Case 118

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?