Clinical course and treatment of our Jehovah’s Witness patient
| Day . | Hgb, g/dL . | Plt, ×109/L . | Clinical course . | Treatments* . |
|---|---|---|---|---|
| 1 | 8.4 | 12 | Transient aphasia, bilateral arm and face numbness and weakness, hand clumsiness. | MP 375, folic acid |
| 2 | 7.8 | 16 | Neurologic symptoms resolved. | |
| 3 | 7.8 | 24 | Rituximab | |
| 4 | 7.5 | 10 | Apheresis, Epo | |
| 5 | 6.9 | 9 | Acute transient episode of feeling faint, aphasia, left arm weakness. | Apheresis, IVIg |
| 6 | 6.0 | 10 | Neurologic symptoms resolved; no further neurologic abnormalities. | |
| 7 | 5.7 | 15 | MP 1000, IVIg | |
| 8 | — | — | MP 1000, IV iron, rituximab | |
| 9 | 6.6 | 28 | MP 1000 | |
| 10 | — | — | Gradual improvement. Hallucinations and proximal muscle weakness attributed to corticosteroids. | Koate, prednisone 80 |
| 11 | 7.2 | 45 | ||
| 12 | 7.7 | 74 | Rituximab | |
| 14 | 9.1 | 96 | Prednisone 40 | |
| 16 | 9.3 | 109 | Discharged to rehabilitation for steroid-induced proximal muscle weakness. Regained strength with physical therapy. | |
| 19 | 10.0 | 115 | Rituximab | |
| 21 | 11.8 | 90 | ||
| 23 | 12.7 | 125 | ||
| 28 | 13.0 | 231 | Discharged to home. ADAMTS13, 99%. | |
| 60 | — | — | Return to work. |
| Day . | Hgb, g/dL . | Plt, ×109/L . | Clinical course . | Treatments* . |
|---|---|---|---|---|
| 1 | 8.4 | 12 | Transient aphasia, bilateral arm and face numbness and weakness, hand clumsiness. | MP 375, folic acid |
| 2 | 7.8 | 16 | Neurologic symptoms resolved. | |
| 3 | 7.8 | 24 | Rituximab | |
| 4 | 7.5 | 10 | Apheresis, Epo | |
| 5 | 6.9 | 9 | Acute transient episode of feeling faint, aphasia, left arm weakness. | Apheresis, IVIg |
| 6 | 6.0 | 10 | Neurologic symptoms resolved; no further neurologic abnormalities. | |
| 7 | 5.7 | 15 | MP 1000, IVIg | |
| 8 | — | — | MP 1000, IV iron, rituximab | |
| 9 | 6.6 | 28 | MP 1000 | |
| 10 | — | — | Gradual improvement. Hallucinations and proximal muscle weakness attributed to corticosteroids. | Koate, prednisone 80 |
| 11 | 7.2 | 45 | ||
| 12 | 7.7 | 74 | Rituximab | |
| 14 | 9.1 | 96 | Prednisone 40 | |
| 16 | 9.3 | 109 | Discharged to rehabilitation for steroid-induced proximal muscle weakness. Regained strength with physical therapy. | |
| 19 | 10.0 | 115 | Rituximab | |
| 21 | 11.8 | 90 | ||
| 23 | 12.7 | 125 | ||
| 28 | 13.0 | 231 | Discharged to home. ADAMTS13, 99%. | |
| 60 | — | — | Return to work. |
Days begin with hospital admission on day 1.
Epo, recombinant human erythropoietin; Hgb, hemoglobin concentration; MP, methylprednisolone (and prednisone); Plt, platelet count.
Doses, regimens: apheresis, plasmapheresis with albumin replacement; Epo, 10 000 U then 20 000 U, 3 times per week; folic acid, 1 mg per day; IVIg, 70 g (1 g/kg); IV iron, ferrous gluconate, 125 mg IV daily; Koate, 2000 U (30 U/kg), given once; MP, milligrams per day; rituximab, 375 mg/m2.