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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2003 September;69(9):691-5
language: English, Italian
Replacement treatment with protein C in an 18-year-old man with meningococcal sepsis and purpura fulminans
Vaccarella G., Pelella R.
Anesthesia and Resuscitation Service D. Cotugno Hospital, Naples, Italy
In separate studies on Neisseria meningitidis sepsis, Powars and Fiynvandraat suggested that low protein C levels may be responsible for disseminated intravascular coagulopathy and purpura fulminans. Following on this observation, we used protein C concentrate in an 18-year-old male patient with septic shock and purpura fulminans. The patient’s coagulation parameters were seriously altered: AT 45%; protein C 21%; PT 50%; platelets 55000; D-dimer 2400. Early treatment included immediate administration of 3000 IU of antithrombin and intensive therapy: antibiotic therapy, volemic replacement, supported by inotropic drugs and oxygen therapy. Given the patient’s low protein C levels and the progression of purpura, replacement therapy with protein C concentrate was instituted. The initial dose of 80 IU/kg/bw (5600 IU) in bolus, was adjusted according to blood laboratory values and then set at 2000 IU every 8 hours for 4 days. An increase in protein C was observed (78%) after the 1st administration, while the D-dimer levels fell by 50%. By day 7, the patient’s cardiocirculatory conditions had stabilized and the coagulation parameters had normalized; the patient was discharged from the intensive care unit. Protein C replacement therapy normalized the coagulation parameters and blocked the evolution of the skin injuries.