Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
REVIEW ARTICLE
Year : 2020  |  Volume : 18  |  Issue : 2  |  Page : 77-82

Low-volume plasma exchange and low-dose steroid to treat secondary hemophagocytic lymphohistiocytosis: A potential treatment for severe COVID-19?


1 Department of Hepatology, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
2 Division of Critical Care, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Medicine - Medicine Unit I, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
4 Department of Transfusion Medicine and Immunohaematology, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
5 Department of Nephrology, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
6 Department of The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
7 Department of Research Haematology, University College London, London, United Kingdom
8 Department of Hepatology, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India; Liver Unit, University Hospitals Birmingham, Birmingham, United Kingdom

Correspondence Address:
Dr. C E Eapen
Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_48_20

Rights and Permissions

Secondary hemophagocytic lymphohistiocytosis (sHLH) may be responsible for some of the deaths in adult patients with severe COVID-19. We present our experience of low-volume plasma exchange (PLEX) with low-dose steroid in the treatment of adult patients with sHLH and acute liver failure caused by dengue virus and other nonviral triggers and discuss how this may be effective in the management of severe COVID-19. sHLH is poorly understood and without effective treatment. Endothelium of the capillaries of the lungs and kidneys and of liver sinusoids does not express von Willebrand factor (VWF) in health and is where most macrophages are located. Plasma VWF levels are high in sHLH and require clearance by macrophages, which when activated enlarge and likely block the lumen. Current histology studies neither appreciate microcirculatory sludge nor display endothelial–macrophage interactions. We hypothesize that low-volume PLEX and low-dose steroid may reverse sHLH and improve survival in severe COVID-19 patients with acute lung injury.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed2960    
    Printed51    
    Emailed0    
    PDF Downloaded207    
    Comments [Add]    
    Cited by others 1    

Recommend this journal