COVID‐19‐associated thrombotic angiopathy improved after plasma exchange

Elkayam, Natalie; Raju, G. Praveen; Huang, Yiwu; Lipshitz, Jay; Peeke, Stephen; Bluth, Martin H.

doi:10.1002/ccr3.4991

Cited by 2 publications

(3 citation statements)

References 9 publications

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“…It is well known that many patients with a clinical presentation of aHUS (regardless of a recognized underlying complement risk factor) usually require a trigger for aHUS to manifest. Among the reported conditions that could act as a triggering factor for the onset of aHUS, there are only five patients in whom no preliminary event or evident coexisting pathologies were reported, and COVID-19 appeared to be the only recognized trigger for aHUS [ 48 , 49 , 52 , 61 , 64 ], whereas, in all other cases, various other triggering factors were observed in addition to COVID-19 infection. Eight of the reported patients were solid organ transplant recipients (heart or kidney) treated with immunosuppressants known to be associated with TMA (e.g., calcineurin inhibitors (CNI) and sirolimus), one patient was treated with gemcitabine for disseminated cancer, and the other recognized risk factors included concurrent treatment with hydroxychloroquine (HCQ), pregnancy, chronic infections such as HCV, and several others.…”

Section: Covid-19-associated Tmamentioning

confidence: 99%

Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review

Vrecko

Rigler

Večerić-Haler

2022

IJMS

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Coronavirus disease 2019 (COVID-19) can lead to clinically significant multisystem disorders that also affect the kidney. According to recent data, renal injury in the form of thrombotic microangiopathy (TMA) in native kidneys ranks third in frequency. Our review of global literature revealed 46 cases of TMA in association with COVID-19. Among identified cases, 18 patients presented as thrombotic thrombocytopenic purpura (TTP) and 28 cases presented as atypical hemolytic uremic syndrome (aHUS). Altogether, seven patients with aHUS had previously proven pathogenic or likely pathogenic genetic complement abnormalities. TMA occurred at the time of viremia or even after viral clearance. Infection with COVID-19 resulted in almost no or only mild respiratory symptoms in the majority of patients, while digestive symptoms occurred in almost one-third of patients. Regarding the clinical presentation of COVID-19-associated TMA, the cases showed no major deviations from the known presentation. Patients with TTP were treated with plasma exchange (88.9%) or fresh frozen plasma (11.1%), corticosteroids (88.9%), rituximab (38.9%), and caplacizumab (11.1%). Furthermore, 53.6% of patients with aHUS underwent plasma exchange with or without steroid as initial therapy, and 57.1% of patients received a C5 complement inhibitor. Mortality in the studied cohort was 16.7% for patients with TTP and 10.7% for patients with aHUS. The exact role of COVID-19 in the setting of COVID-19-associated TMA remains unclear. COVID-19 likely represents a second hit of aHUS or TTP that manifests in genetically predisposed individuals. Early identification of the TMA subtype and appropriate prompt and specific treatment could lead to good outcomes comparable to survival and recovery statistics for TMA of all causes.

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Section: Covid-19-associated Tmamentioning

confidence: 99%

Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review

Vrecko

Rigler

Večerić-Haler

2022

IJMS

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“…A total of 63 patients were identified as having TMA associated with COVID-19. Of these, 24 were reported as COVID-19-related TMA (Table 2) [21–39] , 23 as TTP (Table 3) [40–61] , and 16 as aHUS (Table 4). [62–73]…”

Section: Discussionmentioning

confidence: 99%

“…A total of 63 patients were identified as having TMA associated with COVID-19. Of these, 24 were reported as COVID-19related TMA (Table 2) [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] , 23 as TTP (Table 3) , and 16 as aHUS (Table 4). [62][63][64][65][66][67][68][69][70][71][72][73] [40] The cases of COVID-19-related TMA had a male predominance (58.3%) with a mean age of 44.5 years (interquartile range: 34.75-57.75 years).…”

Section: Discussionmentioning

confidence: 99%

Coronavirus disease 2019-associated thrombotic microangiopathy treated with plasma exchange and antihypertensive therapy in a patient with HIV: A case report with literature review

Masuda,

Fukushima,

Hebisawa

et al. 2023

Medicine

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Rationale: Coronavirus disease 2019 (COVID-19) is an infectious disease that often causes complications in multiple organs and thrombosis due to abnormal blood coagulation. This case report aimed to describe the clinical course of COVID-19-associated thrombotic microangiopathy (TMA) and reviewed the comprehensive information on TMA, thrombotic thrombocytopenic purpura (TTP), and atypical hemolytic uremic syndrome associated with COVID-19 in the past literature. Patient concerns: A 46-year-old Japanese man was diagnosed with human immunodeficiency virus infection 10 years ago and treated with antiretroviral therapy. The patient presented with fever, malaise, hematuria, and bilateral upper abdominal discomfort for the past 4 days. Diagnoses: COVID-19-associated TMA was diagnosed based on a positive polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 and laboratory findings such as thrombocytopenia, acute kidney injury, and hemolytic anemia. Malignant hypertension and human immunodeficiency virus infection were also considered as differential diagnoses of TMA. Interventions: Considering the possibility of TTP, plasma exchange was performed, and glucocorticoids were administered. Hemodialysis was performed for acute kidney injury. Antihypertensive drugs were administered to control the high blood pressure. Outcomes: Platelet count and renal function improved, and hemodialysis was no longer required. The patient was in good general condition and was discharged from the hospital. Lessons: COVID-19-associated TMA should be considered as a differential diagnosis during the COVID-19 epidemic. Excessive inflammation and severe COVID-19 are not essential for TMA development. Early intervention using conventional TMA treatments, such as plasma exchange and corticosteroids, might be important in improving prognosis while differentiating between TTP and atypical hemolytic uremic syndrome. Antihypertensive therapy may be helpful in the treatment of COVID-19-associated TMA.

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COVID‐19‐associated thrombotic angiopathy improved after plasma exchange

Abstract: Utilization of therapeutic plasma exchange in select patients with COVID-19 microangiopathy may provide useful treatment by modulation of inflammatory cytokines and coagulation cascade to maintain homeostasis.

Cited by 2 publications

References 9 publications

Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review

Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review

Coronavirus disease 2019-associated thrombotic microangiopathy treated with plasma exchange and antihypertensive therapy in a patient with HIV: A case report with literature review

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