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Protein C in the treatment of coagulopathy in meningococcal disease

Rintala, Esa MD; Seppala, Olli-Pekka MD; Kotilainen, Pirkko MD; Pettila, Ville MD; Rasi, Vesa MD

Case Report
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Objective To evaluate the clinical and laboratory effects of the substitution of protein C (PC) as an adjunct to conventional therapy in the treatment of purpura fulminans associated with meningococcal sepsis.

Design case series.

Setting Medical and medical-surgical intensive care units of two university hospitals.

Patients Three patients with purpura fulminans and multiple organ failure caused by Neisseria meningitidis.

Intervention Intravenous administration of PC concentrate (100 IU/kg every 6 to 8 hrs).

Measurements and Main Results The administration of PC resulted in normal or above normal levels of the plasma PC activity in all patients. The laboratory and clinical parameters reflecting the severity of coagulopathy improved during the treatment, as did peripheral ischemia and the clinical manifestations of multiple organ failure. No adverse events were noted. One patient died of cerebral edema.

Conclusion The administration of PC had a beneficial effect on coagulopathy and peripheral gangrene formation associated with meningococcal disease and showed no adverse effects. (Crit Care Med 1998; 26:965-968)

From the Department of Medicine, Turku University Central Hospital, Kiinamyllynkatu (Drs. Rintala, Seppala, and Kotilainen), Turku, Finland; the Department of Anaesthesiology, Helsinki University Central Hospital (Dr. Pettila), Helsinki, Finland; and the Finnish Red Cross Blood Transfusion Service, Department of Haemostasis, Kivihaantie (Dr. Rasi), Helsinki, Finland.

Address requests for reprints to: Esa Rintala, MD, Department of Medicine, Turku University Central Hospital, Kiinamyllynkatu 4-8, FIN-20520 Turku, Finland.

Patients 1 and 2 have been reported in Lancet 1996; 347:1767.

© Williams & Wilkins 1998. All Rights Reserved.