4. Treatment


Hematology was consulted and plasmapheresis was immediately scheduled. A Quinton catheter was placed in the internal jugular vein under ultrasound guidance. Mr. R underwent plasmapheresis daily while hospitalized, in addition to prednisone therapy.

 


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On day 3 in-hospital, Mr. R’s LDH dropped dramatically to 358 U/L, and his platelets rose slowly to 65. On day 5, his LDH and platelet count normalized to 165 U/L and 301, respectively. After six plasmapheresis treatments, 
Mr. R’s platelet count stablilized and the gross hematuria cleared. He was discharged on 60 mg of prednisone, with instructions to taper down by 20 mg every four days.

The catheter was removed nine days after initial presentation. At his two-week outpatient follow-up, Mr. R was back to full health. He was no longer smoking cigarettes or marijuana, he was back at work, and he felt more energetic. In addition, he started a light workout regime. He did not have any complications from the TTP or treatment. He continues to follow up with hematology as an outpatient. 


5. Discussion


TTP is a rare, most often idiopathic, acute hematologic state, traditionally described in a “classic pentad,” consisting of hemolytic anemia, thrombocytopenia, renal insufficiency, neurologic abnormalities and fever as the representative findings. With modern medicine and plasmapheresis available, all five components are rarely present in one individual.1