Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2020; 8(12): 2617-2622
Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2617
Successful treatment of plasma exchange-refractory thrombotic thrombocytopenic purpura with rituximab: A case report
Jian Chen, Jing-Xia Jin, Xiao-Fei Xu, Xuan-Xuan Zhang, Xing-Nong Ye, Jian Huang
Jian Chen, Xuan-Xuan Zhang, Department of Ultrasonography, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
Jing-Xia Jin, Xiao-Fei Xu, Xing-Nong Ye, Jian Huang, Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
Author contributions: Chen J reviewed the literature and contributed to manuscript drafting; Jin JX and Xu XF performed the diagnostic investigations and treatments; Ye XN and Zhang XX helped collect the data and analyzed and interpreted the imaging findings; Huang J followed the patient, and reviewed and revised the entire manuscript; all authors issued final approval for the version to be submitted.
Supported by the Public Technology Research Projects of Yiwu, China, No. 2016S05; the Key Project of Jinhua Science and Technology Plan, No. 2020XG-29; the 2018-2020 Key Medical Discipline (Hematology) Fund of Yiwu, China; the 2019-2021 Key Medical Discipline (Hematology) Fund of Jinhua, China; the Project of Educational Commission of Zhejiang Province of China, No. Y201942124; and the 2019-2024 Academician Workstation Fund of the Fourth Affiliated Hospital of Zhejiang University School of Medicine.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian Huang, MD, PhD, Chief Physician, Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, No. 1, Shangcheng Road, Yiwu 322000, Zhejiang Province, China. househuang@zju.edu.cn
Received: April 13, 2020
Peer-review started: April 13, 2020
First decision: April 28, 2020
Revised: May 5, 2020
Accepted: May 21, 2020
Article in press: May 21, 2020
Published online: June 26, 2020
Processing time: 71 Days and 18.3 Hours
Abstract
BACKGROUND

Thrombotic thrombocytopenic purpura (TTP), a subtype of thrombotic microangiopathy, has a very high fatality rate if there is no timely diagnosis or treatment. Here, we report a case of TTP refractory to high displacement plasma exchange, which was later successfully treated with rituximab.

CASE SUMMARY

Here we report a case of refractory TTP in a 63-year-old woman with a low platelet count and decreased ADAMTS13 activity. Her platelet count was 9 × 109/L, hemoglobin level was 81 g/L, and ADAMTS13 was < 5%. She was diagnosed with thrombotic thrombocytopenic purpura. After 8 d of daily plasma exchange (PEX), her platelet levels were still low. However, after 6 d of treatment with rituximab, her platelet count increased and ADAMTS13 activity returned to normal.

CONCLUSION

PEX can cure most patients, but the relapse rate can be up to 50%-60%. This case suggested that rituximab can improve the curative efficiency of PEX and prevent disease relapse in TTP.

Keywords: Thrombotic thrombocytopenic purpura; ADAMTS13; Plasma exchange; Rituximab; Case report

Core tip: Thrombotic thrombocytopenic purpura (TTP) has a very high fatality rate if there is no timely diagnosis or treatment. Here we report a case of refractory TTP in a woman with decreased ADAMTS13 activity. Although the patient was refractory to daily plasma exchange, her platelet count and ADAMTS13 activity returned to normal after 6 d of treatment with rituximab. This case suggested that rituximab can improve the curative efficiency of plasma exchange in TTP.