Treating thrombotic thrombocytopenic purpura without plasma exchange during the COVID-19 pandemic. A case report and a brief literature review

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.

Microangiopatía trombótica sistémica asociada a infección activa por SARS-CoV-2: a propósito de un caso

“…A pesar de la limitada evidencia, la terapia de recambio plasmático ha mostrado beneficio en casi todos los tipos de MAT y debe ser considerada estándar en su tratamiento incluso en pacientes con COVID-19. En la literatura existen un número limitado de casos reportados de PTT adquirida en contexto de COVID-19 tratadas con dosis estándar de corticosteroides en conjunto con terapia de recambio plasmático con una respuesta adecuada 10 ; de igual forma se han reportado casos de PTT donde el tratamiento utilizado ha sido inmunoglobulina o dosis bajas de rituximab, sin requerimiento de terapia de recambio plasmático con un adecuado desenlace 11 . En el caso de nuestro paciente, la respuesta a la terapia con plasmaféresis fue exitosa, con una recuperación de la función renal y normalización en los niveles de plaquetas, hemoglobina y sin presencia de nuevos episodios trombóticos.…”

ECG signal monitoring based on Covid-19 patients: Overview

“…Confinement and home maintenance strategies were introduced to break the curve and control disease transmission. This pandemic is known for its strong propagation, which limits the relationship between the different populations [5][6][7]. To control this pandemic, we can take China as an example.…”

Treatment of immune-mediated thrombotic thrombocytopenic purpura without plasma exchange

“…All patients had a good clinical and laboratory response, although most likely slower (median time to platelet count normalization, 14 days) than they would have had with standard treatment; ADAMTS13 response was not reported. 5 Another report described a patient with relapsed iTTP treated with low-dose rituximab plus corticosteroids without TPE due to difficulties related to the COVID-19 pandemic, obtaining complete hematological response in 6 weeks. 5 More recently, few cases of iTTP successfully treated with immunosuppressive therapy together with caplacizumab and without TPE have been published.…”

“…5 Another report described a patient with relapsed iTTP treated with low-dose rituximab plus corticosteroids without TPE due to difficulties related to the COVID-19 pandemic, obtaining complete hematological response in 6 weeks. 5 More recently, few cases of iTTP successfully treated with immunosuppressive therapy together with caplacizumab and without TPE have been published. [6][7][8][9] One report described a patient with a first episode of iTTP successfully treated with rituximab and caplacizumab, because of the patient's request not to be hospitalized.…”