Further evidence for the benefit of therapeutic plasma exchange for acute multi-organ failure syndrome refractory to red cell exchange in sickle cell disease.

Acute multiorgan failure syndrome (MOFS) remains a significant cause of mortality in sickle cell disease (SCD) patients despite red cell exchange (RCE). In small case series and reports, therapeutic plasma exchange (TPE) has shown benefit in MOFS. As further support for consideration of this modality, we present two patients with SCD and MOFS refractory to RCE who were subsequently treated with TPE.

Reflections on caring for the international uninsured patient.

Nonmedical considerations too often affect treatment decisions for uninsured patients and result in care that falls significantly short of the Hippocratic Oath. The greatness of a society is not in its might or wealth but rather in the level of benevolence and compassion it is able to show by caring for the weak and less fortunate. Should doctors not practice medicine accordingly?