Early Plasma Exchange May Improve Outcome for E. coli-HUS Patients
If performed early enough after the onset of illness, plasma exchange may be an effective treatment for symptoms of hemolytic uremic syndrome (HUS), a rare but potentially fatal complication of E. coli infection, according to results from a small Danish study published in The Lancet.
E. coli-HUS, which affects young children more frequently than adults, is characterized by acute hemolytic anemia, abnormally low platelet count and renal insufficiency. Most cases are associated with enteritis resulting from a Shiga toxin that is released by certain strains of E coli.
Senior author Martin Tepel, MD, from the Department of Nephrology, Odense University Hospital, Denmark, and his group used plasmapheresis to treat four women and one man ranging in age from 44 to 77 years old. All of them had symptoms of HUS associated with E coli, including enteritis, bloody diarrhea acute hemolytic anemia, abnormally low platelet count, acute kidney injury, and progressive central nervous dysfunction.
All the patients contracted E coli 0104:H4 infections while visiting northern Germany last spring. The patients were treated daily with plasma exchange by centrifugation and substitution with fresh frozen plasma.
After treatment, median platelet counts increased, median lactate dehydrogenase (LDH) concentrations decreased and renal function and neurological status improved. Researchers also found an association between the time therapy was initiated and how quickly the treatment showed affect.
Five to eight days after they began treatment, all of the patients were discharged from hospital with normal neurological status. The authors of the study say these results show plasma exchange, if performed early enough after the onset of illness, could be an effective treatment for HUS in adults and merits further study
