Background Chronic urticaria is a common disease. Plasmapheresis is an alternative treatment that can be appropriate for patients who are resistant to treatment with 2nd generation antihistamines or for whom treatment with omalizumab is unsuitable. Objective To investigate the effect of plasmapheresis treatment in chronic urticaria. Methods A retrospective analysis was performed based on the data of 98 patients suffering from refractory chronic urticaria who received plasmapheresis as an alternative treatment in Vilnius University’s Hospital Santaros Clinics from 2000 to 2020. The efficiency of the treatment was evaluated by clinical judgment. Results 58.2% of the patients exhibited a complete or significant response; of these, 37.8% had temporary relief of symptoms and 20.4% achieved disease remission; 41.8% showed no response to the plasmapheresis. Men (34.8%) had a tendency to achieve disease remission more often than women (16%) (p < 0.05). One patient did not finish the plasmapheresis treatment due to the symptoms’ exacerbation and treatment with omalizumab was initiated. Conclusion Plasmapheresis is a safe and effective alternative treatment when traditional treatment is unavailable or does not relieve symptoms completely. Our data showed that plasmapheresis was effective in more than half of our patients.
Heparin-induced thrombocytopenia (HIT) is a lifethreatening immune complication of exposure to unfractionated heparin or low molecular weight heparins (LMWH) that occurs independently of the dose in a small percentage of patients. The clinical case and diagnosis of HIT, which started as skin necrosis will be discussed here.A 75-year-old obese woman (weight 98 kg, height 164 cm, BMI 36.4 kg/m/2) was hospitalized due to unexplained chronic abdominal pain and jaundice. Although on admission there were no clinical signs of deep venous thrombosis, she was prescribed a prophylactic dose of nadroparin 2850 U s/c; as she was motionless and after a few days of investigations, she was diagnosed with metastatic neoplasia of liver and intrahepatic ducts. After 8 days, a one 20 cm area of nonpalpable purpura with surrounding erythema and hemorrhagic vesicles on the central abdominal part was noticed (Figure 1). There was no pruritus or surrounding pain. The platelet count was decreased from 217,000/microl at hospitalization to 68,000/microl when the skin necrosis developed. Protein S, protein C, prothrombin time, and thrombin time were normal. Commercial diagnostic test kit for PF4/heparin antibodies identification of all isotypes was used (ID-PaGIA Heparin/PF4 Antibody Test (DiaMed GmbH). Two different titrations were made (1:4 and 1:32) and both of them were positive.Based on the clinical picture, nadroparin-induced skin necrosis was diagnosed. We also clinically suspected a
We described a rare case of nadroparin-induced skin necrosis with thrombocytopenia.LMWH therapy is used in thrombosis prophylaxis, it is important to recognize that skin necrosis can be a part of HIT early in its course and change heparin or LMWH to non-heparin anticoagulants such as director thrombin III inhibitors.
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