Massachusetts General Hospital pathway for treatment of infectious purpura fulminans
| Days of presentation . | Laboratory monitoring . | Treatment . | ||||
|---|---|---|---|---|---|---|
| Intravenous UFH . | FFP . | Cryoprecipitate . | PC replacement . | Antithrombin concentrate . | ||
| 0-3 | • Complete blood count • D-dimer or fibrin split products • Fibrinogen • PT and aPTT • Anti-Xa (while on UFH) • Antithrombin, PC, and PS activities | 80 U/kg bolus followed by 18 U/kg/h, targeting anti-Xa 0.3-0.7 U/mL | 2 units followed by 1 unit every 4 hours | 10 units, targeting fibrinogen ≥100 mg/dL | PC concentrate 100 U/kg or prothrombin complex concentrate 25-50 U/kg, targeting PC activity >80% | 85 U/kg, targeting antithrombin activity >80% |
| 4-5 | 1 unit every 6 hours | |||||
| 6-7 | 1 unit every 8 hours | |||||
| • Consider intravenous vitamin K 5 mg at the time of presentation • In patients on anticoagulation, platelets may be transfused to maintain platelet count ≥30 000/µL, but platelets should not be transfused in absence of anticoagulation or bleeding | ||||||
| • For acute infectious purpura fulminans: broad-spectrum antibiotics with coverage against Neisseria meningitidis and other encapsulated organisms as well as methicillin-resistant Staphylococcus aureus until a culprit microorganism is identified | ||||||
| Days of presentation . | Laboratory monitoring . | Treatment . | ||||
|---|---|---|---|---|---|---|
| Intravenous UFH . | FFP . | Cryoprecipitate . | PC replacement . | Antithrombin concentrate . | ||
| 0-3 | • Complete blood count • D-dimer or fibrin split products • Fibrinogen • PT and aPTT • Anti-Xa (while on UFH) • Antithrombin, PC, and PS activities | 80 U/kg bolus followed by 18 U/kg/h, targeting anti-Xa 0.3-0.7 U/mL | 2 units followed by 1 unit every 4 hours | 10 units, targeting fibrinogen ≥100 mg/dL | PC concentrate 100 U/kg or prothrombin complex concentrate 25-50 U/kg, targeting PC activity >80% | 85 U/kg, targeting antithrombin activity >80% |
| 4-5 | 1 unit every 6 hours | |||||
| 6-7 | 1 unit every 8 hours | |||||
| • Consider intravenous vitamin K 5 mg at the time of presentation • In patients on anticoagulation, platelets may be transfused to maintain platelet count ≥30 000/µL, but platelets should not be transfused in absence of anticoagulation or bleeding | ||||||
| • For acute infectious purpura fulminans: broad-spectrum antibiotics with coverage against Neisseria meningitidis and other encapsulated organisms as well as methicillin-resistant Staphylococcus aureus until a culprit microorganism is identified | ||||||
UFH, unfractionated heparin.