , Plasma Exchange/methods , Adult , COVID-19/mortality , COVID-19/therapy , Critical Care , Critical Illness , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Plasma Exchange/adverse effects , Treatment Outcome
11.
J Thromb Thrombolysis ; 52(2): 504-507, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1202813

ABSTRACT

Thrombotic thrombocytopenic purpura (TTP) which can cause significant mortality is a thrombotic microangiopathy due to deficiency of VWF cleaving protease ADAMTS13 and as per medical literature there are examples that TTP can be caused by COVID 19 infection. A 35 years old female after admission with right sided weakness and slurring of speech was found to be COVID positive and diagnosed as a case of TTP. Patient had absent ADAMTS13 level on day 1. Treatment was started with therapeutic plasma exchange (TPE) later injection Vincristine and Rituximab was given after 4th TPE as it was suspected as refractory case. Finally patient received 16 TPE procedures with cryo poor plasma as exchange fluid and gradually her platelet count started to maintain normal and she was discharged. Specific management and such association of this type of cases need to be studied more judiciously.


Subject(s)
ADAMTS13 Protein , COVID-19 , Purpura, Thrombotic Thrombocytopenic , Rituximab/administration & dosage , Vincristine/administration & dosage , ADAMTS13 Protein/blood , ADAMTS13 Protein/deficiency , Adult , Antineoplastic Agents/administration & dosage , COVID-19/blood , COVID-19/complications , COVID-19/diagnosis , Female , Humans , Immunologic Factors/administration & dosage , Plasma Exchange/methods , Platelet Count/methods , Purpura, Thrombotic Thrombocytopenic/blood , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/etiology , Purpura, Thrombotic Thrombocytopenic/therapy , SARS-CoV-2/isolation & purification , Treatment Outcome
12.
Ther Apher Dial ; 25(4): 390-400, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1197083

ABSTRACT

We retrospectively analyzed the characteristics and outcomes of five patients with COVID-19 who were received glucocorticoid (with or without pulse therapy) and therapeutic plasma exchange. The efficacy of the treatment was determined by whether the patient was able to be transferred from the COVID-19 exclusive ICU to the general ward. In comparing patients who received prednisolone pulse therapy (three cases) with those who did not (two cases), 2/3 (66%) and 0/2 (0%) patients could be discharged from the COVID-19 dedicated ICU, respectively. Among five patients who was performed plasma exchange, two elderly male patients who underwent plasma exchange as early as within 8 days of disease exacerbation survived and were able to be transferred to the general ward. This observational study indicates that plasma exchange in conjunction with methylprednisolone pulse therapy at the appropriate time may be an effective treatment for elderly patients with severe COVID-19.


Subject(s)
COVID-19/therapy , Glucocorticoids/therapeutic use , Plasma Exchange/methods , SARS-CoV-2 , Aged , Aged, 80 and over , Combined Modality Therapy , Fatal Outcome , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
13.
Transfus Apher Sci ; 60(3): 103119, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1164555

ABSTRACT

This study aimed to evaluate the effectiveness and the role of therapeutic plasma exchange (TPE) in treatment of children with severe MIS-C. In addition, we assessed demographic data, clinical features, laboratory abnormalities, underlying conditions, treatments, and outcomes. Patients with severe MIS-C who were admitted to the pediatric intensive care unit (PICU) between September 01 and October 05, 2020 were included in this observational, descriptive, retrospective study. The data collected included the patients' demographic data, presenting symptoms, clinical features, laboratory parameters, diagnostic investigations, and medications. Of 27 children with MIS-C, 63 % were male. The median age of the patients was nine years. Intravenous immunoglobulin and corticosteroids were used for treatment in 100 % of the patients, anakinra in 51.8 %, vasopressors in 85.1 %, noninvasive mechanical ventilation in 25.9 %, and invasive mechanical ventilation in 18.5 %. Ten of the 27 patients (37 %) underwent TPE. In the patients who underwent TPE, the median PELOD score was 21 (IQR: 11-30.25) before TPE and 10 (IQR: 10-11) after TPE (p < 0.001). Moreover, their median left ventricular ejection fraction (LVEF) was 52 % (IQR: 49.25 %-55 %) before TPE and median LVEF was 66.5 (IQR: 58 %-68.5 %) after TPE (p = 0.012). The median number of TPE sessions was three (IQR: 2-4.75). The mortality rate of the patients with severe MIS-C admitted to the PICU was 7.4 %. We suggest that TPE should be considered as a therapeutic option in children with severe MIS-C. Early initiation of TPE followed by immunomodulatory therapy in critically ill children with MIS-C may help improve clinical and laboratory outcomes.


Subject(s)
Critical Illness/therapy , Multiple System Atrophy/therapy , Plasma Exchange/methods , Adolescent , Child , Female , Humans , Intensive Care Units, Pediatric , Male , Multiple System Atrophy/pathology
14.
Chest ; 159(3): e151-e154, 2021 03.
Article in English | MEDLINE | ID: covidwho-1108122

ABSTRACT

CASE PRESENTATION: A 64-year-old previously healthy man presented with 8 weeks of progressive dyspnea on exertion and cough. Prior to presentation, the patient was able to bicycle > 60 miles per week and work full-time in a home improvement store. He was up-to-date with age-appropriate cancer screening and immunizations, and home medications included famotidine for reflux and nonsteroidal antiinflammatories for osteoarthritis, both as-needed. He had no significant respiratory exposure, aside from previous work as an electrician. His symptoms began in mid-February 2020 amid the coronavirus disease 2019 pandemic, although he had no known exposure to the virus.


Subject(s)
COVID-19/diagnosis , Fructose-Bisphosphate Aldolase/blood , Glucocorticoids/administration & dosage , Lung/diagnostic imaging , Myositis , Plasma Exchange/methods , Rituximab/administration & dosage , Threonine-tRNA Ligase/immunology , Autoantibodies/blood , Diagnosis, Differential , Disease Progression , Humans , Immunosuppressive Agents/administration & dosage , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/physiopathology , Male , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/etiology , Myositis/blood , Myositis/diagnosis , Myositis/physiopathology , Myositis/therapy , Oxygen Inhalation Therapy/methods , Prognosis , Treatment Outcome
15.
Transfus Apher Sci ; 60(3): 103107, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1104307

ABSTRACT

We report the case of a patient diagnosed with a clinical relapse of acquired immune-mediated thrombotic thrombocytopenic purpura (TTP) who was successfully treated with low-dose rituximab plus corticosteroids without the use of plasma exchange (PEx), which was unavailable at the time due to the COVID-19 pandemic. Rituximab 100 mg weekly for 4 weeks was administered, combined with 1 mg/kg of prednisone, obtaining a complete hematological response in 6 weeks. This case suggests that PEx may be unnecessary for a subset of patients with relapsed TTP who are clinically stable without significant end-organ damage. A brief literature review regarding TTP patients treated without plasma exchange is also included.


Subject(s)
COVID-19/epidemiology , Plasma Exchange/methods , Purpura, Thrombotic Thrombocytopenic/therapy , Adult , Female , Humans , Pandemics , SARS-CoV-2/isolation & purification , Young Adult
17.
J Neuroimmunol ; 353: 577521, 2021 04 15.
Article in English | MEDLINE | ID: covidwho-1091758

ABSTRACT

BACKGROUND: Serious neurological complications of SARS-CoV-2 are increasingly being recognized. CASE: We report a novel case of HHV6 myelitis with parainfectious MOG-IgG in the setting of COVID-19-induced lymphopenia and hypogammaglobulinemia. The patient experienced complete neurological recovery with gancyclovir, high dose corticosteroids, and plasma exchange. To our knowledge, this is the first case of HHV6 reactivation in the central nervous system in the setting of COVID19 infection and the first case of MOG-IgG myelitis in the setting of SARS-CoV-2 and HHV6 coinfection. CONCLUSION: Patients with neurological manifestations in the setting of COVID19-related immunodeficiency should be tested for opportunistic infections including HHV6. Viral infection is a known trigger for MOG-IgG and therefore this antibody should be checked in patients with SARS-CoV-2 associated demyelination.


Subject(s)
COVID-19/complications , Coinfection/complications , Lymphopenia/virology , Myelitis, Transverse/virology , Roseolovirus Infections/immunology , Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , Autoantibodies/immunology , Autoantigens/immunology , COVID-19/immunology , Coinfection/immunology , Ganciclovir/therapeutic use , Herpesvirus 6, Human , Humans , Male , Methylprednisolone/therapeutic use , Middle Aged , Myelitis, Transverse/immunology , Myelitis, Transverse/therapy , Plasma Exchange/methods , Roseolovirus Infections/drug therapy , SARS-CoV-2 , Virus Activation/immunology
18.
J Thromb Thrombolysis ; 52(2): 468-470, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1002138

ABSTRACT

Acquired thrombotic thrombocytopenic purpura (TTP) is an autoimmune disease that can be triggered by different events, including viral infections. It presents as thrombotic microangiopathy and can lead to severe complications that often require management in the intensive care unit (ICU). We report a patient who presented with acquired TTP following COVID-19 infection. A 44-year-old woman presented to the emergency department with severe anemia, acute kidney injury and respiratory failure due to COVID-19. Clinical and laboratory findings were suggestive for thrombotic microangiopathy. On day 8 laboratory tests confirmed the diagnosis of acquired TTP. The patient needed 14 plasma exchanges, treatment with steroids, rituximab and caplacizumab and 18 days of mechanical ventilation. She completely recovered and was discharged home on day 51. Acquired TTP can be triggered by different events leading to immune stimulation. COVID-19 has been associated with different inflammatory and auto-immune diseases. Considering the temporal sequence and the lack of other possible causes, we suggest that COVID-19 infection could have been the triggering factor in the development of TTP. Since other similar cases have already been described, possible association between COVID and TTP deserves further investigation.


Subject(s)
COVID-19 , Plasma Exchange/methods , Purpura, Thrombotic Thrombocytopenic , Respiration, Artificial/methods , Respiratory Insufficiency , Rituximab/administration & dosage , Single-Domain Antibodies/administration & dosage , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Adult , COVID-19/complications , COVID-19/immunology , COVID-19/physiopathology , COVID-19/therapy , Female , Fibrinolytic Agents/administration & dosage , Humans , Immunologic Factors/administration & dosage , Male , Purpura, Thrombotic Thrombocytopenic/blood , Purpura, Thrombotic Thrombocytopenic/etiology , Purpura, Thrombotic Thrombocytopenic/physiopathology , Purpura, Thrombotic Thrombocytopenic/therapy , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Thrombotic Microangiopathies/diagnosis , Thrombotic Microangiopathies/etiology , Treatment Outcome
20.
BMJ Case Rep ; 13(12)2020 Dec 17.
Article in English | MEDLINE | ID: covidwho-991776

ABSTRACT

We present the case of a 39-year-old man with epigastric pain, nausea and vomiting. The patient scored 4 in the Visual Triage Checklist of acute respiratory symptoms; a COVID-19 swab was taken. Prompt review of the peripheral blood smear showed evidence of microangiopathic haemolytic anaemia and thrombocytopenia. Because the patient had a picture of thrombotic thrombocytopenic purpura, plasma exchange and corticosteroids were started immediately. After 3 days, he developed severe ischaemic stroke and his swabs came back positive for COVID-19 by reverse transcription PCR. Therefore, triple therapy was started (lopinavir/ritonavir, ribavirin and interferon beta-1b). White blood cell count reached 50×109/L (normal range, 4.5-11×109/L), mainly neutrophils. All the workup for autoimmune diseases was negative. The patient showed delayed improvement in lactate dehydrogenase, haemoglobin and platelet count until we increased the volume of plasma exchange and subsided the inflammatory response of COVID-19. After that, the patient showed an excellent recovery.


Subject(s)
COVID-19/diagnosis , Ischemic Stroke/diagnosis , Purpura, Thrombotic Thrombocytopenic/diagnosis , Adult , COVID-19/complications , Drug Combinations , Humans , Interferon-beta/therapeutic use , Ischemic Stroke/etiology , Lopinavir/therapeutic use , Male , Plasma Exchange/methods , Purpura, Thrombotic Thrombocytopenic/etiology , Ritonavir/therapeutic use , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL