Therapeutic plasma exchange for the acute management of the catastrophic antiphospholipid syndrome: beta(2)-glycoprotein I antibodies as a marker of response to therapy

We describe two patients with the catastrophic antiphospholipid syndrome as sociated with elevation of beta(2)-glycoprotein I antibodies and fulminant thrombotic diatheses. Both patients were treated with therapeutic plasma ex change (TPE), which resulted in a marked decrease in antibody titer accompa nied by an improved clinical outcome in one patient (IgG antibody). In the second patient, the outcome was poor despite TPE (IgA antibody). There were no significant complications of TPE in either case. Because of the fulmina nt nature of the catastrophic antiphospholipid syndrome, we conclude that a trial of TPE is warranted for the acute management. Further studies are ne eded to clarify which patients may benefit from this treatment. J. Clin. Ap heresis 14:171-176, 1999. (C) 1999 Wiley-Liss, Inc.