Ferritin-guided therapeutic plasma exchange (TPE) administration in COVID-19-induced cytokine storm syndrome: a case series
Abstract
SESSION TITLE: Management of COVID-19-Induced Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Therapeutic plasma exchange (TPE) in the management of COVID-19-induced cytokine storm syndrome (CSS) has remained unclear since the pandemic's emergence. A recent meta-analysis by Beraud et. al examined the use of TPE for treatment of CSS in COVID-19 patients. Although inconsistencies were noted, they demonstrated a general downtrend in cytokine markers and acute phase reactants following TPE administration. TPE was associated with improvements in clinical outcomes and appeared safe in critically ill patients. The analysis highlighted an ongoing need to establish clear criteria to identify a target population. This case series presents 3 critically ill adult COVID-19 patients with CSS and extreme hyperferritinemia (>10,000 ng/mL) who received TPE. We propose the use of ferritin as a sole biomarker for guiding therapy in this patient demographic. CASE PRESENTATION: Patient 1 presented with ferritin 16,060 and CRP 8.22. Despite receiving standard COVID-19 therapies, she decompensated and required intubation. Repeat labs revealed ferritin 92,488 and CRP 9.75. TPE was initiated. Ferritin decreased following each TPE session as shown in Graph 1. Patients 2 and 3 also presented with extreme hyperferritinemia and showed a similar downtrend following TPE therapy. All 3 patients made successful recoveries. DISCUSSION:…
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