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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Human protein C concentrate in a patient with meningitis and bleeding as a complication of treatment with recombinant activated protein C


Some case reports suggest that protein C zymogen supplementation may improve the outcome of patients with congenital or acquired protein C deficiency, such as sepsis-induced purpura fulminans. We describe the case report of a patient suffering from meningitis who developed a bleeding complication after recombinant human activated protein C administration and was successfully treated without any further bleeding complication with protein C concentrate.
Protein C concentrate can be considered in adult patients with meningitis, even if at risk or in the presence of bleeding.

Key words: sepsis, purpura fulminans, protein C, bleeding

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Human protein C concentrate in pediatric septic patients


Severe sepsis and septic shock are leading causes of morbidity and mortality in the pediatric population. Unlike what is suggested for the adult population, recombinant human activated protein C (rhAPC) is contraindicated in children. Long before rhAPC was considered for use in pediatric patients, case reports appeared on the safe administration of protein C zymogen. Therefore, we conducted a systemic review of currently available data on protein C zymogen (PC) use among children affected by severe sepsis or septic shock.

A total number of 13 case series or case reports and a dose-finding study were found on the use of PC in the pediatric intensive care unit, reporting on 118 treated children, with an overall survival of 84%. There was no bleeding complication, the only reported complication being a single mild allergic reaction.

These studies show that PC is safe, not associated with bleeding and possibly useful for improving coagulation abnormalities of sepsis.


Key words: sepsis, pediatric, protein C, drug therapy, review

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Human protein C concentrates in adult septic patients


Some case reports and case series suggest that protein C concentrates may improve the outcome in patients with congenital or acquired protein C deficiency (not only in those with sepsis induced purpura fulminans). We reviewed the published literature on the use of protein C concentrates in adult septic patients and found that it is limited to less than 70 patients reported in observational studies with a 70% survival, and added our personal experience (two adult patients with sepsis and contraindications to recombinant activated protein C).

Key words: sepsis, protein C, cardiac surgery

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