卡泊单抗成功治疗血栓性血小板减少性紫癜的心脏受累
Caplacizumab in the successful management of cardiac involvement in thrombotic thrombocytopenic purpura.
作者信息
Mahmoud Amir A, Eltaher Basant, Hashem Anas
机构信息
Department of Internal Medicine, Rochester General Hospital, Rochester, New York.
Department of Hematology and Bone Marrow Transplant, Ain Shams University, Cairo, Egypt.
出版信息
Proc (Bayl Univ Med Cent). 2022 Aug 2;35(6):832-833. doi: 10.1080/08998280.2022.2101106. eCollection 2022.
Cardiac involvement is well documented in thrombotic thrombocytopenic purpura (TTP). Management remains challenging due to thrombocytopenia. Caplacizumab is a novel medication in TTP, but questions remain on its overall benefit in TTP patients. We report a 76-year-old woman who was admitted for non-ST segment elevation myocardial infarction, left systolic ventricular dysfunction, severe hemolytic anemia, and thrombocytopenia suggestive of TTP (PLASMIC score 7). Therapeutic plasma exchange (TPE) and caplacizumab were started alongside an immunosuppressive regimen. After 3 days of treatment, repeat echocardiography showed complete resolution of left ventricular dysfunction. We were able to stop TPE and start aspirin on the fourth day after normalization of platelet count. Our report outlines the potential benefits of caplacizumab for the time-sensitive management of acute coronary syndrome and the compromised volume status of heart failure patients, with early platelet recovery and lower duration of TPE.
血栓性血小板减少性紫癜（TTP）中心脏受累已有充分记录。由于血小板减少，其治疗仍然具有挑战性。卡泊单抗是治疗TTP的一种新型药物，但对于其在TTP患者中的总体益处仍存在疑问。我们报告了一名76岁女性，因非ST段抬高型心肌梗死、左心室收缩功能障碍、严重溶血性贫血和提示TTP的血小板减少症（血浆评分7）入院。在免疫抑制治疗方案的同时开始进行治疗性血浆置换（TPE）和使用卡泊单抗。治疗3天后，重复超声心动图显示左心室功能障碍完全缓解。血小板计数恢复正常后的第四天，我们能够停止TPE并开始使用阿司匹林。我们的报告概述了卡泊单抗对于急性冠状动脉综合征的时间敏感性管理以及心力衰竭患者容量状态受损的潜在益处，包括早期血小板恢复和缩短TPE持续时间。
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