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June 8, 2005

Cocaine-Induced Acute Hepatitis and Thrombotic Microangiopathy

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(22):2715-2716. doi:10.1001/jama.293.22.2715-a

To the Editor: Dr Balaguer and colleagues1 used 5% albumin solution as the sole replacement fluid in plasma exchange in the treatment of a woman diagnosed with thrombotic microangiopathy (TMA). We believe that rather than supporting the use of albumin for thrombotic thrombocytopenic purpura (TTP) in this setting, the medical literature indicates that in such a moribund patient with multiple organ failure, the use of plasma exchange with fresh-frozen plasma may have been more appropriate.2,3 We are also interested in knowing the human immunodeficiency virus (HIV) status of this patient and whether testing for cryoglobulinemia had been performed, since the patient was positive for hepatitis C virus. Either condition if present could have contributed to her illness.4,5

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