| Autor: |
Pallavi, Galera, Hannah C, Martin, Linda, Welch, Paula, Sulmasy, Jan, Cerny, Mindy, Greene, Michelle, Vauthrin, Jeffrey A, Bailey, Robert, Weinstein |
| Rok vydání: |
2014 |
| Předmět: |
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| Zdroj: |
Journal of clinical apheresis. 30(6) |
| ISSN: |
1098-1101 |
| Popis: |
Sirolimus is an immunosuppressant used to prevent graft versus host disease in allogeneic hematopoietic stem cell transplant recipients. It has a large volume of distribution (12 ± 7.5 l/kg) and within the intravascular space ∼95% of it is bound to red blood cells. Because of potential toxic effects at high trough levels, therapeutic drug monitoring is recommended for sirolimus. We present a case of severe hepatic dysfunction due to Hepatitis B and sirolimus toxicity, in a 51-year-old male stem cell transplant recipient. An automated red cell exchange decreased his blood sirolimus level from 22.6 to 10.3 ng/ml (55% reduction) and improved his liver enzymes. Re-equilibration of sirolimus from other compartments to the blood necessitated a series of four red cell exchanges, after which the sirolimus level was 4.7 ng/ml. Although the patient ultimately succumbed to multiorgan failure, red cell exchange may be considered for acute removal of sirolimus in selected patients. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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