Plasma

Abstract

Anaphylaxis: case report A 39-year-old woman developed anaphylaxis during treatment with plasma for thrombocytopenia. The woman presented to the emergency department (ED) in July 2020 due to appearance of bruises on the lower and upper limbs in relation with severe thrombocytopenia and mild anaemia. CBC repeated in the ED confirmed worsening thrombocytopenia and anaemia. On day +1, she started receiving methylprednisolone, followed by prednisone with folic acid and daily plasma exchanges (PEX) using plasma [Octaplas; route and dosage not stated] as per local policy. During the third and fourth PEX, she suddenly presented in a few minutes after the infusion of 40mL plasma (during third PEX) and 25mL of plasma (during the fourth PEX) with typical clinical symptoms of anaphylaxis and respiratory distress. She had an immediate onset of tachypnoea and dyspnoea (with oxygen saturation of 85% during the third PEX and of 80% during the fourth PEX), severe hypotension (particularly during the fourth PEX, BP of <80/40mm Hg), progressive urticaria and tachycardia (>110 beats/min). Further, she developed psychomotor agitation, diffuse pain, a feeling of impending doom and mild nausea. Body temperature during both anaphylaxis episode was 38.2°C. The woman’s apheretic procedure and PEX therapy was stopped. She was immediately treated with chlorphenamine, hydrocortisone and dopamine along with oxygen by vent mask (for anaphylaxis during the third procedure). Chloride sodium was also added to the treatment. For anaphylaxis episode during the fourth PEX, the same resuscitation protocol was repeated, but 40% oxygen was implemented and epinephrine [adrenaline] was added. Both severe clinical presentations, resolved following 120 minutes and 150 minutes, respectively. A day later, she presented with new onset transient mild headache and lower limb paraesthesia, and CBC showed persistent transfusion-dependent anaemia and a moderate increase in platelets count. Considering the intolerance to plasma, rituximab and caplacizumab were started on day +5. This treatment was well tolerated without any drugrelated adverse events.