The Use of Therapeutic Plasma Exchange in the Treatment of a Pregnant Woman with COVID-19 Induced Acute Respiratory Distress Syndrome
Tóm tắt
A 27-year-old woman at 17 weeks gestation was admitted to the intensive care unit (ICU) with a history of fever, dyspnea, and dry cough for 3 days. She was diagnosed with coronavirus disease 2019 (COVID-19) based on her nasopharyngeal swab polymerase chain reaction (PCR) that was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the ICU, the patient developed acute respiratory distress syndrome (ARDS) and increased levels of inflammatory markers. She was then intubated for mechanical ventilation and had a treatment for critical COVID-19 illness during pregnancy. She also received three cycles on alternating days of therapeutic plasma exchange (TPE) since she was failing to respond to conventional medical treatment. During hospitalization, the patient’s fetus was closely monitored by repetitive ultrasound. After 27 days of hospitalization and 10 days of mechanical ventilation weaning, the patient’s respiratory condition improved and her inflammatory biomarkers normalized. She was discharged from the hospital with an apparently healthy 20th week fetus. This case report highlights the role of TPE for treatment of ARDS due to cytokine storm in pregnant women with severe COVID-19 infection. This case emphasizes that careful evaluation of clinical and biological progression of the patient’s status is very important and when conventional therapies are failing, alternative therapies such as TPE should be considered.
Tài liệu tham khảo
Azer SA. COVID-19: pathophysiology, diagnosis, complications and investigational therapeutics. New Microbes New Infect. 2020;37: 100738.
Zhou X, Cheng Z, Luo L, Zhu Y, Lin W, Ming Z, et al. Incidence and impact of disseminated intravascular coagulation in COVID-19 a systematic review and meta-analysis. Thromb Res. 2021;201:23–9.
Kim JI, Im Y, Song JE, Jang SJ. Healthcare considerations for special populations during the COVID-19 pandemic: a review. J Korean Acad Nurs. 2021;51(5):511–24.
Wastnedge EAN, Reynolds RM, van Boeckel SR, Stock SJ, Denison FC, Maybin JA, et al. Pregnancy and COVID-19. Physiol Rev. 2021;101(1):303–18.
Berkowitz K, LaSala A. Risk factors associated with the increasing prevalence of pneumonia during pregnancy. Am J Obstet Gynecol. 1990;163(3):981–5.
Bobati SS, Naik KR. Therapeutic plasma exchange—an emerging treatment modality in patients with neurologic and non-neurologic diseases. J Clin Diagn Res. 2017;11(8):EC35–EC37.
CMcG/AH. Guidelines for therapeutic plasma exchange in critical care: National Health Service. 2019. https://www.bsuh.nhs.uk/library/wp-content/uploads/sites/8/2020/09/TPE.pdf.
Jaiswal V, Nasa P, Raouf M, Gupta M, Dewedar H, Mohammad H, et al. Therapeutic plasma exchange followed by convalescent plasma transfusion in critical COVID-19—an exploratory study. Int J Infect Dis. 2021;102:332–4.
Khamis F, Al-Zakwani I, Al Hashmi S, Al Dowaiki S, Al Bahrani M, Pandak N, et al. Therapeutic plasma exchange in adults with severe COVID-19 infection. Int J Infect Dis. 2020;99:214–8.
Pastick KA, Nicol MR, Smyth E, Zash R, Boulware DR, Rajasingham R, et al. A systematic review of treatment and outcomes of pregnant women with COVID-19—a call for clinical trials. Open Forum Infect Dis. 2020;7(9):ofaa350.
Padmanabhan AC-SL, Aqui N, Balogun RA, et al. Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Writing Committee of the American Society for Apheresis: the eighth special issue. J Clin Apher. 2019;34:171–354.
Knaup H, Stahl K, Schmidt BMW, Idowu TO, Busch M, Wiesner O, et al. Early therapeutic plasma exchange in septic shock: a prospective open-label nonrandomized pilot study focusing on safety, hemodynamics, vascular barrier function, and biologic markers. Crit Care. 2018;22(1):285.
Hadem JHC, Schneider AS, Wiesner O, et al. Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational single-centre study of 23 patients. BMC Anesthesiol. 2014;14(24):1–10.
Patel PNV, Vanchiere J, Conrad SA. Use of therapeutic plasma exchange as a rescue therapy in 2009 pH1N1 influenza A—an associated respiratory failure and hemodynamic shock. Pediatr Crit Care Med. 2011;12(2):87–9.
Faqihi F, Alharthy A, Abdulaziz S, Balhamar A, Alomari A, AlAseri Z, et al. Therapeutic plasma exchange in patients with life-threatening COVID-19: a randomised controlled clinical trial. Int J Antimicrob Agents. 2021;57(5): 106334.
Zhang LZH, Ma S, Chen J, et al. Efficacy of therapeutic plasma exchange in severe COVID-19 patients. Br J Haematol. 2020;190:181–232.
Felsenstein S, Herbert JA, McNamara PS, Hedrich CM. COVID-19: Immunology and treatment options. Clin Immunol. 2020;215: 108448.
Lin SH, Zhao YS, Zhou DX, Zhou FC, Xu F. Coronavirus disease 2019 (COVID-19): cytokine storms, hyper-inflammatory phenotypes, and acute respiratory distress syndrome. Genes Dis. 2020;7(4):520–7.
Balagholi S, Dabbaghi R, Eshghi P, Mousavi SA, Heshmati F, Mohammadi S. Potential of therapeutic plasmapheresis in treatment of COVID-19 patients: Imm. Transfus Apher Sci. 2020;59(6): 102993.
Yang XH, Sun RH, Zhao MY, Chen EZ, Liu J, Wang HL, et al. Expert recommendations on blood purification treatment protocol for patients with severe COVID-19. Chronic Dis Transl Med. 2020;6(2):106–14.
Force ADT, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–33.
Maisel AMC, Adams KJ, Anker SD, et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail. 2008;10:824–39.
Cappanera S, Palumbo M, Kwan SH, Priante G, Martella LA, Saraca LM, et al. When does the cytokine storm begin in COVID-19 patients? A quick score to recognize it. J Clin Med. 2021;10(2):297.