Resumo

TAPIA-PEREZ, Rafael Fredy; MELENDEZ-PEREZ, Shirley Hildegad; MANZANEDA-QUIROZ, Marzaid  e  ALVAREZ-GAMERO, Julio César. Rituximab use in thrombotic thrombocytopenic purpura. Acta méd. peruana [online]. 2015, vol.32, n.2, pp.113-117. ISSN 1728-5917.

Thrombotic thrombocytopenic purpura (TTP) is a clinical syndrome characterized by microangiopathic hemolytic anemia, fever, thrombocytopenia, neurological involvement and renal damage. Its incidence is rare and its cause unknown in 90%. We report the case of a patient of 49 years who was admitted with epigastric pain accompanied by weakness, nausea, vomiting and metrorrhagia. She showed hemoglobin about 7,4 g/dL, hematocrit 24,4%, platelets 30000/ mm3 and increased bilirubins. A day after, right faciobrachio-crural hemiparesis and diffuse ecchymosis were added. The brain TEM shows no pathological evidence. She has two tonic-clonic seizures and there is important deterioration. In the blood smear is evidenced schistocytes, platelets 18400/mm3, and hemoglobin 6,8 gr/dL. We propose the diagnosis of TTP and started treatment with plasmapheresis and methylprednisolone. At 7 days there is no improvement. Rituximab is indicated and the platelets in two days rose to 60000/mm3. Improvements in clinical and laboratory parameters are observed.

Palavras-chave : purpura, thrombotic thrombocytopenic; antibodies, monoclonal; plasmapheresis; rituximab.

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