Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
Division of Critical Care Medicine, Department of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Rd, Bangkoknoi, Bangkok, 10700, Thailand.
J Med Case Rep. 2024 Sep 3;18(1):418. doi: 10.1186/s13256-024-04726-6.
Pregnant women are more likely to have a higher severity of illness after being infected with coronavirus disease 2019 compared with the general population, particularly in the hyperinflammatory phase. However, immunomodulatory drugs are contraindicated and have been associated with an increased risk of fetal abnormalities. Therefore, we are reporting our experience with the use of HA330 hemoperfusion in combination with standard therapy in severe to critical coronavirus disease 2019 cases among pregnant patients.
From January 2020 to December 2021, four pregnant Thai women were treated with hemoperfusion using a cytokine adsorptive technique. The patients' ages ranged from 21 to 36 years old, and their gestational ages at the time of admission ranged from 18 to 38 weeks. Two patients required intubation. Extracorporeal blood purification with an adsorptive cartridge (HA330, Jafron, China) was applied as an adjunctive strategy to standard therapy approximately one week after the onset of symptoms, and most patients received three sessions of hemoperfusion. The baseline C-reactive protein level was greater than 80 mg/dL. The results showed that hemoperfusion could decrease the C-reactive protein level by approximately 80% and improve oxygenation. The newborns were delivered by Cesarean section without complications. Neither mortality nor serious adverse events related to hemoperfusion occurred.
This report may help ensure the use of the hemoperfusion strategy in pregnant patients during a cytokine storm. However, a larger cohort is needed to confirm its safety and efficacy.
与普通人群相比，感染 2019 年冠状病毒病的孕妇疾病严重程度更高，尤其是在过度炎症期。然而，免疫调节药物是禁忌的，并且与胎儿畸形风险增加有关。因此，我们报告了在严重至危重新冠病毒病孕妇患者中使用 HA330 血液灌流联合标准治疗的经验。
从 2020 年 1 月至 2021 年 12 月，4 名泰国孕妇接受了使用细胞因子吸附技术的血液灌流治疗。患者年龄在 21 至 36 岁之间，入院时的孕龄在 18 至 38 周之间。2 名患者需要插管。在症状出现后大约一周，应用吸附性筒（HA330，中国捷扶康）进行体外血液净化作为标准治疗的辅助策略，大多数患者接受了三次血液灌流。基线 C 反应蛋白水平大于 80mg/dL。结果表明，血液灌流可以将 C 反应蛋白水平降低约 80%，并改善氧合。新生儿通过剖宫产分娩，无并发症。没有与血液灌流相关的死亡或严重不良事件发生。
本报告可能有助于确保在细胞因子风暴期间在孕妇中使用血液灌流策略。然而，需要更大的队列来确认其安全性和疗效。
