29 November 2022: Articles
Therapeutic Plasma Exchange and Supratherapeutic Levels of Unfractionated Heparin in the Management of Critically Ill Patient with Myasthenia Gravis: A Case Report
Unusual clinical course, Unusual or unexpected effect of treatment, Unexpected drug reaction
Shaden D. Alshehri A , Khalid Al Sulaiman A* , Ohoud Aljuhani A , Shmeylan A. Al Harbi A , Mai Alalawi A , Abeer A. Alenazi A , Raed Kensara A , Omar A. Alshaya ADOI: 10.12659/AJCR.937617
Am J Case Rep 2022; 23:e937617
Table 1. Unfractionated heparin (UFH) and pre- and post-therapeutic plasma exchange (TPE) parameters.
| Day 8 of ICU admission | Day 10 of ICU admission | Day 12 of ICU admission | Day 14 of ICU admission | Day 16 of ICU admission | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Pre-TPE | Post-TPE | Pre-TPE | Post-TPE | Pre-TPE | Post-TPE | Pre-TPE | Post-TPE | Pre-TPE | Post-TPE | |
| UFH Infusion rate (U/h) | 1600 | 1600 | 1600 | Held then reduced to 1300 | 1600 | Held then reduced to 1300 | 1600 | 1600 | 2000 | Held then reduced to 1700 |
| aPTT (s) | 20 | 96.4 | 44.1 | 170 | 45.3 | 170 | 49 | 90.2 | 62.9 | 170 |
| PT (s) | 10.1 | 12.9 | 10.5 | 12.2 | 10.6 | 12.3 | 10.5 | 11.2 | 11 | 11.9 |
| INR | 0.92 | 1.21 | 0.96 | 1.14 | 0.97 | 1.15 | 0.96 | 1.03 | 1.01 | 1.1 |
| Calcium (mmol/L) | 2.13 | 2.1 | 2.13 | 2.15 | 2.13 | 2.12 | 2.14 | 2.14 | 2.19 | 2.29 |
| Fibrinogen (gm/L) | 4.44 | – | 3.34 | – | 3.53 | – | 5.64 | – | 5.14 | – |
| TPE duration (min) | 79 | 93 | 96 | 85 | 81 | |||||
| Total blood volume (mL) | 3973 | 4171 | 4171 | 3840 | 3807 | |||||
| Removed bag (mL) | 3163 | 3446 | 3446 | 3291 | 3339 | |||||
| Replacement fluid used (mL) | 2554 | 2799 | 2781 | 2685 | 2753 | |||||
| Reference ranges: aPTT: 50–80 s; PT: 9.38–12.34 s; INR: 0.80–1.20; calcium: 2.1–2.55 mmol/L; fibrinogen: 1.5–4.1 gm/L. INR – international normalized ratio; aPTT – partial thromboplastin time. | ||||||||||