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Successful treatment of plasma exchange-refractory thrombotic thrombocytopenic purpura with rituximab: A case report.
World J Clin Cases. 2020 Jun 26; 8(12):2617-2622.WJ

Abstract

BACKGROUND

Thrombotic thrombocytopenic purpura (TTP), a subtype of thrombotic microangiopathy, has a very high fatality rate if there is no timely diagnosis or treatment. Here, we report a case of TTP refractory to high displacement plasma exchange, which was later successfully treated with rituximab.

CASE SUMMARY

Here we report a case of refractory TTP in a 63-year-old woman with a low platelet count and decreased ADAMTS13 activity. Her platelet count was 9 × 109/L, hemoglobin level was 81 g/L, and ADAMTS13 was < 5%. She was diagnosed with thrombotic thrombocytopenic purpura. After 8 d of daily plasma exchange (PEX), her platelet levels were still low. However, after 6 d of treatment with rituximab, her platelet count increased and ADAMTS13 activity returned to normal.

CONCLUSION

PEX can cure most patients, but the relapse rate can be up to 50%-60%. This case suggested that rituximab can improve the curative efficiency of PEX and prevent disease relapse in TTP.

Authors+Show Affiliations

Department of Ultrasonography, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China.Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China.Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China.Department of Ultrasonography, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China.Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China.Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China. househuang@zju.edu.cn.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32607340

Citation

Chen, Jian, et al. "Successful Treatment of Plasma Exchange-refractory Thrombotic Thrombocytopenic Purpura With Rituximab: a Case Report." World Journal of Clinical Cases, vol. 8, no. 12, 2020, pp. 2617-2622.
Chen J, Jin JX, Xu XF, et al. Successful treatment of plasma exchange-refractory thrombotic thrombocytopenic purpura with rituximab: A case report. World J Clin Cases. 2020;8(12):2617-2622.
Chen, J., Jin, J. X., Xu, X. F., Zhang, X. X., Ye, X. N., & Huang, J. (2020). Successful treatment of plasma exchange-refractory thrombotic thrombocytopenic purpura with rituximab: A case report. World Journal of Clinical Cases, 8(12), 2617-2622. https://doi.org/10.12998/wjcc.v8.i12.2617
Chen J, et al. Successful Treatment of Plasma Exchange-refractory Thrombotic Thrombocytopenic Purpura With Rituximab: a Case Report. World J Clin Cases. 2020 Jun 26;8(12):2617-2622. PubMed PMID: 32607340.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful treatment of plasma exchange-refractory thrombotic thrombocytopenic purpura with rituximab: A case report. AU - Chen,Jian, AU - Jin,Jing-Xia, AU - Xu,Xiao-Fei, AU - Zhang,Xuan-Xuan, AU - Ye,Xing-Nong, AU - Huang,Jian, PY - 2020/04/13/received PY - 2020/05/05/revised PY - 2020/05/21/accepted PY - 2020/7/2/entrez PY - 2020/7/2/pubmed PY - 2020/7/2/medline KW - ADAMTS13 KW - Case report KW - Plasma exchange KW - Rituximab KW - Thrombotic thrombocytopenic purpura SP - 2617 EP - 2622 JF - World journal of clinical cases JO - World J Clin Cases VL - 8 IS - 12 N2 - BACKGROUND: Thrombotic thrombocytopenic purpura (TTP), a subtype of thrombotic microangiopathy, has a very high fatality rate if there is no timely diagnosis or treatment. Here, we report a case of TTP refractory to high displacement plasma exchange, which was later successfully treated with rituximab. CASE SUMMARY: Here we report a case of refractory TTP in a 63-year-old woman with a low platelet count and decreased ADAMTS13 activity. Her platelet count was 9 × 109/L, hemoglobin level was 81 g/L, and ADAMTS13 was < 5%. She was diagnosed with thrombotic thrombocytopenic purpura. After 8 d of daily plasma exchange (PEX), her platelet levels were still low. However, after 6 d of treatment with rituximab, her platelet count increased and ADAMTS13 activity returned to normal. CONCLUSION: PEX can cure most patients, but the relapse rate can be up to 50%-60%. This case suggested that rituximab can improve the curative efficiency of PEX and prevent disease relapse in TTP. SN - 2307-8960 UR - https://www.unboundmedicine.com/medline/citation/32607340/Successful_treatment_of_plasma_exchange-refractory_thrombotic_thrombocytopenic_purpura_with_rituximab:_A_case_report L2 - https://www.wjgnet.com/2307-8960/full/v8/i12/2617.htm DB - PRIME DP - Unbound Medicine ER -
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