1
|
Wardhani SO, Fajar JK, Soegiarto G, Wulandari L, Maliga HA, Ilmawan M, Merysa R, Simamora AB, Aini Q, Noviantari K, Lestari AW, Harnila MY, Syafi'i I, Djianzonie JAC, Siagian N, Nining S, Hanim RZ, Wahyuni W, Aulia F, Juliansyah J, Mahmud R, Tamara F, Mahendra AI, Wowor AC, Baladraf F, Hadinata PH, Ikkeputri A, Nadya H, Kartini DA, Husnah M, Nainu F, Harapan H. The association between therapeutic plasma exchange and the risk of mortality among patients critically ill with COVID-19: a meta-analysis. F1000Res 2021; 10:1280. [PMID: 35083038 PMCID: PMC8749910 DOI: 10.12688/f1000research.74972.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Cytokine storm has been widely known to contribute to the development of the critical condition in patients with coronavirus disease 2019 (COVID-19), and studies had been conducted to assess the potential aspect of cytokine storm elimination by performing therapeutic plasma exchange (TPE). However, contradictory findings were observed. The objective of this study was to assess the association between TPE and the reduction of mortality of critically ill COVID-19 patients. Methods: A meta-analysis was conducted by collecting data from PubMed, Scopus, and Web of Science. Data on the mortality rate of critically ill COVID-19 patients treated with TPE plus standard of care and that of patients treated with standard of care alone were analyzed using a Z test. Results: We included a total of four papers assessing the association between TPE and the risk of mortality among critically ill COVID-19 patients. Our findings suggested that critically ill COVID-19 patients treated with TPE had lower risk of mortality compared to those without TPE treatment. Conclusion: Our study has identified the potential benefits of TPE in reducing the risk of mortality among critically ill COVID-19 patients.
Collapse
Affiliation(s)
- Shinta Oktya Wardhani
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Jonny Karunia Fajar
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Gatot Soegiarto
- Division of Allergy & Immunology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60286, Indonesia
| | - Laksmi Wulandari
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60286, Indonesia
| | | | - Muhammad Ilmawan
- Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Risna Merysa
- Faculty of Nursing, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Arlentina Bentivolia Simamora
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Qurrata Aini
- Faculty of Nursing, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Komang Noviantari
- Faculty of Nursing, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Ayu Widya Lestari
- Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | | | - Imam Syafi'i
- Faculty of Pharmacy, Universitas Indonesia, Jakarta, 10430, Indonesia
| | | | - Nenci Siagian
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60286, Indonesia
| | - Sri Nining
- Faculty of Nursing, Universitas Indonesia, Jakarta, 10430, Indonesia
| | | | - Wahyuni Wahyuni
- Faculty of Public Health, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Fitri Aulia
- Faculty of Public Health, Universitas Indonesia, Jakarta, 10430, Indonesia
| | | | - Reflin Mahmud
- Faculty of Nursing, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Fredo Tamara
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Aditya Indra Mahendra
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Amanda Cininta Wowor
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Fikri Baladraf
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Ponda Hernest Hadinata
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Adhityari Ikkeputri
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Hana Nadya
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | | | - Milda Husnah
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Tamalanrea, Makassar, 90245, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| |
Collapse
|
2
|
Seyhanli A, Yavuz B, Selimoglu I, Sengun IS, Aslan AT, Ozsan GH, Alacacioglu I, Demirkan F. Therapeutic plasma exchange in neurological diseases: Eleven years experience at a tertiary care center in Turkey. Ther Apher Dial 2021; 26:465-470. [PMID: 34173719 DOI: 10.1111/1744-9987.13703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 06/12/2021] [Indexed: 11/27/2022]
Abstract
Therapeutic plasma exchange (TPE) is an apheresis procedure in which plasma is separated from the blood cellular components ex vivo, allocated, and replaced with another plasma or a plasma-replacing fluid. This study aimed to define the rate of complications and determine TPE distribution in various neurological diseases. Our study is a retrospective analysis of neurologic diseases requiring TPE between 2008 and 2019 that were selected using the medical records of neurology departments and apheresis units database. We performed 1459 TPE procedures on 207 patients between 2008 and 2019. TPE Procedure is most frequently applied in patients with Myasthenia-Gravis syndrome (34.7%). The complication ratio was 1.6% from a total of 1459 TPE procedures. The most commonly specified adverse event was allergic reactions 11 (5.3%), followed by hypotension 6 (2.9%). TPE was safe and tolerable, with manageable complications in experienced hands.
Collapse
Affiliation(s)
- Ahmet Seyhanli
- Department of Hematology, Republic of Turkey Ministry of Health, Sivas Provincial Health Directorate, Sivas Numune Hospital, Sivas, Turkey
| | - Boran Yavuz
- Department of Hematology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Ismail Selimoglu
- Department of Internal Medicine, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Ihsan Sukru Sengun
- Department of Neurology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Abdullah Taha Aslan
- Department of Neurology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Guner Hayri Ozsan
- Department of Hematology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Inci Alacacioglu
- Department of Hematology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Fatih Demirkan
- Department of Hematology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| |
Collapse
|
3
|
Dogra A, Rana K, Rathod C, Prakash S. Outcome of therapeutic plasma exchange in Myasthenia gravis patients. J Family Med Prim Care 2021; 9:5971-5975. [PMID: 33681028 PMCID: PMC7928125 DOI: 10.4103/jfmpc.jfmpc_1026_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022] Open
Abstract
Aims: The aim of this study was to evaluate the indications, adverse reactions, and outcome of therapeutic plasma exchange (TPE) in myasthenia gravis (MG) patients. Settings and Design: Retrospective Observational study. Methods and Material: A total of 18 patients of MG had undergone 18 cycles and 87 session of TPE at our Institution, a tertiary care center in Western India. It was performed using a single volume plasma exchange with intermittent cell separator (Freseniouscomtec), subclavian central line access, and with alternate day interval. Outcome was assessed shortly after each session and overall outcome at the time of discharge. Results: Total of 68 patients of MG were admitted to Neurology Intensive care unit (ICU) during the study period [January 2016–December 2019]. Out of them, TPE was done in 18 patients. Among the 18 patients, 11 patients had myasthenic crisis and 7 patients had worsening of MG. The mean number of TPE session was 4.2(SD ± 1.2), volume exchange was 2215 ml (SD ± 435); overall incidence of adverse reaction was 33.3%. All patients had immediate benefits of each TPE cycle. Good acceptance of procedure was observed in 72.2% of patients. Conclusions: TPE is cost-effective rapid therapy for myasthenic crisis and progressive myasthenia gravis. It reduces ICU stays and improves outcome.
Collapse
Affiliation(s)
- Ashu Dogra
- Department of Transfusion Medicine, SBKS Medical College, Sumandeep University, Pipariya, India
| | - Kaushik Rana
- Department of Neurology, SBKS Medical College, Sumandeep University, Pipariya, India
| | - Chirag Rathod
- Department of Medicine, GMERS Medical College, Gotri, Vadodara, Gujarat, India
| | - Sanjay Prakash
- Department of Neurology, SBKS Medical College, Sumandeep University, Pipariya, India
| |
Collapse
|
4
|
Solanki A, Singh A, Chauhan A, Agarwal D, Himanshu D, Chandra T. Therapeutic plasma exchange an emerging treatment modality: A 3-year retrospective analysis of patients admitted in a multispecialty hospital of North India. Asian J Transfus Sci 2021; 15:46-51. [PMID: 34349456 PMCID: PMC8294433 DOI: 10.4103/ajts.ajts_125_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/10/2020] [Accepted: 03/21/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Therapeutic plasma exchange (TPE) is increasingly used throughout the medical field. We aimed to analyze the various aspects of TPE practices at our hospital in terms of clinical indications, technical feasibility, safety, outcome as well as complications associated with the procedures. MATERIALS AND METHODS The data included demographic profiles, clinical parameters, and technical characteristics of each TPE procedure. All the information was noted in data spread sheet (Microsoft Excel 2013) for further analysis. RESULTS This is a 3-year retrospective study of total 266 TPE procedures carried out on 92 patients with different clinical conditions. Out of them, 55 (59.8%) were male and 37 (40.2%) were female patients. There were six major categories such as (1) neurological, (2) hematological, (3) gastrological, (4) renal, (5) rheumatic, and (6) others. The TPE treatment was highest in neurology group (60.2%), followed by gastrology group (24.4%). Most of the procedures (82.6%) were according to the American society of apheresis 2016 I or II categories (76/92 patients). CONCLUSION TPE is beneficial and used as primary or secondary adjunctive therapy for a wide spectrum of various diseases and syndromes. TPE is considered as safe, cost-effective, and life-saving treatment modality in various diseases.
Collapse
Affiliation(s)
- Archana Solanki
- Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashutosh Singh
- Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Abhishek Chauhan
- Department of Radiodiagnosis, Dr RML Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Devisha Agarwal
- Department of ENT, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D. Himanshu
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tulika Chandra
- Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
5
|
Ipe TS, Meyer EK, Sanford KW, Joshi SK, Wong ECC, Raval JS. Use of therapeutic plasma exchange for pediatric neurological diseases. J Clin Apher 2020; 36:161-176. [PMID: 33063869 DOI: 10.1002/jca.21850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/10/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022]
Abstract
Therapeutic plasma exchange is used to treat neurological diseases in the pediatric population. Since its first use in pediatric patients with hepatic coma in the form of manual whole blood exchange, therapeutic plasma exchange has been increasingly used to treat these disorders of the nervous system. This expansion is a result of improved techniques and apheresis instruments suitable for small children, as well as the recognition of its applicability to many diseases in the pediatric population. This review provides a historical overview of the use of therapeutic apheresis in children and highlights the most common applications for therapeutic plasma exchange to treat neurological disorders in children.
Collapse
Affiliation(s)
- Tina S Ipe
- Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Erin K Meyer
- American Red Cross, Columbus, Ohio, USA.,Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kimberly W Sanford
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarita K Joshi
- Department of Hematology/Oncology and Bone Marrow Transplant, University of Washington, Seattle, Washington, USA
| | - Edward C C Wong
- Department of Pediatrics and Pathology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA.,Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jay S Raval
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW For over 30 years, the American Society for Apheresis (ASFA) has published practice guidelines on the use of therapeutic apheresis in the Journal of Clinical Apheresis (JCA) Special Issue. These guidelines are periodically reviewed with the addition of new indications, retirement of some former indications and the provision of updated recommendations for current indications based on new published literature. During the last 12 years, updated guidelines have been published every 3 years to provide a reflection of current evidence-based apheresis practice. Recently, the eighth special issue was published. Significant updates and changes to the last edition are discussed in this review. RECENT FINDINGS This review provides a description of the development of the eighth special issue with the evolution of the ASFA guidelines since introduced in 1986. There are no new indications for therapeutic apheresis listed in the 2019 edition, however, several recommended category changes to existing indications have been made. There are also several organizational changes with the renaming of some fact sheets. SUMMARY ASFA has recently published its latest guidelines for therapeutic apheresis in the Journal of Clinical Apheresis 'Eighth Special Edition'. This review describes the evolution of the ASFA guidelines and highlights significant changes to the prior edition.
Collapse
|
7
|
Szczepiorkowski ZM. Indications for therapeutic apheresis in hematological disorders. Semin Hematol 2020; 57:57-64. [PMID: 32892844 DOI: 10.1053/j.seminhematol.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The early apheresis devices were developed in 1930s, but therapeutic apheresis only became widely used decades later, when automated cell separators were introduced. Progress in technical development of these devices continues to this day. Initial use of therapeutic apheresis has not been evidence based. Documents such as the Guidelines by the American Society for Apheresis provided hematologist with better tools to assess the role of therapeutic apheresis in daily practice. This review focuses on the use of therapeutic apheresis in patients with hematological disorders. Four separate apheresis modalities most encountered by hematologists are discussed: therapeutic plasma exchange, therapeutic leukocytapheresis, red blood cell exchange, and extracorporeal photopheresis. Examples of indications are provided and discussed. The future of therapeutic apheresis and its role in different diseases is undergoing continuous re-evaluation as disease pathogenesis is better understood and new treatment options become available.
Collapse
Affiliation(s)
- Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
| |
Collapse
|
8
|
Atay G, Demirkol D. Therapeutic Plasma Exchange Application in Children Requires Individual Decision. J Pediatr Intensive Care 2020; 10:106-109. [PMID: 33884210 DOI: 10.1055/s-0040-1714098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/03/2020] [Indexed: 01/27/2023] Open
Abstract
Therapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain-Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.
Collapse
Affiliation(s)
- Gürkan Atay
- Department of Pediatric Intensive Care, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Demet Demirkol
- Department of Pediatric Intensive Care, Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Child Health Institute, Istanbul University, Istanbul, Turkey
| |
Collapse
|
9
|
Ashok Kumar P, Paulraj S, Udekwu A. Hemodynamic Collapse Following Therapeutic Plasma Exchange in a Patient Receiving an Angiotensin Receptor Blocker. Cureus 2020; 12:e7028. [PMID: 32211262 PMCID: PMC7081960 DOI: 10.7759/cureus.7028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Therapeutic plasma exchange (TPE) is a procedure for removal of plasma and its components while leaving behind cellular elements via an apheresis device. It is used in multiple conditions one among which is systemic lupus erythematosus (SLE). Adverse reactions from TPE range from mild hypotension and fever to life-threatening cardiovascular compromise. We report the case of sudden hemodynamic collapse following TPE for a neuropsychiatric lupus flare in a patient on losartan. A 62-year-old Caucasian female with a history of drug-induced lupus presented to the hospital with symptoms of a neuropsychiatric lupus flare. She was initiated on TPE with 5% albumin based on recommendations by her rheumatologist. Shortly after TPE, she became hypotensive with poor response to fluid boluses, requiring pressor support and intubation. These symptoms resolved within 24 hours on supportive measures. This was believed to be due to losartan use on the day of TPE. The medication was discontinued and she had further sessions of TPE with no complications. Angiotensin-converting enzyme (ACE) inhibitors have previously been associated with flushing and hypotension in patients undergoing TPE. Patients undergoing TPE have an activation of the prekallikrein and bradykinin system on contact with the extracorporeal membranes. ACE inhibitors potentiate this reaction by inhibiting bradykinin catabolism. Angiotensin receptor blockers (ARBs) have also been postulated to cause elevated bradykinin levels although data pertaining to the use of ARBs in TPE is limited. We hope to highlight this rare interaction in our case and emphasize the need for further data with regard to the same.
Collapse
Affiliation(s)
| | - Shweta Paulraj
- Internal Medicine, Upstate Medical University, Syracuse, USA
| | | |
Collapse
|
10
|
Roman-Filip C, Catană MG, Bereanu A, Lăzăroae A, Gligor F, Sava M. THERAPEUTIC PLASMA EXCHANGE AND DOUBLE FILTRATION PLASMAPHERESIS IN SEVERE NEUROIMMUNE DISORDERS. Acta Clin Croat 2019; 58:621-626. [PMID: 32595246 PMCID: PMC7314295 DOI: 10.20471/acc.2019.58.04.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique, which removes large molecular weight particles such as autoantibodies from plasma. TPE is accepted by the American Society for Apheresis as first line treatment for some severe neuroimmune disorders. Double filtration plasmapheresis (DFPP) is a newer technique in which plasma is not entirely removed, only the antibodies, using special filters. High-dose intravenous immunoglobulins are an alternative treatment for these patients but are much more expensive. We reviewed medical records of 20 patients with severe neurological diseases requiring TPE or DFPP. We analyzed the indications, complications and efficacy of these procedures. After completing the procedures, neurological improvement was recorded in 80% of the patients, 5% had no improvement, and the mortality was 15%. The rate of neurological improvement was similar to other studies. None of the patients presented catheter related complications. Systemic complications were mild, transient and completely reversible.
Collapse
Affiliation(s)
| | - Maria-Gabriela Catană
- 1Lucian Blaga University, Faculty of Medicine, Sibiu, Romania; 2Department of Neurology, University Emergency County Hospital Sibiu, Sibiu, Romania; 3Department of Anesthesia, University Emergency County Hospital Sibiu, Sibiu, Romania
| | - Alina Bereanu
- 1Lucian Blaga University, Faculty of Medicine, Sibiu, Romania; 2Department of Neurology, University Emergency County Hospital Sibiu, Sibiu, Romania; 3Department of Anesthesia, University Emergency County Hospital Sibiu, Sibiu, Romania
| | - Ana Lăzăroae
- 1Lucian Blaga University, Faculty of Medicine, Sibiu, Romania; 2Department of Neurology, University Emergency County Hospital Sibiu, Sibiu, Romania; 3Department of Anesthesia, University Emergency County Hospital Sibiu, Sibiu, Romania
| | - Felicia Gligor
- 1Lucian Blaga University, Faculty of Medicine, Sibiu, Romania; 2Department of Neurology, University Emergency County Hospital Sibiu, Sibiu, Romania; 3Department of Anesthesia, University Emergency County Hospital Sibiu, Sibiu, Romania
| | - Mihai Sava
- 1Lucian Blaga University, Faculty of Medicine, Sibiu, Romania; 2Department of Neurology, University Emergency County Hospital Sibiu, Sibiu, Romania; 3Department of Anesthesia, University Emergency County Hospital Sibiu, Sibiu, Romania
| |
Collapse
|
11
|
Baruah S, Periyavan S. Adverse effects of intermittent flow therapeutic plasmapheresis in neurology patients in a resource constrained setting. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2019. [DOI: 10.4103/gjtm.gjtm_1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Abstract
The constant technological advancement implies the definition of new diagnostic and therapeutic strategies that are in contrast with present requirements to reduce health costs. As far as apheretic therapy is concerned cost analysis should be carried out on a variable series: prevention, method efficacy, selection of one method rather than another, patient's social and working recovery, disablement, reduction in hospitalization and drugs. So, if on one hand we find ourselves facing therapeutical technology the cost of which is well defined, on the other an accurate “therapeutic prescription” is lacking in this sector, such as: choice of method, number of treatments, percentage of plasma exchange, distance between each treatment and number of cycles. The techniques on the market are: plasma-exchange by means of centrifugation or plasmaftitration, the double cascade selective method, various selective techniques of immunoabsorption and finally photopheresis. Each of these methods has different applications, potentialities and costs. The selective methods of immunoabsorption are the most expensive, while the double filtration cascade is the most economical and versatile, since it can be used in many pathologies with very encouraging results, although all its active processes are not yet well defined.
Collapse
Affiliation(s)
- G.E. Russo
- Plasmapheresis and Dialysis Service, I Medical Clinics, Policlinico Umberto I, “La Sapienza” University, Roma - Italy
| | - N. Leopardi
- Plasmapheresis and Dialysis Service, I Medical Clinics, Policlinico Umberto I, “La Sapienza” University, Roma - Italy
| | - E. Vitaliano
- Plasmapheresis and Dialysis Service, I Medical Clinics, Policlinico Umberto I, “La Sapienza” University, Roma - Italy
| |
Collapse
|
13
|
De Palo T, Giordano M, Bellantuono R, Colella V, Troise D, Palumbo F, Caringella D. Therapeutic Apheresis in Children: Experience in a Pediatric Dialysis Center. Int J Artif Organs 2018. [DOI: 10.1177/039139880002301209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of apheretic procedures in pediatric patients has always been restricted by technical difficulties and the low incidence of diseases requiring this kind of treatment. The aim of the present study was to describe the solutions adopted to solve technical difficulties related to priming, vascular access and monitoring and then to evaluate clinical results. Between 1982 and 2000, 51 consecutive children (28 male, 23 female) with a mean age of 4.9 ± 4.8 years (3 months – 14.8 years) and a mean weight of 19.7 ± 12.8 kg (5 – 52 kg), with renal and/or extra-renal diseases requiring apheretic procedures were selected for the study. The overall number of procedures performed were: 226 plasma-exchange (PE), 6 LDL-apheresis (LDL-A) and 8 protein A immunoadsorption (IAPA) sessions. Our therapeutic protocol involves hematic flux of 20 – 100 ml/min and ultrafiltration of 5–20 ml/min. In each 70–95 minute session we exchanged plasmatic volume with fresh frozen plasma or with a solution of 6% albumin in lactated Ringer's, using heparin (10–20 UI/kg/h). We used Paired Filtration Dialysis Monitor in PE and LDL-A; Citem 10 in IAPA. As plasma separator, we used a filter made of polypropylene, 0.2 m2 surface, 30 ml priming (Hemaplex BT 900). Hemolytic uremic syndrome was the most commonly treated disease (18/51 cases) with good results in 10/18 cases. We recorded, good results in vasculitis as well, in one girl with focal glomerulosclerosis in transplanted kidney and rapid improvement in all children with Guillaine-Barré Syndrome. PE treatment was effective in metabolic disorders such as tirosynemia and familiar hypercolesterolemia. Only 4/12 patients with acute liver failure due to viral hepatitis recovered. We had poor results in the remaining eight cases. Complications were rare and no viral infection was found in any patient. Our data show that it is possible to use these procedures in pediatric patients even though clinical indications and real effectiveness still need to be cleared up.
Collapse
Affiliation(s)
- T. De Palo
- Pediatric Nephrology and Dialysis, Children Hospital Giovanni XXIII, Bari - Italy
| | - M. Giordano
- Pediatric Nephrology and Dialysis, Children Hospital Giovanni XXIII, Bari - Italy
| | - R. Bellantuono
- Pediatric Nephrology and Dialysis, Children Hospital Giovanni XXIII, Bari - Italy
| | - V. Colella
- Pediatric Nephrology and Dialysis, Children Hospital Giovanni XXIII, Bari - Italy
| | - D. Troise
- Pediatric Cardiac Surgery, Children Hospital Giovanni XXIII, Bari - Italy
| | - F. Palumbo
- Institute of Urology, University of Bari, Bari - Italy
| | - D.A. Caringella
- Pediatric Nephrology and Dialysis, Children Hospital Giovanni XXIII, Bari - Italy
| |
Collapse
|
14
|
Ahammed Nizar OT, Rai P, Rao SN, Shenoy MP. Plasmapheresis: A Retrospective Audit of Procedures from a Tertiary Care Center in Southern India. Indian J Crit Care Med 2018; 21:857-860. [PMID: 29307968 PMCID: PMC5752796 DOI: 10.4103/ijccm.ijccm_177_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: The term plasmapheresis/plasma exchange refers to the removal of the plasma component of blood and its replacement with various fluids. Plasma Exchange (PE) has been used to treat a variety of conditions that are associated with an aberrant immune response. We undertook this retrospective study aiming to look at plasmapheresis procedures conducted in the nephrology department over a fixed time period. Materials and Methods: Retrospective analysis of PE procedures from January 2013 to October 2016 was conducted in the nephrology and Intensive Care Unit of a tertiary care teaching hospital. The goal was to achieve a total removal of 150–200 ml/plasma per kg body weight. As replacement, we used a standard protocol of 100 ml of 20% albumin in 1 L of normal saline and 2–3 units of fresh frozen plasma. All results were expressed as mean ± standard deviation and statistical analysis was done using the Student's t-test for continuous and Fisher's exact test for categorical data. Results: A total of 192 procedures performed on 40 patients (22 males and 18 females). Age ranged from 15 to 79 years with a mean age of 37.5 years. Guillain–Barre syndrome accounted for 67.5% (>two-third of causes) for PE. Vascular access was femoral catheter in 27 (67.5%) and internal jugular catheter in 13 (32.5%). Mild hypotension occurred in 15 procedures (7.8%) of patients and allergic reactions such as rashes and chills occurred in 5 cycles (2.6%). A total of 36 patients (90%) showed significant improvement in condition, 2 did not show any change, while one worsened and one died due to respiratory complications. Conclusion: Our small series of data of plasmapheresis procedures from nephrology perspective has reaffirmed the safety and efficacy of the therapy in an experienced setup.
Collapse
Affiliation(s)
- O T Ahammed Nizar
- Department of Internal Medicine, K.S. Hegde Medical Academy, Mangalore, Karnataka, India
| | - Pratheeksha Rai
- Department of Internal Medicine, K.S. Hegde Medical Academy, Mangalore, Karnataka, India
| | - Shobhana Nayak Rao
- Department of Nephrology, K.S. Hegde Medical Academy, Mangalore, Karnataka, India
| | - M Pradeep Shenoy
- Department of Nephrology, K.S. Hegde Medical Academy, Mangalore, Karnataka, India
| |
Collapse
|
15
|
Sinanović O, Zukić S, Burina A, Pirić N, Hodžić R, Atić M, Alečković-Halilović M, Mešić E. Plasmapheresis in neurological disorders: six years experience from University Clinical center Tuzla. F1000Res 2017; 6:1234. [PMID: 28928949 PMCID: PMC5590081 DOI: 10.12688/f1000research.11841.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 12/30/2022] Open
Abstract
Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that is designed to remove substances with a large molecular weight. The TPE procedure includes removal of antibodies, alloantibodies, immune complexes, monoclonal protein, toxins or cytokines, and involves the replenishment of a specific plasma factor. The aim of the study was to describe the clinical response to TPE in various neurological patients, and to assess the clinical response to this therapy. Methods: The study was retrospective. We analyzed the medical records of 77 patients who were treated at the Department of Neurology, University Clinical Center (UCC) Tuzla from 2011 to 2016. Results: 83 therapeutic plasma exchanges were performed in the 77 patients. There was a slight predominance of male patients (54.5%), with an average age of 51±15.9 years. The most common underlying neurological diseases were Guillain–Barré syndrome (GBS) (37.7%), then chronic inflammatory demyelinating polyneuropathy (CIDP) (23.4%), multiple sclerosis (MS) (11.7%) and myasthenia gravis (10.4%). Less frequent neurological diseases that were encountered were paraneoplastic polyneuropathies (5.2%), neuromyelitis optica (also known as Devic’s disease) (3.9%), motor neuron disease (3.9%), polymyositis (2.6%) and multifocal motor neuropathy (1.2%). Conclusions: Six years experience of therapeutic plasma exchange in neurological patients in our department have shown that, following evidence-based guidelines for plasmapheresis, the procedure was most effective in patients with GBS, CIDP and myasthenia gravis.
Collapse
Affiliation(s)
- Osman Sinanović
- Department of Neurology, University Clinical Centre Tuzla, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sanela Zukić
- Department of Neurology, University Clinical Centre Tuzla, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Adnan Burina
- Department of Neurology, University Clinical Centre Tuzla, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Nermina Pirić
- Department of Neurology, University Clinical Centre Tuzla, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Renata Hodžić
- Department of Neurology, University Clinical Centre Tuzla, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Mirza Atić
- Division of Nephrology and Dialysis, Department of Internal Diseases, University Clinical Centre Tuzla, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Mirna Alečković-Halilović
- Division of Nephrology and Dialysis, Department of Internal Diseases, University Clinical Centre Tuzla, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Enisa Mešić
- Division of Nephrology and Dialysis, Department of Internal Diseases, University Clinical Centre Tuzla, University of Tuzla, Tuzla, Bosnia and Herzegovina
| |
Collapse
|
16
|
Bobati SS, Naik KR. Therapeutic Plasma Exchange - An Emerging Treatment Modality in Patients with Neurologic and Non-Neurologic Diseases. J Clin Diagn Res 2017; 11:EC35-EC37. [PMID: 28969140 DOI: 10.7860/jcdr/2017/27073.10480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/07/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Therapeutic Plasma Exchange (TPE) is a procedure in which the patient's blood is passed through an apheresis machine, where the filtered plasma is removed and discarded with reinfusion of red blood cells along with replacement fluid such as plasma or albumin in to the patient. We present our experience with TPE in treatment of various neurologic and non-neurologic diseases. AIM To evaluate TPE as primary therapy or as a first-line adjunct to other initial therapies as mentioned by American Society for Apheresis (ASFA). MATERIALS AND METHODS A retrospective analysis of TPE procedures was done for a period of nine years, from January 2007 to May 2016 in a tertiary care teaching hospital. A total of 584 TPE procedures were performed in 161 patients between 2 to 75 years of age. Clinical and laboratory investigations like ECG, chest X-ray, cardiorespiratory status and serology were carried out before the TPE procedure. RESULTS A total of 161 patients were enrolled in the present study. Guillain-Barre Syndrome (GBS) (67.7%, n=109) was the main indication for TPE, followed by Myasthenia Gravis (MG) (13.04%, n=21). Overall incidence of adverse reactions was 9.93%, inadequate vascular access was a common complication encountered in paediatric age group. CONCLUSION Our results show that TPE is not only safe and effective treatment alternative to Intravenous Immunoglobulin (IVIG), it also strongly holds evidence in the improvement of neurological disorders compared to non-neurological disorders. There is need of further detail evaluation on large number of cases for proper evidence based practice.
Collapse
Affiliation(s)
- Shreedevi S Bobati
- Junior consultant, Department of Transfusion Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka, India
| | - Karkal Ravishankar Naik
- Professor and Head, Department of Neurology, KLE University's J.N.Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi Karnataka, India
| |
Collapse
|
17
|
Gajjar M, Patel T, Bhatnagar N, Solanki M, Patel V, Soni S. Therapeutic plasma exchange in pediatric patients of Guillain-Barre syndrome: Experience from a Tertiary Care Centre. Asian J Transfus Sci 2016; 10:98-100. [PMID: 27011681 PMCID: PMC4782505 DOI: 10.4103/0973-6247.165834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background and Objective: Therapeutic Plasma Exchange (TPE) is performed effectively and safely in adult patients, but the use of TPE is limited in paediatric patients due to lack of universally accepted indications and technical challenges like establishment of adequate vascular access, low blood volume, increased incidence of adverse events during procedure and poor co-operation of patients during procedure. We present our experience of TPE in paediatric patients to assess the effectiveness and safety of TPE in paediatric patients. Materials and Methods: A total 122 TPE procedures were performed in 40 paediatric patients between 3 to 15 years of age group with Guillain Barre Syndrome (GBS). TPE procedures were performed on alternate days depending on the clinical condition of the patient. Patient's total blood volume was calculated as per Nadler's formula and processed through central double lumen catheter. 1-1.5 plasma volume was exchanged with normal saline and fresh frozen plasma. Results: A total of 122 TPE procedures (with an average of three procedures per patient) were performed on 40 paediatric patients. More than three TPE procedures were performed in 29 patients, of which 27 patients showed improvement from grade-0 and grade-I to grade-III. One did not show any response and succumbed to the disease. Complications were observed in 14 patients which were well managed. Inadequate vascular access was most common complication observed in 11 patients. Conclusion: TPE in paediatric patients has been increasing and has been shown to be effective as first line or adjunctive therapy in selected diseases. It is safe procedure when volume shifts, calcium supplementation and venous access are taken care.
Collapse
Affiliation(s)
- Maitrey Gajjar
- Department of Immunohaematology and Blood Transfusion, B J Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Tarak Patel
- Department of Immunohaematology and Blood Transfusion, B J Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Nidhi Bhatnagar
- Department of Immunohaematology and Blood Transfusion, B J Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Meghana Solanki
- Department of Immunohaematology and Blood Transfusion, B J Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Vaidehi Patel
- Department of Immunohaematology and Blood Transfusion, B J Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Shital Soni
- Department of Immunohaematology and Blood Transfusion, B J Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| |
Collapse
|
18
|
Gafoor VA, Jose J, Saifudheen K, Musthafa M. Plasmapheresis in neurological disorders: Experience from a tertiary care hospital in South India. Ann Indian Acad Neurol 2015; 18:15-9. [PMID: 25745304 PMCID: PMC4350207 DOI: 10.4103/0972-2327.144301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 07/17/2014] [Accepted: 07/18/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Therapeutic plasma exchange (PE) or plasmapheresis is the treatment of choice in many neurological disorders. Even though it is safe in experienced hands, there is a major concern about its safety among physicians. OBJECTIVES To analyze our experience with 230 patients who underwent PE for various neurological disorders. MATERIALS AND METHODS Retrospective review of PE procedures done during a period of 48 months, from July 2007 to June 2011 in a tertiary care teaching hospital in South India. Indications, clinical results and technical factors are discussed. RESULTS The main indication for PE was GBS (203 patients; 88.3%). Age of patients ranged from 14-65 (mean = 42.3 years). The most common complications were paraesthesias and/or cramps (36.1%) and hypotension (32.2%). Four pregnant patients who underwent PE had good recovery with one intrauterine death. There was no mortality. CONCLUSION The analysis of 240 cases of PE done in our department shows that the procedure is safe, with only minimal procedure related complications and no mortality.
Collapse
Affiliation(s)
- V Abdul Gafoor
- Department of Neurology, Medical College, Calicut, Kerala, India
| | - James Jose
- Department of Neurology, Medical College, Calicut, Kerala, India
| | - K Saifudheen
- Department of Neurology, Medical College, Calicut, Kerala, India
| | - Mohamed Musthafa
- Department of Neurology, Medical College, Calicut, Kerala, India
| |
Collapse
|
19
|
Kumar R, Birinder SP, Gupta S, Singh G, Kaur A. Therapeutic plasma exchange in the treatment of myasthenia gravis. Indian J Crit Care Med 2015; 19:9-13. [PMID: 25624644 PMCID: PMC4296418 DOI: 10.4103/0972-5229.148631] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The aim of this study was to analyze the retrospective experience related to the indication, complication and outcome of Therapeutic Plasma Exchange (TPE) in Myasthenia gravis (MG). It is a well known autoimmune disease characterized by antibodies against the acetylcholine receptor (anti-ACHR) on the post synaptic surface of the motor end plate. Plasma exchange is the therapeutic modality well established in MG with a positive recommendation based on strong consensus of class III evidence. MATERIALS AND METHODS A total of 35 patients of MG were submitted to a total of 41 cycles and 171 session of TPE. It was performed using a single volume plasma exchange with intermittent cell separator (Hemonetics) by Femoral or central line access and schedule preferably on alternate day interval. Immediate outcome was assessed shortly after each session and overall outcome at discharge. RESULTS Total of 110 patients of MG who were admitted to our hospital during the study period of two years. 35 (31.8%) patients had TPE performed with mean age of 32 years (M:F = 2:1). The mean number of TPE session was 4.2 (SD±1.2), volume exchange was 2215 ml (SD±435); overall incidence of adverse reaction was 21.7%. All patients had immediate benefits of each TPE cycle. Good acceptance of procedure was observed in 78.3% of patients. CONCLUSION TPE may be considered as one of the treatment options especially in developing countries like ours as it is relatively less costly but as effective for myasthenic crisis as other modalities.
Collapse
Affiliation(s)
- Rajesh Kumar
- Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Paul Birinder
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sonia Gupta
- Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Amarjit Kaur
- Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
20
|
Winters JL. American Society for Apheresis guidelines on the use of apheresis in clinical practice: practical, concise, evidence-based recommendations for the apheresis practitioner. J Clin Apher 2014; 29:191-3. [PMID: 24890667 DOI: 10.1002/jca.21334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 12/24/2022]
Abstract
The 6th Guidelines on the use of therapeutic apheresis in clinical practice published by the American Society of Apheresis provide practical, concise, and evidence based guidance for the apheresis medicine practitioner. The overall format of the Guidelines has remained unchanged with the 6th edition, compared to the 5th edition, with enhancements in the committee process of creating the guidelines. Because of changes in the writing committee structure, a number of changes have occurred in the ASFA category and recommendation grade for the use of apheresis in the treatment for a number of previously categorized clinical indications. In addition, eight new indications for apheresis, twenty three new clinical situations for previously categorized diseases, and ten new apheresis treatments for previously categorized disorders have been added. The 6th Guidelines continue to be an invaluable resource for those involved in apheresis medicine.
Collapse
Affiliation(s)
- Jeffrey L Winters
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
21
|
Manipulation of the Humoral Immune System and the Host Immune Response to Infection. Xenotransplantation 2014. [DOI: 10.1128/9781555818043.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
22
|
Barrett CL, Louw VJ, Webb MJ. Exchange transfusion as a life-saving intervention in three patients with different haematological malignancies with severe hyperleukocytosis where leukapheresis was not available. Transfus Apher Sci 2013; 49:397-402. [PMID: 24100166 DOI: 10.1016/j.transci.2013.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/27/2013] [Accepted: 09/04/2013] [Indexed: 12/01/2022]
Abstract
Hyperleukocytosis is a rare but potentially serious complication of haematological malignancies. It is usually treated with rehydration, prevention of tumour lysis syndrome and the administration of cytotoxic therapy. Leukapheresis may be life-saving in emergency cases. In this article we describe how, in a resource-limited setting where leukapheresis was not available, manual exchange transfusion was utilised as a life-saving intervention in three patients with different haematological malignancies complicated by hyperleukocytosis. Further we outline the procedure that was carried out and evaluated possible complications associated with this rarely used practice.
Collapse
Affiliation(s)
- Claire L Barrett
- Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa.
| | | | | |
Collapse
|
23
|
Barrett CL, Louw VJ, Webb MJ. WITHDRAWN: Exchange transfusion as a life-saving intervention in three patients with different haematological malignancies with severe hyperleukocytosis where leukapheresis was not available. Transfus Apher Sci 2013:S1473-0502(13)00196-1. [PMID: 23786874 DOI: 10.1016/j.transci.2013.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, 10.1016/j.transci.2013.09.003. The duplicate article has therefore been withdrawn.
Collapse
Affiliation(s)
- Claire L Barrett
- Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa.
| | - Vernon J Louw
- Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| | - Michael J Webb
- Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
24
|
Weiss PF, Klink AJ, Friedman DF, Feudtner C. Pediatric therapeutic plasma exchange indications and patterns of use in us children's hospitals. J Clin Apher 2012; 27:287-94. [DOI: 10.1002/jca.21242] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 06/20/2012] [Indexed: 01/04/2023]
|
25
|
Winters JL. Apheresis medicine state of the art in 2010: American Society for Apheresis fifth special edition of the Journal of Clinical Apheresis. J Clin Apher 2011; 26:239-42. [DOI: 10.1002/jca.20307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 07/12/2011] [Indexed: 12/18/2022]
|
26
|
Okafor C, Ward DM, Mokrzycki MH, Weinstein R, Clark P, Balogun RA. Introduction and overview of therapeutic apheresis. J Clin Apher 2011; 25:240-9. [PMID: 20806281 DOI: 10.1002/jca.20247] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chidi Okafor
- Department of Medicine, Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia 22908, USA
| | | | | | | | | | | |
Collapse
|
27
|
Benefits and limitations of plasmapheresis in renal diseases: an evidence-based approach. J Artif Organs 2010; 14:9-22. [DOI: 10.1007/s10047-010-0529-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 11/08/2010] [Indexed: 01/26/2023]
|
28
|
Lambert C, Gericke M, Smith R, Hermans C. Plasma extraction rate and collection efficiency during therapeutic plasma exchange with Spectra Optia in comparison with Haemonetics MCS+. J Clin Apher 2010; 26:17-22. [DOI: 10.1002/jca.20271] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 09/13/2010] [Indexed: 11/12/2022]
|
29
|
|
30
|
McLeod BC. Therapeutic apheresis: history, clinical application, and lingering uncertainties. Transfusion 2009; 50:1413-26. [DOI: 10.1111/j.1537-2995.2009.02505.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
31
|
De Silvestro G, Tison T, Vicarioto M, Bagatella P, Stefanutti C, Marson P. The Italian registry of pediatric therapeutic apheresis: A report on activity during 2005. J Clin Apher 2009; 24:1-5. [DOI: 10.1002/jca.20184] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
32
|
Kaplan AA. Therapeutic Plasma Exchange: Core Curriculum 2008. Am J Kidney Dis 2008; 52:1180-96. [DOI: 10.1053/j.ajkd.2008.02.360] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 03/10/2008] [Indexed: 11/11/2022]
|
33
|
Lu Q, Nedelcu E, Ziman A, Bumerts P, Fernando L, Schiller G. Standardized protocol to identify high-risk patients undergoing therapeutic apheresis procedures. J Clin Apher 2008; 23:111-5. [PMID: 18521857 DOI: 10.1002/jca.20167] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As the scope of therapeutic apheresis (TA) expands and more procedures are requested for critically ill patients, adverse reactions (AR) associated with TA become a major concern for physicians, nurses, patients and their families. To assess the risks for ARs associated with patients' underlying diseases, we developed a preprocedure assessment tool with a set of high-risk criteria which included: (1) unstable vital signs, (2) active nonphysiological bleeding, (3) evidence of severe bronchoconstriction, (4) severe anemia, (5) projected extracorporeal volume (ECV) >15% of total blood volume (TBV) in adults or >10% of TBV in pediatric patients, (6) pregnancy, and (7) conditions requiring continuous nursing support. A standard operating procedure with a "Request for Apheresis Procedure on High-Risk Patient" form and protocol were developed to identify patients as high-risk before initiation of a TA procedure. Here we report our experience in the 3-year period following the implementation of this protocol. During this period, a total of 3,254 TA procedures were performed, 44 of which were for patients identified as high-risk by the protocol. The incidence of overall ARs was 8% for all TA procedures and 45.5% for procedures performed for high-risk patients. The incidence of moderate-to-severe ARs was 3.7% for all TA procedures and 36.4% for procedures performed for high-risk patients. The protocol identified a group of patients with an increased risk for ARs, especially moderate-to-severe reactions during and/or immediately following TA.
Collapse
Affiliation(s)
- Qun Lu
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1732, USA. qunlu@mednet. ucla.edu
| | | | | | | | | | | |
Collapse
|
34
|
Maguire OC, Mc Carthy D, Cunningham SK. The effect of plasmapheresis on the concentration of certain plasma proteins: a case identified by an inaccurate LDL-cholesterol estimation. Ann Clin Biochem 2008; 45:436-9. [DOI: 10.1258/acb.2008.007231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 35-year-old man was found to have a negative LDL-cholesterol concentration (−0.05 mmol/L) when estimated on a fasting plasma sample using the Friedewald equation. Plasma urea, electrolytes and liver function tests (LFTs) were normal except for a raised total bilirubin of 74 μmol/L. Haematological results showed both a low haemoglobin and fibrinogen concentration. It transpired that the patient had undergone daily plasmapheresis treatments on the previous four days; plasma had been exchanged with a 5% albumin solution. He had been diagnosed with Evan's syndrome previously (characterized by autoimmune haemolytic anaemia) and had been admitted with severe anaemia, which had proved unresponsive to conventional treatments. The concentration of most plasma substances is reduced by 50–60% after one standard plasmapheresis treatment, with the rate of return to steady state concentrations varying among analytes. The finding of a negative LDL-cholesterol concentration (arising primarily as a result of normal triglyceride concentrations) may reflect the more efficient removal of LDL and HDL lipoproteins during the plasmapheresis procedure (PP) than lipoproteins containing proportionally more triglycerides. Plasma lipids, total protein, immunoglobulins and transferrin had recovered to steady state concentrations by eight days post-plasmapheresis, whereas caeruloplasmin concentrations had not. This case report illustrates the difficulties of obtaining accurate information on the steady state concentrations of plasma analytes, in particular protein bound substances, when analysis is carried out on a sample from a patient that has recently undergone plasmapheresis. The normal plasma albumin in this situation did not flag the possibility of the sample being artefactually diluted.
Collapse
Affiliation(s)
| | - D Mc Carthy
- Department of Haematology, St Vincent's University Hospital, Dublin 4, Ireland
| | | |
Collapse
|
35
|
|
36
|
Szczepiorkowski ZM, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Shaz BH, Weinstein R, Wirk A, Winters JL. Guidelines on the use of therapeutic apheresis in clinical practice—Evidence-based approach from the apheresis applications committee of the American society for apheresis. J Clin Apher 2007; 22:106-75. [PMID: 17394188 DOI: 10.1002/jca.20129] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Society for Apheresis (ASFA) Apheresis Applications Committee is charged with a review and categorization of indications for therapeutic apheresis. This elaborate process had been undertaken every 7 years resulting in three prior publications in 1986, 1993, and 2000 of "The ASFA Special Issues." This article is the integral part of the Fourth ASFA Special Issue. The Fourth ASFA Special Issue is significantly modified in comparison to the previous editions. A new concept of a fact sheet has been introduced. The fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis. A detailed description of the fact sheet is provided. The article consists of 53 fact sheets devoted to each disease entity currently categorized by the ASFA. Categories I, II, and III are defined as previously in the Third Special Issue. However, a few new therapeutic apheresis modalities, not yet approved in the United States or are currently in clinical trials, have been assigned category P (pending) by the ASFA Clinical Categories Subcommittee. The diseases assigned to category IV are discussed in a separate article in this issue.
Collapse
Affiliation(s)
- Zbigniew M Szczepiorkowski
- Transfusion Medicine Service, Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Shaz BH, Linenberger ML, Bandarenko N, Winters JL, Kim HC, Marques MB, Sarode R, Schwartz J, Weinstein R, Wirk A, Szczepiorkowski ZM. Category IV indications for therapeutic apheresis—ASFA fourth special issue. J Clin Apher 2007; 22:176-80. [PMID: 17377982 DOI: 10.1002/jca.20131] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The American Society for Apheresis (ASFA) Committee on Clinical Applications systematically and critically reviews published information on the use of therapeutic apheresis in clinical practice. On the basis of this review, selected diseases are assigned one of five categories (category I, II, III, IV, and P). The diseases, which were classified as category IV indications, and the rationale for such assignment are reviewed in this article. The diseases assigned to category I, II, III, and newly created category P are discussed in a separate article in this issue.
Collapse
Affiliation(s)
- Beth H Shaz
- Department of Pathology and Laboratory Medicine, Grady Hospital, Emory University, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Yeo FE, Bohen EM, Yuan CM, Sawyers ES, Abbott KC. Therapeutic plasma exchange as a nephrological procedure: A single-center experience. J Clin Apher 2005; 20:208-16. [PMID: 16035100 DOI: 10.1002/jca.20059] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the United States, therapeutic plasma exchange (TPE) is both performed and requested by a wide range of services, often on an empiric basis (before a diagnosis is established). Whether empiric therapy is beneficial has not been established. Patients were identified from an electronic procedure log that included those patients who received plasmapheresis at Walter Reed Army Medical Center from 1996 to 2003. The clinical indications, referring service, and outcomes (including deaths) that occurred were tabulated. Between March 1997 and August 2003, 568 TPE treatments were performed in 54 patients. The majority of the diagnoses were either neurologic (48%) or hematologic (37%). Thirty-three patients (61%) received TPE for a Category I indication. Twelve cases were performed empirically (without an established diagnosis) at the request of the referring service, most (7) performed for presumed thrombotic thrombocytopenic purpura (TTP). Almost 80% of patients required central venous catheters for treatment. Twelve patients (22%) experienced a major complication including death, and six patients (11%) died. Of the patients who died, 5 (83%) were treated empirically versus one death (17%) among patients not treated empirically, P < 0.001 by Chi Square. Only one of the seven patients treated empirically for TTP died, however. In logistic regression analysis, empiric treatment was the only factor independently associated with death, adjusted odds ratio, 34.2, 95% CI, 3.4, 334.8, P = 0.003. The most common indication for TPE was neurological disease, which also accounted for the highest proportion of complications. With the exception of presumed TTP, performing TPE in the absence of a confirmed diagnosis was not beneficial.
Collapse
Affiliation(s)
- Fred E Yeo
- Nephrology Service, National Naval Medical Center, Bethesda, Maryland, USA
| | | | | | | | | |
Collapse
|
39
|
|
40
|
|
41
|
Wright EC, Tullus K, Dillon MJ. Retrospective study of plasma exchange in children with systemic lupus erythematosus. Pediatr Nephrol 2004; 19:1108-14. [PMID: 15300476 DOI: 10.1007/s00467-004-1552-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2003] [Revised: 03/19/2004] [Accepted: 05/05/2004] [Indexed: 12/16/2022]
Abstract
A retrospective review of patients was conducted to evaluate the short-term effect of therapeutic plasma exchange (TPE) in children with active systemic lupus erythematosus (SLE). Between April 1984 and March 2003, 22 children underwent 112 TPE sessions. The median number of daily, double-volume sessions was 6 (range 1-16). Plasma exchange was performed by centrifugation, using 4.5% albumin with fresh-frozen plasma as required. All children were receiving standard immunosuppressive therapy. The predominant clinical features that led to TPE were categorised into systems and outcome was evaluated according to clinical improvement or lack of it. There was benefit for central nervous system and pulmonary manifestations (10 cases, 11 episodes). Of 8 children treated for renal manifestations, 6 achieved good outcomes. Two children became dialysis dependent despite treatment; however, both had been successfully treated with TPE before. Five children received more than one course of TPE. No child died during the procedure and major complications were few. Our data show that TPE can be used as adjunctive therapy in childhood SLE with few complications. Outcome is difficult to measure but in our experience, during the acute phase of illness, TPE appears to be of benefit.
Collapse
Affiliation(s)
- Elizabeth C Wright
- Renal Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1 N 3JH, UK.
| | | | | |
Collapse
|
42
|
Carandina-Maffeis R, Nucci A, Marques JFC, Roveri EG, Pfeilsticker BHM, Garibaldi SG, de Deus-Silva L. Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:391-5. [PMID: 15273832 DOI: 10.1590/s0004-282x2004000300003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD ± 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD ± 35.2); median 100.5 (extremes of 55 and 215). The mean volume of plasma exchanged in each session was 2396 ml (SD ± 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.
Collapse
|
43
|
Tiftik N, Kiykim A, Altintas E, Sezer K, Doruk N, Sezgin O, Seyrek E, Buyukafsar K, Oral U. Therapeutic plasma exchange for multidrug intoxication: A case report. J Clin Apher 2003; 18:132-3. [PMID: 14569605 DOI: 10.1002/jca.10057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Naci Tiftik
- Department of Internal Medicine, Mersin University Medical School, Mersin, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Smith JW, Weinstein R, Hillyer KL. Therapeutic apheresis: a summary of current indication categories endorsed by the AABB and the American Society for Apheresis. Transfusion 2003; 43:820-2. [PMID: 12757535 DOI: 10.1046/j.1537-2995.2003.00397.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- James W Smith
- Oklahoma Blood Institute, Oklahoma City, Oklahoma 73104, USA.
| | | | | |
Collapse
|
45
|
Naschitz JE, Kovaleva J, Shaviv N, Rennert G, Yeshurun D. Vascular disorders preceding diagnosis of cancer: distinguishing the causal relationship based on Bradford-Hill guidelines. Angiology 2003; 54:11-7. [PMID: 12593491 DOI: 10.1177/000331970305400102] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The literature investigating the association between vascular disorders and malignant neoplasms does not comprehensively review the full spectrum of vascular disorders associated with cancer, or provide proof that cancer is an etiologic factor in the development of these disorders. This paper investigates the causal role of cancer in the pathogenesis of vascular disorders, based on the Bradford-Hill criteria of causation. The Medline database was searched for articles on vascular disorders preceding the diagnosis of cancer (VDPCD). Included in the analysis were vascular disorders caused either by direct tumoral involvement of vessels or by paraneoplastic mechanisms. Vascular disorders caused by adverse reactions to anticancer therapy were excluded from analysis. Seven categories of VDPCDs were recognized: venous thromboembolism, arterial thrombosis and embolism, nonbacterial thrombotic endocarditis, migratory superficial thrombophlebitis, vasculitis, thrombotic microangiopathy, and leukothrombosis. To establish causality of the association between VDPCDs and malignancy, the degree of fulfillment of the Bradford-Hill criteria was assessed. A strong association was found in the literature between venous thromboembolism and cancer (OR 2.3-14.9 and SIR 1.3-4.4). Consistency and temporality of the association were confirmed in all VDPCD variants. Seven Bradford-Hill criteria were fulfilled for cancer associated with venous thromboembolism, six criteria for superficial phlebitis and cancer, and five criteria for each of the other VDPCDs. In conclusion, these data support the causal role of cancer in the pathogenesis of all seven categories of VDPCDs. Recognition of such a causal link between cancer and various vascular disorders may promote an earlier cancer diagnosis.
Collapse
|
46
|
Saydain G, George L, Raoof S. New therapies: plasmapheresis, intravenous immunoglobulin, and monoclonal antibodies. Crit Care Clin 2002; 18:957-75. [PMID: 12418449 DOI: 10.1016/s0749-0704(02)00028-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rheumatologic emergencies may pose a serious threat to life, and the treatment of patients with these illnesses continues to be challenging. In the last decade extensive animal and human research has led to development of new therapies. Considerable progress has been made in the therapy for RA. Newly developed biologic therapies have shown promising results in clinical studies, and two agents have already been approved by the FDA. These drugs are currently available for therapy and are under close postmarketing scrutiny to assess long-term efficacy and safety. Similar therapies are under investigation for SLE. Plasmapheresis, once used for many diseases, is now restricted mostly to conditions for which its use has been shown to be beneficial in randomized, controlled studies. Immunoadsorption is used to target specific disease-producing pathogens for removal during extracorporeal therapy. Evidence is accumulating for the use of IVIGs in several immune-mediated conditions. The outlook for some emergencies continues be grim, however, and various therapies are used based on evidence from anecdotal case reports and case series. The new therapies are relatively safe, but careful monitoring is needed, because there is potential for serious adverse events.
Collapse
Affiliation(s)
- Ghulam Saydain
- Division of Pulmonary and Critical Care, Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA.
| | | | | |
Collapse
|
47
|
McCarthy LJ. Therapeutic apheresis: current perspectives. THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 2002; 6:1. [PMID: 11886569 DOI: 10.1046/j.1526-0968.2002.00224.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
48
|
Ruzzenenti MR, Bruni R, Florio G, De Luigi MC, Lercari G, Barabino GF, Nunzi E, Valbonesi M. Lepromatous vasculitis successfully treated by plasma exchange (PE). J Clin Apher 2001; 16:37-8. [PMID: 11309832 DOI: 10.1002/jca.1009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Vascular involvement is presently considered a "common pathway" in a number of diseases that is mediated by circulating immune complexes (CIC). CIC are found in the circulation when the disease is active and in single patients their level may parallel disease activity. Lepromatous leprosis is characterized by the presence of CIC and deposits of immunoglobulins and complement in vascular lesions of the different organs and an Arthus-like mechanism is considered as the basis for the clinical picture. The same mechanism is considered to play an essential pathophysiologic role in Lucio's phenomenon, which is characterized by lymphohistiocytic vascular infiltrates with or without thrombosis and secondary cutaneous infarction. Lepromatous vascular involvement is mediated by CIC whose antigen composition is known, the same as it is with HCV mediated cryoglobulinemia, HBV positive panarteritis nodosa, rheumatoid vasculitis, or Wagner's granulomatosis, which are usually treated by PE [1-3]. PE has been employed for lepromatous vasculitis since 1979 [4] and other cases have been successfully treated afterwards [5,6]. We report on another patient successfully treated by plasma exchange.
Collapse
Affiliation(s)
- M R Ruzzenenti
- Immunohematology Service, S. Martino University Hospital, Genova, Italy
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Bosch T. Plasmapheresis in Renal Disease. Ther Apher Dial 2001. [DOI: 10.1046/j.1526-0968.2001.00205.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
50
|
Bosch T, Wendler T. Extracorporeal Plasma Treatment in Primary and Recurrent Focal Segmental Glomerular Sclerosis: A Review. Ther Apher Dial 2001. [DOI: 10.1046/j.1526-0968.2001.00318.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|