Iatrogenic thyrotoxicosis and the role of therapeutic plasma exchange

2017 ◽  
Vol 32 (6) ◽  
pp. 579-583 ◽  
Author(s):  
Kabeer K. Shah ◽  
Michael M. Mbughuni ◽  
Edwin A. Burgstaler ◽  
Darci R. Block ◽  
Jeffrey L. Winters
Author(s):  
Rehab AL-Ansari ◽  
Mohanad Bakkar ◽  
Leena Abdalla ◽  
Khaled Sewify

Background: Thrombotic thrombocytopenic purpura (TTP) is an uncommon haematological disease which can occur at any age and may present with COVID-19. This case describes a COVID-19 complication associated with a presentation resembling TTP. Case description: A 51-year-old man who had received a kidney transplant and was on immunosuppressant medication, was admitted to a critical care unit with severe COVID-19 pneumonia/acute respiratory distress syndrome (ARDS) which required intubation, mechanical ventilation and inotropic support. The course was complicated by the classic pentad of thrombocytopenia, intravascular haemolysis, acute kidney injury, neurological symptoms and fever, which prompted the diagnosis of probable TTP. After five sessions of therapeutic plasma exchange, the patient’s general status improved, he was weaned off mechanical ventilation and his renal panel and haemolytic markers normalized. Conclusion: TTP is a life-threatening condition which requires urgent management with therapeutic plasma exchange. This case highlights some possible complications of COVID-19 generally and in immunocompromised patients specifically. The potential role of plasma exchange in COVID-19 patients without a positive diagnosis of TTP (the so-called ‘TTP resembling presentation’) is an area of further research.


Author(s):  
Jill Adamski

Therapeutic plasma exchange (TPE) is a process by which whole blood is removed from a patient and separated into 3 components: red blood cells, white blood cells (buffy coat), and plasma. After separation, the plasma is discarded, and the other blood components are returned to the patient along with exogenous fluid to replace the removed plasma. TPE is an important tool to remove pathogenic substances (eg, antibodies) from plasma, and this technique is considered first-line therapy for numerous conditions that affect patients in the critical care unit. This chapter describes the role of TPE in management of hematologic disorders, some of which have neurologic manifestations.


2016 ◽  
Vol 13 (1) ◽  
pp. 31-36 ◽  
Author(s):  
R.N. Makroo ◽  
S. Nayak ◽  
M. Chowdhry ◽  
S. Jasuja ◽  
G. Sagar ◽  
...  

Author(s):  
Joy Varghese ◽  
Vivek Joshi ◽  
Madhan Kumar Bollipalli ◽  
Selvakumar Malleeswaran ◽  
Rajinikanth Patcha ◽  
...  

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 498
Author(s):  
Gurkan Atay ◽  
Canan Hasbal ◽  
Mücahit Türk ◽  
Seher Erdoğan ◽  
Betül Sözeri

Multisystemic inflammatory syndrome in children (MIS-C) is a new potentially life-threatening disease that is related to coronavirus disease 2019 (COVID-19). The aim of this study is to reveal the clinical and laboratory results of MIS-C and the role of therapeutic plasma exchange (TPE) in its treatment. Clinical, laboratory and radiological characteristics of the patients who were admitted to the pediatric ward and pediatric intensive care unit (PICU) of a tertiary hospital with a diagnosis of MIS-C between April 2020 and March 2021 were included in the study. Forty-one patients were admitted to our hospital with a diagnosis of MIS-C. Twenty-one (51.2%) patients were admitted to the PICU. Six patients needed invasive mechanical ventilation (14.6%), 10 patients (24.4%) TPE and 3 patients (7.3%) needed extracorporeal membrane oxygenation (ECMO). The patients were grouped according to need for PICU admission (Group 1: no need for PICU, Group 2: need for PICU admission). Group 2 had significantly higher levels of C-reactive protein (CRP), alanine aminotransferase (ALT), ferritin, D-dimer, pro-B type natriuretic peptide (pro BNP) and lactate (p < 0.05). Hyponatremia found to be an independent risk factor for inpatient MIS-C in the PICU. We think that dynamic laboratory trending is beneficial in determining the need for PICU admission and TPE may be effective in critically ill patients.


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