Fig. 1.

The clinical course. We initiated plasma exchange on day 2 (plasma separator: polyethylene; membrane surface area: 0.5 m²; replacement fluid: fresh frozen plasma; exchanged plasma volume: 2,800 mL; blood flow rate: 100 ml/min; plasma removal and replacement rate: 30 ml/min). However, serum creatinine level rose to 4.78 mg/dL, and she developed oliguria and fluid overload. We started hemodialysis on day 6 (dialyzer: cellulose triacetate; membrane surface area: 0.7 m.²; blood flow rate: 100 ml/min; dialysate flow rate: 500 ml/min). Urine volume gradually increased and hemolytic anemia resolved; thus, hemodialysis and plasma exchange were stopped on day 7. Prior to anti-C5 monoclonal antibody administration, the patient’s thrombocytopenia, AKI, DIC, and hemolysis improved, and her condition stabilized. Cr, creatinine; Hb, hemoglobin; HD, hemodialysis; LDH, lactate dehydrogenase; PE, plasma exchange; Plt, Platelet; RBCs, red blood cells; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2