RESUMO
Solvent/detergent treated plasma (S/DP) has reduced protein S activity (about 0.5 units/mL) as compared with fresh frozen plasma (FFP). When used as replacement fluid for repetitive therapeutic plasma exchange (PEX), e.g., in patients with thrombotic thrombocytopenic purpura (TTP), S/DP could lead to lowered protein S levels and, possibly, risk of hypercoagulable complications. We describe three patients with TTP who had low functional protein S (FPS) levels during PEX for TTP. Each developed one or more deep vein thromboses (DVTs) while receiving 100% S/DP or 50% S/DP and 50% cryosupernatant plasma (CSP) as replacement fluid. FPS levels rose when 100% CSP was substituted for S/DP. Our observations suggest that use of S/DP alone or in 50% combination with CSP as replacement fluid in PEX for TTP may lead to difficulty in maintaining safe FPS levels. Determination of risk of resulting clinically significant thrombotic events requires further study.
Assuntos
Troca Plasmática/efeitos adversos , Proteína S/análise , Púrpura Trombocitopênica Trombótica/terapia , Trombose Venosa/etiologia , Adulto , Idoso , Detergentes/farmacologia , Feminino , Humanos , MasculinoRESUMO
We describe two patients with the catastrophic antiphospholipid syndrome associated with elevation of beta(2)-glycoprotein I antibodies and fulminant thrombotic diatheses. Both patients were treated with therapeutic plasma exchange (TPE), which resulted in a marked decrease in antibody titer accompanied by an improved clinical outcome in one patient (IgG antibody). In the second patient, the outcome was poor despite TPE (IgA antibody). There were no significant complications of TPE in either case. Because of the fulminant nature of the catastrophic antiphospholipid syndrome, we conclude that a trial of TPE is warranted for the acute management. Further studies are needed to clarify which patients may benefit from this treatment.
