A case report of uncompensated alkalosis induced by daily plasmapheresis in a patient with thrombotic thrombocytopenic purpura.

Abstract

Plasmapheresis (PP) is widely known as the standard therapy for thrombotic thrombocytopenic purpura (TTP). Citrate is used as an anticoagulant in fresh frozen plasma, and the large amount of citrate infused during PP induces metabolic alkalosis. A 29-year-old woman was diagnosed with TTP associated with systemic lupus erythematosus, and was treated by daily PP in addition to a steroid, an immunosuppressant, vincristine, and cyclophosphamide. Uncompensated alkalosis caused by a combination of metabolic and respiratory alkalosis developed after artificial ventilation was discontinued. Her metabolic status improved after controlling her respiratory status and the activity of the TTP. Metabolic alkalosis is a common complication in TTP patients treated by frequent PP, but several factors that affect metabolic status may aggravate the alkalosis and induce uncompensated alkalosis.

• Authors: Yoshiko Nagai, Mitsuyo Itabashi, Mayuko Mizutani, Tetsuya Ogawa, Wako Yumura, Ken Tsuchiya, Kosaku Nitta
• Journal: Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy (Ther Apher Dial) Vol. 12 Issue 1 Pg. 86-90 (Feb 2008) ISSN: 1744-9987 [Electronic] Australia
• PMID: 18257819 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticoagulants
• Glucocorticoids
• Immunosuppressive Agents
• Citric Acid
• Vincristine
• Cyclophosphamide

Topics

• Adult
• Alkalosis (etiology)
• Anticoagulants (adverse effects)
• Citric Acid (adverse effects)
• Cyclophosphamide (therapeutic use)
• Female
• Glucocorticoids
• Humans
• Immunosuppressive Agents (therapeutic use)
• Lupus Erythematosus, Systemic (complications)
• Plasmapheresis (adverse effects)
• Purpura, Thrombotic Thrombocytopenic (etiology, therapy)
• Vincristine (therapeutic use)