Tuesday March 6, 2007
What if plasma exchange is not available as treatment for TTP

Q: You just diagnosed a patient with thrombotic thrombocytopenic purpura (TTP) but you were informed by the nursing supervisor that plasma exchange with fresh frozen plasma is not available in hospital due to technical reason and it will take time before patient can be transferred to a facility where the said services are available. What would be your alternate plan to bridge that time?

A; High-dose plasma infusion with rate of 25-30 mL/kg per day. When immediate plasma exchange with fresh frozen plasma is not available, simple plasma infusion can be performed until transfer to a higher care facility is available. There is always a substanial risk of fluid overload with such high plasma infusion and you have to weigh risks and benefits of the clinical decision or to watch patient closely while plasma is infusing.


Reference: click to get abstract/article

High-dose plasma infusion versus plasma exchange as early treatment of thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome - Medicine. 82(1):27-38, January 2003.

Friday March 2, 2007
Vancomycin induced thrombocytopenia

So far Vancomycin was not blamed for thromboctopenia but this week in The New England Journal of Medicine, case series of 34 patients with vancomycin induced thrombocytopenia has been reported. The mean nadir platelet count was 13.6, with severe bleeding reported in 10 patients. Drug-dependent, platelet-reactive antibodies of the IgG class, the IgM class, or both were identified.

Platelet levels returned to baseline after vancomycin was stopped.


Related previous pearl: Vancomycin-induced Stevens-Johnson syndrome



Reference: click to get abstract

Vancomycin-Induced Immune Thrombocytopenia - Volume 356:904-910, The New England Journal of Medicine, March 1, 2007, number 9