title: A case report of uncompensated alkalosis induced by daily plasmapheresis in a patient with thrombotic thrombocytopenic purpura.
abstract: Plasmapheresis (PP) is widely known as the standard therapy for thrombotic thrombocytopenic purpura (TTP). Citrate is used as an anticoagulant in fresh frozen plasma, and the large amount of citrate infused during PP induces metabolic alkalosis. A 29-year-old woman was diagnosed with TTP associated with systemic lupus erythematosus, and was treated by daily PP in addition to a steroid, an immunosuppressant, vincristine, and cyclophosphamide. Uncompensated alkalosis caused by a combination of metabolic and respiratory alkalosis developed after artificial ventilation was discontinued. Her metabolic status improved after controlling her respiratory status and the activity of the TTP. Metabolic alkalosis is a common complication in TTP patients treated by frequent PP, but several factors that affect metabolic status may aggravate the alkalosis and induce uncompensated alkalosis.
authors.affiliation: Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nagai
authors.forename: Mitsuyo
authors.initials: M
authors.lastname: Itabashi
authors.forename: Mayuko
authors.initials: M
authors.lastname: Mizutani
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ogawa
authors.forename: Wako
authors.initials: W
authors.lastname: Yumura
authors.forename: Ken
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D000328:Adult; D000471:Alkalosis / Q000209:etiology*; D000925:Anticoagulants / Q000009:adverse effects; D019343:Citric Acid / Q000009:adverse effects; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D010956:Plasmapheresis / Q000009:adverse effects*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology / Q000628:therapy*; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D019343:Citric Acid; D014750:Vincristine; D003520:Cyclophosphamide