Korean J Intern Med.  2019 Jul;34(4):902-909. 10.3904/kjim.2016.194.

Application of therapeutic plasma exchange in patients having severe fever with thrombocytopenia syndrome

Affiliations
  • 1Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea. neosangtaek@naver.com
  • 2Department of Laboratory Medicine, Jeju National University School of Medicine, Jeju, Korea.
  • 3Department of Microbiology and Immunology, Jeju National University School of Medicine, Jeju, Korea.
  • 4Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.

Abstract

BACKGROUND/AIMS
Severe fever with thrombocytopenia syndrome (SFTS) is a viral hemorrhagic fever with a high fatality rate. However, effective treatments for SFTS cases not responded to supportive therapy have not been established. Herein, we introduced the therapeutic plasma exchange (TPE) in SFTS patients in a tertiary hospital between 2013 and 2015.
METHODS
TPE was performed in patients with rapidly progressing SFTS. Clinical, laboratory, and virological parameters were compared before and after TPE.
RESULTS
Among 27 confirmed SFTS patients, two patients were treated with TPE and ribavirin combination in May 2013, then, 14 patients with rapidly progressing SFTS patients were treated with only TPE from June 2013 to September 2015: their median age was 58 years (interquartile range, 50 to 70) and eight (57.1%) were male. Body temperature, pressure-adjusted heart rate, white blood cell and platelet counts, coagulation profile, serum creatinine, and multiple organ dysfunction score improved immediately after TPE. In addition, the mean cyclic threshold value of real-time reverse transcriptase polymerase chain reaction for SFTS virus after TPE (mean ± standard deviation, 31.3 ± 2.9) was significantly higher than that before TPE (26.5 ± 2.9; p < 0.001), indicating that serum viral loads decreased after TPE. Finally, 13 of 14 TPE-treated patients (92.8%) recovered from rapidly progressing SFTS without sequelae.
CONCLUSIONS
SFTS patients treated with TPE showed improvements in clinical, laboratory, and virological parameters. These results suggest that TPE would be a therapeutic modality as rescue therapy in patients with rapidly progressing SFTS.

Keyword

Severe fever with thrombocytopenia syndrome; Plasma exchange; Therapeutics

MeSH Terms

Body Temperature
Creatinine
Fever*
Heart Rate
Hemorrhagic Fevers, Viral
Humans
Leukocytes
Male
Organ Dysfunction Scores
Plasma Exchange*
Plasma*
Platelet Count
Reverse Transcriptase Polymerase Chain Reaction
Ribavirin
Tertiary Care Centers
Thrombocytopenia*
Viral Load
Creatinine
Ribavirin
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