Plasmapheresis in the treatment of severe meningococcal or pneumococcal septicaemia with DIC and fibrinolysis. Preliminary data on eight patients.

Abstract

Plasmapheresis (50 ml fresh frozen plasma/kg body weight per session--total 9-11 liters) was performed within 36 hours of the onset of septicaemia in 7 patients (1 woman and 6 men, age 14-48 years). One 8 year old girl was treated with exchange blood transfusion (2 liters). All had symptoms of severe septic shock caused by Neisseria meningitidis (6) or by Streptococcus pneumoniae (2). All patients demonstrated signs of DIC and concomitant fibrinolysis with low platelet values, normal to low fibrinogen levels, circulating soluble fibrin and increasing amounts of FDP. Persistent extreme values were observed in 2 patients that died, whereas coagulation/fibrinolysis parameters frequently improved during plasmapheresis and gradually (more than 6 days) returned to normal values in the survivors. Although plasmapheresis was largely successful and signs of DIC and fibrinolysis were normalized, 2 patients died and 1 survived with severe sequelae. Thus, it remains to accumulate more data to conclude if plasmapheresis is beneficial in the treatment of severe septic shock and DIC.