Refractory thrombotic thrombocytopenic purpura treated successfully with monoclonal antibody (rituximab)
Thrombotic thrombocytopenic purpura (TTP) is a nonimmune, microangiopathic hemolytic anemia, associated with thrombocytopenia, fever, neurologic, or renal dysfunction. Plasma exchange (PEX) with or without steroids constitutes first-line therapy in TTP. However, a subset of the patients may be refra...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | APIK Journal of Internal Medicine |
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| Online Access: | http://www.ajim.in/article.asp?issn=2666-1802;year=2023;volume=11;issue=2;spage=128;epage=131;aulast=Prusty |
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| author | B Saroj Kumar Prusty Kiran Kumar Ramineni G Krishna Mohan Reddy Sashi Kiran Annavarajula Majed Abdul Basit Momin |
| author_facet | B Saroj Kumar Prusty Kiran Kumar Ramineni G Krishna Mohan Reddy Sashi Kiran Annavarajula Majed Abdul Basit Momin |
| author_sort | B Saroj Kumar Prusty |
| collection | DOAJ |
| description | Thrombotic thrombocytopenic purpura (TTP) is a nonimmune, microangiopathic hemolytic anemia, associated with thrombocytopenia, fever, neurologic, or renal dysfunction. Plasma exchange (PEX) with or without steroids constitutes first-line therapy in TTP. However, a subset of the patients may be refractory to PEX. Rituximab appears to be an alternative effective therapy for refractory or relapsing TTP. Here, we report a case of TTP in a 43-year-old female presented with fever, generalized weakness, headache, vomiting, and ecchymotic patches over forearms and upper chest for 7 days along with one episode of seizure. The laboratory evaluation revealed severe thrombocytopenia, anemia, and indirect hyperbilirubinemia with peripheral blood smear showing schistocytes (fragmented red blood cells). Initial therapy with multiple PEXs along with parenteral corticosteroids resulted in only minimal improvement of platelet count. Subsequently, rituximab was administered which helped in normalization of platelet count and overall clinical improvement. This case highlights the importance of timely utilization of second-line drugs such as rituximab in refractory TTP. |
| first_indexed | 2024-03-13T10:39:19Z |
| format | Article |
| id | doaj.art-c12146e8892e4813a79890f5bff7ed14 |
| institution | Directory Open Access Journal |
| issn | 2666-1802 2666-1810 |
| language | English |
| last_indexed | 2024-03-13T10:39:19Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | APIK Journal of Internal Medicine |
| spelling | doaj.art-c12146e8892e4813a79890f5bff7ed142023-05-18T04:59:01ZengWolters Kluwer Medknow PublicationsAPIK Journal of Internal Medicine2666-18022666-18102023-01-0111212813110.4103/ajim.ajim_56_21Refractory thrombotic thrombocytopenic purpura treated successfully with monoclonal antibody (rituximab)B Saroj Kumar PrustyKiran Kumar RamineniG Krishna Mohan ReddySashi Kiran AnnavarajulaMajed Abdul Basit MominThrombotic thrombocytopenic purpura (TTP) is a nonimmune, microangiopathic hemolytic anemia, associated with thrombocytopenia, fever, neurologic, or renal dysfunction. Plasma exchange (PEX) with or without steroids constitutes first-line therapy in TTP. However, a subset of the patients may be refractory to PEX. Rituximab appears to be an alternative effective therapy for refractory or relapsing TTP. Here, we report a case of TTP in a 43-year-old female presented with fever, generalized weakness, headache, vomiting, and ecchymotic patches over forearms and upper chest for 7 days along with one episode of seizure. The laboratory evaluation revealed severe thrombocytopenia, anemia, and indirect hyperbilirubinemia with peripheral blood smear showing schistocytes (fragmented red blood cells). Initial therapy with multiple PEXs along with parenteral corticosteroids resulted in only minimal improvement of platelet count. Subsequently, rituximab was administered which helped in normalization of platelet count and overall clinical improvement. This case highlights the importance of timely utilization of second-line drugs such as rituximab in refractory TTP.http://www.ajim.in/article.asp?issn=2666-1802;year=2023;volume=11;issue=2;spage=128;epage=131;aulast=Prustyadamts13 enzymecryo-poor plasma exchangemicroangiopathic hemolytic anemiarefractory thrombotic thrombocytopenic purpurarituximab |
| spellingShingle | B Saroj Kumar Prusty Kiran Kumar Ramineni G Krishna Mohan Reddy Sashi Kiran Annavarajula Majed Abdul Basit Momin Refractory thrombotic thrombocytopenic purpura treated successfully with monoclonal antibody (rituximab) APIK Journal of Internal Medicine adamts13 enzyme cryo-poor plasma exchange microangiopathic hemolytic anemia refractory thrombotic thrombocytopenic purpura rituximab |
| title | Refractory thrombotic thrombocytopenic purpura treated successfully with monoclonal antibody (rituximab) |
| title_full | Refractory thrombotic thrombocytopenic purpura treated successfully with monoclonal antibody (rituximab) |
| title_fullStr | Refractory thrombotic thrombocytopenic purpura treated successfully with monoclonal antibody (rituximab) |
| title_full_unstemmed | Refractory thrombotic thrombocytopenic purpura treated successfully with monoclonal antibody (rituximab) |
| title_short | Refractory thrombotic thrombocytopenic purpura treated successfully with monoclonal antibody (rituximab) |
| title_sort | refractory thrombotic thrombocytopenic purpura treated successfully with monoclonal antibody rituximab |
| topic | adamts13 enzyme cryo-poor plasma exchange microangiopathic hemolytic anemia refractory thrombotic thrombocytopenic purpura rituximab |
| url | http://www.ajim.in/article.asp?issn=2666-1802;year=2023;volume=11;issue=2;spage=128;epage=131;aulast=Prusty |
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