Therapeutic Plasma Exchanges in Combination with High-Dose Steroid-Induced Immunosuppression as an Ultima Ratio Therapy in Severe Coronavirus Disease 2019 (COVID-19): A Case-Series Report

Figures & data

Table 1 Initial Laboratory and Clinical Findings

Parameter	Patient 1	Patient 2	Reference
Clinical presentation
Age [years]	59	64
Weight [kg]	90	117
Height [cm]	156	162
BMI [kg/m^2]	37	44.6	<25
Body temperature [°C]	37.3	38.8	<37.5
Heart rate [bpm]	106	74	60–90
Respiratory rate [bpm]	18	26	12–16
Blood pressure [mmHg]	112/76	106/66	90–140/60–90
Blood
Hemoglobin [mmol/l]	9.3	8.4	8.4–10.7
Hematocrit [l/l]	0.45	0.41	0.4–0.51
RBC [10^12/l]	5.3	4.4	3.9–5.2
WBC [10^9/l]	4.3	5.9	3.9–10.2
PLT [10^9/l]	154	268	150–370
Potassium [mmol/l]	3.6	4.7	3.5–5.1
Sodium [mmol/l]	134	134	135–145
Calcium [mmol/l]	2.19	2.07	2.15–2.5
LDH [µmol/l × s]	4.02	7.7	<4.2
Creatinine [µmol/l]	144	117	62–106
GFR [mL/min/1.73m^2]	35.0	57.5	>90
C-reactive protein [mg/l]	43.0	76.6	<5
Procalcitonin <0.5 µg/l	0.13	0.16	35–52
Quick-test [%]	101	90	80–130
INR	0.99	1.06	2.5–4.5*
PTT [s]	35.7	29.0	26.5–40
D-dimer [<0.62 mg/l]	0.5	1.62	<0.62
SARS-CoV-2 PCR Ct-value	28.25	25.93
Capillary blood gas analysis
O2-Volume	0L/min	7L/min
pH	7.524	7.417	7.37–7.45
pO2 [kPa]	7.6	6.9	9.5–13.9
pCO2 [kPa]	4.1	4.4	4.3–5.7
SO2 [%]	91	83	94–98
ABE [mmol/l]	3.4	−2.6	−2–3
HCO3- [mmol/l]	27.2	21.9	21–26

Figure 1 Chest X-Ray by Patient 1(1A–D) and Patient 2(2A–D). (1A) On admission, (1B) Control after 3 days, (1C) Control on the day 1 at ICU (12 hours after 1B), (1D) Control after treatment. (2A) On admission, (2B) Control on day 8, (2C) Control on day 35 during antibiotic and antifungal Therapy, (2D) After treatment.

Table 2 Laboratory Controls Under Plasmapheresis

Days in ICU		Patient 1					Patient 2
		Day 1	Day 2	Day 4	Day 5	Day 8	Day 1	Day 2	Day 3	Day 5	Day 7	Day 9
Plasmapheresis	Cycle	1/5	2/5	3/5	4/5	5/5	1/6	2/6	3/6	4/6	5/6	6/6
WBC		9.5	8.7	12.3	13.8	14.9	6	8.2	16.5	16.2	16.1	16.8
PLT		268	299	323	332	297	268	389	417	271	268	276
LDH [µmol/l]		6.91	5.29	3.97			7.77	7.02	6.32	8.28	6.75	4.72
Procalcitonin [µg/l]		0.3	0.25	0.17			0.18	0.11	0.8	0.7	0.13
CrP		324	135	16.7	6.7	13.4	76.6	46.7	13.3	9.3	40.2	12.9
IL-6 [ng/l]	<5.9	55.9	9.7	4.1				6.9	9.5	16.8	16.2
FiO2		1	1	0.8	0.8	0.45	1	1	1	1	0.6	0.4
pH	7.37–7.45	7.441	7.408	7.397	7.403	7.436	7.33	7.37	7.42	7.45	7.42	7.48
pO2 [kPa]	9.5–13.9	8.1	8.1	5.7	10.5	11.8	11.1	12.0	7.6	8.5	13.7	10.8
pCO2 [kPa]	4.3–5.7	5.6	5.9	5.7	5.5	5.3	5.4	5.3	5.0	5.9	6.6	5.6
SO2 [%]	94–98	90	89	74	96	97	95	94	90	92	97	96
ABE	−2.0–3.0	4.1	2.8	1.2	0.8	2.3	−4.5	−1.8	−0.1	5.6	6.1	6.7
HCO3-	21–26	27.9	26.7	24.9	25.1	26.4	20.7	22.8	24.2	29.4	30.0	30.5
Quick	80–130%	79	74	74	51	74	90	78	67	65	73	76
INR	2.5–4.5	1.17	1.22	1.22	1.63	1.22	1.06	1.18	1.31	1.34	1.23	1.20
PTT	26.5–40 s	44.60	38.10	33.50	47.30	70.50	29.00	40.30	36.40	34.40	36.20	42.30
Thrombin Time	16–24 s	19.60	20.00	28.50				25.20	23.80		23.00
Fibrinogen	1.6–4 g/l		4.42	1.39	0.58			3.67	1.84		1.88
DD	mg/l	1.11	0.75	0.27	0.30		1.62	1.05	1.02		11.00