Main Article Content

Abstract

Coronavirus Disease (COVID-19) has rapidly spread and caused a high number of mortalities. To this day, effective therapy to cure this virus is yet to be found. A number of treatments were tested; however, the result is not satisfactory. Therapeutic plasma exchange (TPE) is one of the supportive therapies applied to treat COVID-19 patients with moderate to severe symptoms. We reported 41 years old male patient diagnosed with severe COVID-19 infection, acute respiratory distress syndrome (ARDS), and thrombophilia. The patient received a therapy following the Ministry of Health’s guideline for COVID-19 handling. On the third day, respiratory failure occurred with a P/F ratio of 255 and the chest X-ray result showed vascular streak and ground-glass opacity; thus, the hospital decided to perform TPE. The TPE was performed twice in 5 days interval. After TPE was administered, clinical development is observed both subjectively in the form of reduced symptoms, normal respiration rate, and objectively, the improvement in blood gas analysis, increased O2 saturation, and a decrease in interleukin-6 (IL-6) and tumor necrosis factor-a (TNF-a) level significant clinical laboratory and radiological improvement possibly due to cytokine storm which is remedied by TPE action.

Keywords

ARDS COVID-19 thrombophilia therapeutic plasma exchange

Article Details

Author Biography

Reviono Reviono, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia

Pulmonolgist
How to Cite
Reviono, R., & Arifin, A. (2021). Therapeutic Plasma Exchange (TPE) as an effective supportive therapy for COVID-19 case with Acute Respiratory Distress Syndrome (ARDS) and thrombophilia: A Case Report. JKKI : Jurnal Kedokteran Dan Kesehatan Indonesia, 12(1), 92–97. https://doi.org/10.20885/JKKI.Vol12.Iss1.art13

References

  1. Zhang J, Xie B, Hashimoto K. Current status of potential therapeutic candidates for the COVID-19 crisis. Brain, Behavior, and Immunity. 2020;87:59-73.
  2. Khamis F, Al-Zakwani I, Al Hashmi S, Al Dowaiki S, Al Bahrani M, Pandak N, et al. Therapeutic plasma exchange in adults with severe COVID-19 infection. International Journal of Infectious Diseases. International Society for Infectious Diseases. 2020;99:214–8.
  3. Morath C, Weigand MA, Zeier M, Speer C, Tiwari-Heckler S, Merle U. Plasma exchange in critically ill COVID-19 patients. Critical Care. Critical Care; 2020;24(1):1–4.
  4. Keith P, Day M, Perkins L, Moyer L, Hewitt K, Wells A. A novel treatment approach to the novel coronavirus: An argument for the use of therapeutic plasma exchange for fulminant COVID-19. Critical Care. 2020;24(1):1–3.
  5. Gao YM, Xu G, Wang B, Liu BC. Cytokine storm syndrome in coronavirus disease 2019: A narrative review. Journal of Internal Medicine. 2020;(June):1–15.
  6. Tabibi S, Tabibi T, Conic RRZ, Banisaeed N, Streiff MB. Therapeutic Plasma Exchange: A potential Management Strategy for Critically Ill COVID-19 patients. Journal of Intensive Care Medicine. 2020;35(9):827–35.
  7. Keith P, Day M, Choe C, Perkins L, Moyer L, Hays E, et al. The successful use of therapeutic plasma exchange for severe COVID-19 acute respiratory distress syndrome with multiple organ failure. SAGE Open Medical Case Reports. 2020;8:2050313X2093347.
  8. Song CY, Xu J, He JQ, Lu YQ. COVID-19 early warning score: A multi-parameter screening tool to identify highly suspected patients. medRxiv. 2020.
  9. Erlina B, Susanto AD, Nasution SA, Ginanjar E, Pitoyo CW, Susilo A, et al. Pedoman tatalaksana COVID-19. 2nd ed. Jakarta, 2020 p. 47–68.
  10. Zhuplatov SB, Zhuplatov IS. Removal of endotoxins and cytokines by plasmapheresis filtration with plasma exchange therapy (TPE) could benefit patients with Covid-19 in critical condition. 2020;10(5):85–9.
  11. Sokolov AA, Solovyev AG. Russian pioneers of therapeutic hemapheresis and extracorporeal hemocorrection: 100-year anniversary of the world’s first successful plasmapheresis. Therapeutic Apheresis and Dialysis. 2014;18(2):117–21.
  12. Santis GC De, Correa L, Oliveira O De, Maltoni G, Pina B De, Prado A, et al. Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the writing committee of the American Society for Apheresis: The seventh special issue. Journal Of Clinical Apheresis. 2011;185:181–5.
  13. Wang J, Jiang M, Chen X, Montaner LJ. Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: Review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts. Journal of Leukocyte Biology. 2020;108(1):17–41.
  14. Gucyetmez B, Atalan HK, Sertdemir I, Cakir U, Telci L, Ogan A, et al. Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: A retrospective study. Critical Care. Critical Care; 2020;24(1):4–7.
  15. Ma J, Xia P, Zhou Y, Liu Z, Zhou X, Wang J, et al. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19. Clinical Immunology. 2020;214:24–6.