purpura fulminans

 Q: Fresh Frozen Plasma (FFP) is a reliable source of treatment in purpura fulminans (PF) due to meningococcemia?

A) True

B) False

Answer: B

The half-life of protein C in plasma is very short, and administration of FFP can't rely on for this purpose. Patients with meningococcemia may develop protein C deficiency which may lead to purpura fulminans. Ideally, these patients should receive 'protein C concentrate', which is given as a bolus followed by a q6 hours dose. The good guiding lab in such situations is the d-dimer level. Normalization or trend towards normalization of d-dimer is a sign that 'protein C concentrate' can be weaned or discontinued. 

FFP can be used as an alternative if 'protein C concentrate' is not available. It can be given every 6 hours or as a continued drip till clinical signs are resolved. But again, it can not be relied on to resolve the potentially life-threatening purpura fulminans. 

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References:

1. Smith OP, White B, Vaughan D, et al. Use of protein-C concentrate, heparin, and haemodiafiltration in meningococcus-induced purpura fulminans. Lancet 1997; 350:1590. 

2. Rintala E, Seppälä OP, Kotilainen P, et al. Protein C in the treatment of coagulopathy in meningococcal disease. Crit Care Med 1998; 26:965. 

3. Schellongowski P, Bauer E, Holzinger U, et al. Treatment of adult patients with sepsis-induced coagulopathy and purpura fulminans using a plasma-derived protein C concentrate (Ceprotin). Vox Sang 2006; 90:294.