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Plasmapheresis for diffuse alveolar hemorrhage in a patient with Wegener's granulomatosis: Case report and review of the literature
Author(s) -
Nguyen Thong,
Martin Meri King,
Indrikovs Alexander J.
Publication year - 2005
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.20069
Subject(s) - medicine , diffuse alveolar hemorrhage , plasmapheresis , pulmonary hemorrhage , pulmonary function testing , methylprednisolone , cyclophosphamide , apheresis , surgery , pathology , lung , chemotherapy , platelet , antibody , immunology
We present a case of a 20‐year‐old male with Wegener's Granulomatosis involving the upper respiratory tract, lungs, and kidneys. In his fourth hospital admission, the patient presented with diffuse alveolar hemorrhage and poor pulmonary function: FiO 2 of 100% and PEEP of 17cm H 2 O on intubation. Due to a fast clinical deterioration while receiving drug therapy (cyclophosphamide and methylprednisolone), we performed nine daily 1‐volume therapeutic plasma exchanges (TPE) using 5% albumin as replacement fluid. TPE resulted in a decrease in cytoplasmic anti‐neutrophil cytoplasm antibodies (c‐ANCA) titer from 1:1,024 to 1:16. On the ninth day of plasmapheresis, his pulmonary status was markedly improved with FiO 2 of 60% and PEEP of 8 cm H 2 O. The patient was later extubated and discharged home in stable condition. Wegener's Granulomatosis with pulmonary hemorrhage is not included in the current guidelines for therapeutic apheresis; therefore, we report this case and, if warranted, propose this condition to be included in the guidelines. J Clin Apheresis 2005. © 2005 Wiley‐Liss, Inc.