Fig. 1

Trend of labs used to monitor for response to treatment. This figure depicts the patient’s therapeutic response to various interventions, including eculizumab infusions, plasma infusions, and plasma exchange, and transfusion of blood products. The patient was routinely monitored for evidence of (a-c) hemolysis, (d) thrombocytopenia and (f) complement activation. The upper limit of normal LDH is shown by the dashed line, as is the lower limit of normal for haptoglobin and C3. As shown by her ongoing anemia and thrombocytopenia, the need for numerous pRBC transfusions, and her persistently low haptoglobin and elevated lactate dehydrogenase, the patient did not initially respond to eculizmab therapy. Her clinical status improved following three days of plasma exchange followed by more aggressive twice weekly plasma + eculizumab infusions. However, her (e) renal function never recovered and she required chronic renal replacement therapy. LDH, lactate dehydrogenase; pRBC, packed red blood cells; PLEX, plasma exchange; PLT, platelet