Dataset Information

Therapeutic plasma exchange for COVID-19-associated hyperviscosity.

ABSTRACT:

Background

Recent data suggests an association between blood hyperviscosity and both propensity for thrombosis and disease severity in patients with COVID-19. This raises the possibility that increased viscosity may contribute to endothelial damage and multiorgan failure in COVID-19, and that therapeutic plasma exchange (TPE) to decrease viscosity may improve patient outcomes. Here we sought to share our experience using TPE in the first 6 patients treated for COVID-19-associated hyperviscosity.

Study design and methods

Six critically ill COVID-19 patients with plasma viscosity levels ranging from 2.6 to 4.2 centipoise (cP; normal range, 1.4-1.8?cP) underwent daily TPE for 2-3 treatments.

Results

TPE decreased plasma viscosity in all six patients (Pre-TPE median 3.75?cP, range 2.6-4.2?cP; Post-TPE median 1.6?cP, range 1.5-1.9?cP). TPE also decreased fibrinogen levels in all five patients for whom results were available (Pre-TPE median 739?mg/dL, range 601-1188?mg/dL; Post-TPE median 359?mg/dL, range 235-461?mg/dL); D-dimer levels in all six patients (Pre-TPE median 5921?ng/mL, range 1134-60?000?ng/mL; Post-TPE median 4893?ng/mL, range 620-7518?ng/mL); and CRP levels in five of six patients (Pre-TPE median 292?mg/L, range 136-329?mg/L; Post-TPE median 84?mg/L, range 31-211?mg/L). While the two sickest patients died, significant improvement in clinical status was observed in four of six patients shortly after TPE.

Conclusions

This series demonstrates the utility of TPE to rapidly correct increased blood viscosity in patients with COVID-19-associated hyperviscosity. Large randomized trials are needed to determine whether TPE may improve clinical outcomes for patients with COVID-19.

SUBMITTER: Truong AD

PROVIDER: S-EPMC7753437 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Publications

Therapeutic plasma exchange for COVID-19-associated hyperviscosity.

Truong Alexander D AD Auld Sara C SC Barker Nicholas A NA Friend Sarah S Wynn A Thanushi AT Cobb Jason J Sniecinski Roman M RM Tanksley Christin-Lauren CL Polly Derek M DM Gaddh Manila M Connor Michael M Nakahara Hirotomo H Sullivan H Clifford HC Kempton Christine C Guarner Jeannette J Duncan Alexander A Josephson Cassandra D CD Roback John D JD Stowell Sean R SR Maier Cheryl L CL

Transfusion 20201209 4

<h4>Background</h4>Recent data suggests an association between blood hyperviscosity and both propensity for thrombosis and disease severity in patients with COVID-19. This raises the possibility that increased viscosity may contribute to endothelial damage and multiorgan failure in COVID-19, and that therapeutic plasma exchange (TPE) to decrease viscosity may improve patient outcomes. Here we sought to share our experience using TPE in the first 6 patients treated for COVID-19-associated hypervi ...[more]

PMID: 33231313

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Project description:BackgroundFulminant (life-threatening) COVID-19 can be associated with acute respiratory failure (ARF), multi-system organ failure and cytokine release syndrome (CRS). We present a rare case of fulminant COVID-19 associated with reverse-takotsubo-cardiomyopathy (RTCC) that improved with therapeutic plasma exchange (TPE).Case presentationA 40 year old previous healthy male presented in the emergency room with 4 days of dry cough, chest pain, myalgias and fatigue. He progressed to ARF requiring high-flow-nasal-cannula (flow: 60 L/minute, fraction of inspired oxygen: 40%). Real-Time-Polymerase-Chain-Reaction (RT-PCR) assay confirmed COVID-19 and chest X-ray showed interstitial infiltrates. Biochemistry suggested CRS: increased C-reactive protein, lactate dehydrogenase, ferritin and interleukin-6. Renal function was normal but lactate levels were elevated. Electrocardiogram demonstrated non-specific changes and troponin-I levels were slightly elevated. Echocardiography revealed left ventricular (LV) basal and midventricular akinesia with apex sparing (LV ejection fraction: 30%) and depressed cardiac output (2.8 L/min) consistent with a rare variant of stress-related cardiomyopathy: RTCC. His ratio of partial arterial pressure of oxygen to fractional inspired concentration of oxygen was < 120. He was admitted to the intensive care unit (ICU) for mechanical ventilation and vasopressors, plus antivirals (lopinavir/ritonavir), and prophylactic anticoagulation. Infusion of milrinone failed to improve his cardiogenic shock (day-1). Thus, rescue TPE was performed using the Spectra Optia™ Apheresis System equipped with the Depuro D2000 Adsorption Cartridge (Terumo BCT Inc., USA) without protective antibodies. Over 5 days he received daily TPE (each lasting 4 hours). His lactate levels, oxygenation, and LV function normalized and he was weaned off vasopressors. His inflammation markers improved, and he was extubated on day-7. RT-PCR was negative on day-17. He was discharged to home isolation in good condition.ConclusionStress-cardiomyopathy may complicate the course of fulminant COVID-19 with associated CRS. If inotropic therapy fails, TPE without protective antibodies may help rescue the critically ill patient.

Dataset Information

Therapeutic plasma exchange for COVID-19-associated hyperviscosity.

Background

Study design and methods

Results

Conclusions

Publications

Therapeutic plasma exchange for COVID-19-associated hyperviscosity.

Similar Datasets

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