Transfusion Medicine

Case 118

503 Comments
1. Prepared by: Sandra Vazquez Salas, MD

An adult 81 kg patient with a history of chronic HCV infection was brought into the emergency department after being found unconscious. Their spouse stated they had been experiencing fatigue, weakness and fever for the past couple of days. On examination, the patient was noted to have petechia and purpura over his arms, legs, chest and abdomen. Vitals were as follows: Temperature: 38.6 deg C, Heart Rate: 110, Respiratory Rate: 12 br/min and SpO2 97%. A complete blood count (CBC) was notable for a platelet count 15x10^9/L, hemoglobin 8.5 g/dL and hematocrit 30%. A CMP was notable for a creatinine level 1.4 mg/dL. Lactate Dehydrogenase (LDH) level was 1150 U/L. A direct antiglobulin test (DAT) was negative. Baseline labs were not available.

A peripheral blood smear has the below findings:



Question: Emergent therapeutic plasma exchange is requested to treat this pathology. For this procedure, what should be the total plasma exchange volume (1 plasma volume exchange) and type of replacement fluid?

 

503 thoughts on “Case 118”

  1. تجنب وضع الأثاث بطريقة تحول دون توزيع الإضاءة في الغرفة بشكل جيد. التنويع في ترتيب الأثاث ما بين القطع الكبيرة والصغيرة، وتجنّب وضع القطع ذات المساحة الواحدة في جهة واحدة من الغرفة. تجنب ترتيب الأثاث بطريقة تعكس صغر مساحة الغرفة مثل وضع الأثاث أمام النوافذ. تجنّب وضع السرير تحت مروحة السقف بطريقة مباشرة، أو على مقربة من الحافة السفلية للسقف المائل. يجبُ ترك عدة سنتيمترات بين الحائط والأثاث عند ترتيبه، حيثُ يزيد ذلك من مساحة الغرفة على عكس المعتقدات السائدة، وفي حال كانت الغرفة كبيرة الحجم يُمكن وضع الأثاث في منتصف الغرفة وترك عدّة أمتار بينه وبين الحائط

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