The Optimized Parameters of Red Blood Cell Exchange by Apheresis in Transfusion-Dependent Thalassemia, a Small Case Series

Names in bold type indicate presenting author.livedo racemosa on the lower abdomen, and lower back with mottled violaceous reticular patches plus punctate ulcerations.Skin biopsy revealed microvascular thrombi with no evidence of vasculitis.Laboratory work up was negative for hypercoagulable state.Immunofixation electrophoresis was positive for IgG kappa monoclonal protein.Neurology evaluation showed severe chronic axonal sensorimotor neuropathy on electromyography.Sural nerve biopsy was negative for amyloid and revealed perivascular mononuclear inflammation, scarred vessels with occlusion and areas of recanalization.The clinical and histologic findings are consistent with livedoid vasculopathy (LV).The patient noted prompt improvement of his cutaneous findings and gradual improvement of his sensorimotor axonal neuropathy, with 400mg of pentoxifylline three times a day, 325mg of aspirin daily, and 20mg of rivaroxaban daily. Conclusion:LV is a chronic condition related to micro-thrombosis of dermal vessels, which can cause ischemia and ulcerations.In rare instances, LV can induce peripheral neuropathy with limited cases recorded in literature.Our case further supports the importance of recognizing vasculopathy, particularly LV, as a cause for peripheral neuropathy.