CLinical Case Scenario
A 45-year-old female is admitted to the Intensive Care Unit (ICU) with confusion, fever, and petechial rash. She has a history of fatigue, easy bruising, and intermittent abdominal pain over the past two weeks. On physical examination, she is febrile (38.5°C), hypotensive (BP: 95/60 mmHg), and tachycardic (HR: 120 bpm). She has scattered petechiae on her extremities and mild scleral icterus. Initial laboratory findings reveal severe thrombocytopenia (platelet count: 12,000/µL), microangiopathic hemolytic anemia (hemoglobin: 7.5 g/dL with schistocytes seen on blood smear), elevated lactate dehydrogenase (LDH), and normal coagulation parameters. Renal function tests show acute kidney injury (creatinine: 3.2 mg/dL), and a urine dipstick is positive for hemoglobin without red blood cells on microscopy.
The clinical presentation and lab findings strongly suggest a diagnosis of thrombotic thrombocytopenic purpura (TTP). The patient is immediately started on plasma exchange therapy along with corticosteroids. Due to significant renal impairment, continuous renal replacement therapy (CRRT) is initiated concurrently to manage fluid overload and electrolyte imbalances. The ICU team discusses the therapeutic goals and complications associated with TTP and the rationale for the chosen interventions.
What is the primary goal of plasma exchange therapy in the management of TTP?
