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To the Editor: Dr Balaguer and colleagues¹ used 5% albumin solution as the sole replacement fluid in plasma exchange in the treatment of a woman diagnosed with thrombotic microangiopathy (TMA). We believe that rather than supporting the use of albumin for thrombotic thrombocytopenic purpura (TTP) in this setting, the medical literature indicates that in such a moribund patient with multiple organ failure, the use of plasma exchange with fresh-frozen plasma may have been more appropriate.^2-3 We are also interested in knowing the human immunodeficiency virus (HIV) status of this patient and whether testing for cryoglobulinemia had been performed, since the patient was positive for hepatitis C virus. Either condition if present could have contributed to her illness.^4-5

Alaa M. Abd El-Rahman, MD, PhD
alaama5555@yahoo.com
Internal Medicine Department
Faculty of Medicine
Cairo University
Cairo, Egypt

Hussam Ammar, MD
Heartland Medical Center
St Joseph, Mo

1. Balaguer F, Fernandez J, Lozano M, Miquel R, Mas A. Cocaine-induced acute hepatitis and thrombotic microangiopathy [letter]. JAMA. 2005;293:797-798. FREE FULL TEXT 2. George JN. How I treat patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Blood. 2000;96:1223-1229. FREE FULL TEXT 3. von Baeyer H. Plasmapheresis in thrombotic microangiopathy-associated syndromes: review of outcome data derived from clinical trials and open studies. Ther Apher. 2002;6:320-328. PUBMED 4. Alpers CE. Light at the end of the TUNEL: HIV-associated thrombotic microangiopathy. Kidney Int. 2003;63:385-396. FULL TEXT | PUBMED 5. Herzenberg AM, Telford JJ, De Luca LG, Holden JK, Magil AB. Thrombotic microangiopathy associated with cryoglobulinemic membranoproliferative glomerulonephritis and hepatitis C. Am J Kidney Dis. 1998;31:521-526. ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293:2715.

RELATED LETTER

Cocaine-Induced Acute Hepatitis and Thrombotic Microangiopathy
Francesc Balaguer, Javier Fernández, Miguel Lozano, Rosa Miquel, and Antoni Mas
JAMA. 2005;293(7):797-798.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Cocaine-Induced Acute Hepatitis and Thrombotic Microangiopathy—Reply
Javier Fernández, Francesc Balaguer, and Miguel Lozano
JAMA. 2005;293(22):2715-2716.
EXTRACT | FULL TEXT