title: [Replacement therapy with protein C for meningococcal sepsis and fulminant purpura in pediatric patients].
abstract: Disseminated intravascular coagulation as associated to sepsis contributes to the development of clinical multiple organ failure by extensive thrombosis in microcirculation vessels. This condition commonly manifests itself in severe meningococcal sepsis. On the skin, its clinical manifestation is extensive purpura with necrotic lesions that usually progress to serious distal ischemia and may call for amputation. A common denominator in these events regarding hemostasis is a depletion of so-called natural anticoagulant proteins, particularly protein C. According to clinical observations replacement therapy with human plasma-derived protein C concentrates has been associated with significantly improved clinical outcome in patients with meningococcal sepsis and fulminant purpura. This paper reports a case of acquired protein C deficiency in a girl with meningococcal sepsis, fulminant purpura, disseminated intravascular coagulation, and septic shock. Fresh plasma therapy was intended to increase consumption coagulopathy-depleted coagulation factors and to provide small amounts of protein C. The inability to restore protein C concentrations above 30%, and the presence of severe thrombopenia in the setting of disseminated intravascular coagulation led to the onset of replacement therapy using a human protein C concentrate (Ceprotin), which increased plasma protein C concentrations and contributed to revert the existing hypercoagulability status. Finally, evidence available in the literature regarding fulminant meningococcal sepsis management using human protein C concentrates and recombinant activated protein C is discussed.
authors.affiliation: Servicio de Farmacia, Hospital General Universitario de Alicante. paqillinares@eresmas.com
authors.forename: F
authors.initials: F
authors.lastname: Llinares Tello
authors.forename: C
authors.initials: C
authors.lastname: Hernández Prats
authors.forename: A
authors.initials: A
authors.lastname: Burgos San José
authors.forename: N
authors.initials: N
authors.lastname: Bosacoma Ros
authors.forename: P
authors.initials: P
authors.lastname: Alcalá Minagorre
authors.forename: F
authors.initials: F
authors.lastname: López Rodríguez
authors.forename: R
authors.initials: R
authors.lastname: Reig Sáenz
authors.forename: P
authors.initials: P
authors.lastname: Marco Vera
authors.forename: J P
authors.initials: JP
authors.lastname: Ordovás Baines
mesh_terms: D002648:Child; D017809:Fatal Outcome; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006403:Hematologic Tests; D006801:Humans; D011695:IgA Vasculitis / Q000188:drug therapy* / Q000209:etiology; D008589:Meningococcal Infections / Q000150:complications / Q000188:drug therapy*; D011486:Protein C / Q000627:therapeutic use*; D020151:Protein C Deficiency / Q000188:drug therapy* / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D011486:Protein C