Pb2592: therapeutic plasma exchange therapy support for covid-19 with neurological complications: a case report

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: Therapeutic plasma exchange (TPE) has been used as an alternative treatment in severe sepsis for several decades. Several groups, including the US Food and Drug Administration (FDA), have also posited that rescue TPE might have a role in COVID-19, especially with neurological complications, but to date it has been insufficiently studied. Aims: To assess the efficacy of TPE for COVID-19 with neurological complications. Methods: A case report for a COVID-19 patient with neurological complications in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine. Results: On January 03, 2023, a 64-year-old man, with a medical history of cerebral infarction, hypertension, and diabetes, presented to the hospital with a one-day history of disorder of consciousness with convulsions. Temperature (T) was 37.5℃; white blood cell count 14.94×1012/L; lymphocyte absolute value 0.57×109/L; serum potassium 2.22 mol/L; serum sodium 123 mmol/L; C reactive protein (CRP) 59.69 mg/L. Computed tomography (CT) scan showed double pneumonic lesions with multiple patchy high-density foci, left basal ganglia and radial corona with punctate low-density foci (Figure 1A and B). MRI was limited due to internal steel plate. No significant abnormality in nervous system physical examination. SARS-CoV-2 test was positive. The patient received methylprednisolone to alleviate lung inflammation and potassium and sodium supplementation therapy. On day 3, his vital signs were unstable: respiratory rate (RR) 23 breaths/min; heart rate (HR) 95 beats/min, blood pressure (BP) 187/100mmHg, unconsciousness, serum potassium 2.95 mol/L; serum sodium 140.1 mmol/L. He was received urapidil to reduce BP. On day 4, plasma exchange was performed using the Fresenius COM.TEC cell separator through the extracorporeal system, and TPE set was used. Fresh frozen plasma (FFP) was used as the replacement fluid, the total amount was 3000 ml. After 1 session of TPE, the patient became conscious. CRP decreased to 4.4 mg/L. Then, hemoperfusion (HP) using HA380 cartridge was administered for 2 hrs for 2 consecutive days. In order to make sure the antibiotics, and other drugs were not cleared by TPE and HP, they were given after the completion of TPE and HP. After 3 sessions of TPE and HP, white blood cell count decreased from 14.94×1012/L to 5.44×1012/L, lymphocyte absolute value increased from 0.57×109/L to 1.16×109/L, CRP decreased from 59.69 mg/L to 2.8 mg/L. The chest CT revealed improvement of both lungs (Figure 1C). Summary/Conclusion: The most serious developing neurological diseases of COVID-19 include polyneuritis, Guillain–Barré syndrome (GBS), meningitis, encephalitis, and encephalopathy, in addition to cerebral hemorrhage and infarction. The latest guidelines of ASFA accept plasma exchange as the first-line treatment for some of these complications, such as GBS, either alone or in combination with other treatment methods. Therefore, despite several limitations for these therapy, such as removing patients neutralizing antibodies, large amounts of FFP, expensive, time and recourse consuming, TPE would be still prescribed as an important treatment in alleviating inflammatory cytokine storm when needed in COVID-19 patients.Keywords: Plasma, COVID-19