Hemorragia alveolar difusa asociada a vasculitis ANCA positiva, manejo con plasmaféresis. reporte de un caso / ANCA vasculitis associated diffuse alveolar hemorrhage treated with plasmapheresis: a case report

Presentamos el caso de una paciente femenina de 43 años con vasculitis tipo ANCA con severo compromiso pulmonar por desarrollo de hemorragia alveolar difusa (HAD) e insuficiencia respiratoria. Debido al rápido deterioro clínico y pobre respuesta a inmunosupresores (ciclofosfamida y metilprednisolona) se le practicó plasmaféresis resultando en rápida mejoría, permitiendo la liberación en la ventilación mecánica y mejoría radiológica. En la actualidad se puede sugerir esta terapia en pacientes con diagnóstico de vasculitis tipo ANCA con compromiso pulmonar severo.

We describe a 43 years old woman who was diagnosed of ANCAassociated vasculitides (AAV) with onset of diffuse alveolarhemorrhage and poor pulmonary function. She developed a clinicaldeterioration in spite of cyclophosphamide and methylprednisolonetreatment, and plasmapheresis was performed. She was successfullytreated with timely plasma exchange and immunosuppressivetreatment. Early plasmapheresis with immunosuppressant therapycan rescue this fatal complication.

Nitric oxide and prostacyclin inhibit fetal platelet aggregation: a response similar to that observed in adults.

OBJECTIVE: We evaluated the relative importance of two endothelium-derived substances, prostacyclin and nitric oxide, in their ability to inhibit aggregation of fetal and maternal platelets. STUDY DESIGN: The effects of various concentrations of prostacyclin and S-nitroso-N-acetylpenicillamine (which releases nitric oxide) on platelet aggregation were studied by means of platelet-rich plasma from at least five to six subjects per group. Fetal blood was collected from umbilical vein at delivery. Maternal venous blood was collected within 4 hours of delivery. Platelet aggregation was monitored with a platelet aggregation profiler. Adenosine diphosphate was used as the aggregating agent. Statistical differences between means were evaluated with two-way analysis of variance or Student t test. RESULTS: Prostacyclin and S-nitroso-N-acetylpenicillamine inhibited aggregation of fetal and maternal platelets, but prostacyclin was more potent. Fetal platelets were more sensitive than maternal platelets to prostacyclin and S-nitroso-N-acetylpenicillamine. CONCLUSION: Prostacyclin appears to be more important in preventing aggregation of platelets in the feto placental circulation.