Chen J, Jin JX, Xu XF, Zhang XX, Ye XN, Huang J. Successful treatment of plasma exchange-refractory thrombotic thrombocytopenic purpura with rituximab: A case report. World J Clin Cases 2020; 8(12): 2617-2622 [PMID: 32607340 DOI: 10.12998/wjcc.v8.i12.2617]
Corresponding Author of This Article
Jian Huang, MD, PhD, Chief Physician, Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, No. 1, Shangcheng Road, Yiwu 322000, Zhejiang Province, China. househuang@zju.edu.cn
Research Domain of This Article
Hematology
Article-Type of This Article
Case Report
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Chen J, Jin JX, Xu XF, Zhang XX, Ye XN, Huang J. Successful treatment of plasma exchange-refractory thrombotic thrombocytopenic purpura with rituximab: A case report. World J Clin Cases 2020; 8(12): 2617-2622 [PMID: 32607340 DOI: 10.12998/wjcc.v8.i12.2617]
Jian Chen, Xuan-Xuan Zhang, Department of Ultrasonography, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
Jing-Xia Jin, Xiao-Fei Xu, Xing-Nong Ye, Jian Huang, Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
Author contributions: Chen J reviewed the literature and contributed to manuscript drafting; Jin JX and Xu XF performed the diagnostic investigations and treatments; Ye XN and Zhang XX helped collect the data and analyzed and interpreted the imaging findings; Huang J followed the patient, and reviewed and revised the entire manuscript; all authors issued final approval for the version to be submitted.
Supported bythe Public Technology Research Projects of Yiwu, China, No. 2016S05; the Key Project of Jinhua Science and Technology Plan, No. 2020XG-29; the 2018-2020 Key Medical Discipline (Hematology) Fund of Yiwu, China; the 2019-2021 Key Medical Discipline (Hematology) Fund of Jinhua, China; the Project of Educational Commission of Zhejiang Province of China, No. Y201942124; and the 2019-2024 Academician Workstation Fund of the Fourth Affiliated Hospital of Zhejiang University School of Medicine.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Jian Huang, MD, PhD, Chief Physician, Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, No. 1, Shangcheng Road, Yiwu 322000, Zhejiang Province, China. househuang@zju.edu.cn
Received: April 13, 2020 Peer-review started: April 13, 2020 First decision: April 28, 2020 Revised: May 5, 2020 Accepted: May 21, 2020 Article in press: May 21, 2020 Published online: June 26, 2020 Processing time: 71 Days and 18.3 Hours
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.
Core tip: Thrombotic thrombocytopenic purpura (TTP) has a very high fatality rate if there is no timely diagnosis or treatment. Here we report a case of refractory TTP in a woman with decreased ADAMTS13 activity. Although the patient was refractory to daily plasma exchange, her platelet count and ADAMTS13 activity returned to normal after 6 d of treatment with rituximab. This case suggested that rituximab can improve the curative efficiency of plasma exchange in TTP.
