title: Early and repeated use of plasma for the management of Ebola patients: Reflection around a case.
abstract: In December 2013, the most widespread epidemic of Ebola virus disease began in Guinea and continued for over 2 years. At the request of the Guinean state, France deployed a military field hospital to treat Ebola infected healthcare workers. From January to July 2015, our center supported 26 healthcare workers suffering from Ebola virus disease. Despite an individualized care and optimal treatment, the fatality rate remained high at 30.7%. Improved therapies are required to reduce mortality risk in Ebola virus disease. We report the case of a patient admitted to the hospital on the 4th day after onset, who survived despite several clinical and biological predictors of fatal outcome. We transfused plasma at a high dose and spread over time. This innovative therapeutic approach was based on our clinical experience of Ebola patients' management, literature review and knowledge of plasma ability to restore coagulation disorders and endotheliopathy. Even without any bleeding sign, coagulopathy and endothelial permeability disorders participate in hypovolemia and fatal multi-system organ failure. Early intake of therapeutic plasma at repeated doses seems to reduce the endothelial permeability and coagulation disorders related to Ebola virus disease.
authors.affiliation: Centre médical des armées Angers-Le Mans-Saumur, 106, rue Eblé, 49000 Angers, France. Electronic address: fdufourgaume82@hotmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Dufour-Gaume
authors.affiliation: Service de biologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
authors.forename: D
authors.initials: D
authors.lastname: Delaune
authors.affiliation: Centre de transfusion sanguine des armées « Jean-Julliard », 1, rue Lieutenant-Raoul-Batany, BP 410, 92140 Clamart, France.
authors.forename: C
authors.initials: C
authors.lastname: Martinaud
authors.affiliation: Centre de transfusion sanguine des armées « Jean-Julliard », 1, rue Lieutenant-Raoul-Batany, BP 410, 92140 Clamart, France.
authors.forename: A
authors.initials: A
authors.lastname: Sailliol
mesh_terms: D000577:Amides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016913:Blood Component Transfusion; D001793:Blood Preservation; D003131:Combined Modality Therapy; D019468:Disease Management; D005612:Freeze Drying; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D019142:Hemorrhagic Fever, Ebola / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008297:Male; D010949:Plasma; D011719:Pyrazines / Q000627:therapeutic use; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000577:Amides; D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D011719:Pyrazines; C462182:favipiravir
keywords: Coagulation disorders; Coagulopathie; Ebola; Endothelial permeability; Endothélipathy; TCA; aPPT