title: Therapeutic plasmapheresis and red blood cell exchange in a sickle cell trait patient with rhabdomyolysis.
abstract: We report a case of a 16-year-old African-American male with sickle cell trait and a past medical history significant for asthma that was transferred to our hospital for management of respiratory failure. On the fourth day of hospitalization, the patient was found to have increased creatine kinase (CK) levels and urine myoglobin levels consistent with rhabdomyolysis. No clear etiology was identified. Aggressive standard hydration and urine alkalization were applied without response. On the sixth day of hospitalization, the patient underwent a 1-1.5 plasma volume therapeutic plasma exchange (TPE) resulting in a transient reduction of serum CK and myoglobin by 50%, which became elevated once again within 4 h. Since his clinical presentation resembles exertional rhabdomyolysis documented in patients with sickle cell trait, RBC exchange was performed. The patient tolerated the procedure without complications. In addition to his improved overall condition, the patient's post-exchange CK and serum myoglobin levels dropped dramatically without rebound. To our knowledge, this case represents the first reported case of TPE followed by RBC exchange in a SCT patient with rhabdomyolysis.
authors.affiliation: Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA. Richard.Huang.1@uth.tmc.edu
authors.forename: Richard S P
authors.initials: RS
authors.lastname: Huang
authors.forename: Ashok
authors.initials: A
authors.lastname: Tholpady
authors.forename: Amer
authors.initials: A
authors.lastname: Wahed
authors.forename: Brian
authors.initials: B
authors.lastname: Chang
authors.forename: Yu
authors.initials: Y
authors.lastname: Bai
mesh_terms: D000293:Adolescent; D003131:Combined Modality Therapy; D003402:Creatine Kinase / Q000097:blood; D017707:Erythrocyte Transfusion; D005440:Fluid Therapy; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008297:Male; D009212:Myoglobinuria / Q000209:etiology; D010956:Plasmapheresis; D012131:Respiratory Insufficiency / Q000150:complications; D012206:Rhabdomyolysis / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D012805:Sickle Cell Trait / Q000150:complications*; D013224:Status Asthmaticus / Q000150:complications
chemical_list: D003402:Creatine Kinase