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Williams LA, Thiele BA, Kinard T, Kaleta E, Adamski J, Su L, Jones S, Lu Q. Thawed plasma (TP) as a substitute for intravenous immune globulin (IVIG) to prevent hypogammaglobulinemia post-therapeutic plasma exchange. Transfus Apher Sci 2023; 62:103716. [PMID: 37147249 DOI: 10.1016/j.transci.2023.103716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023]
Abstract
Intravenous immune globulin (IVIG) is a common treatment given after plasma exchange procedures to either prevent secondary hypogammaglobulinemia or as an adjunctive treatment for organ transplant rejection. However, side-effects are relatively common with this medication during and after infusion. This case-report describes our alternative to IVIG infusions post-plasma exchange. We hypothesize that in patients unable to tolerate IVIG, using thawed plasma as a replacement fluid provides a suitable increase in the patients post procedure immunoglobulin G (IgG) levels for patients with secondary hypogammaglobulinemia that are unable to tolerate IVIG infusions.
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Affiliation(s)
- Lance A Williams
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, AZ, United States.
| | - Brittney A Thiele
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Rochester, MN, United States
| | - Theresa Kinard
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, AZ, United States
| | - Erin Kaleta
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, AZ, United States
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, AZ, United States
| | - Leon Su
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, AZ, United States
| | - Shauna Jones
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, AZ, United States
| | - Qun Lu
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, AZ, United States
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Abstract
From producing individual blood components for transfusion to the removal of pathogenic substances, apheresis is a cornerstone of modern medical therapies. The use of therapeutic plasma exchange (TPE), in which plasma and its soluble constituents are removed from the body in exchange for a replacement fluid, can be organ- and life-saving in many diseases. Given the notable similarities between TPE and hemodialysis, the nephrologist is often responsible for managing TPE. As such, one must be familiar with the technologies, approach to therapy, indications for use, and complications. TPE uses centrifugation or membrane separation technologies, with the latter able to be performed with certain hemodialysis machines familiar to the nephrologist. Furthermore, primary kidney diseases such as anti-glomerular basement membrane disease are frequently associated with autoantibodies, potentially making them ideal candidates for TPE. Nevertheless, the use of TPE in many kidney diseases is controversial because of the lack of supporting evidence. This review discusses TPE from the perspective of a nephrologist responsible for prescribing and managing TPE, as well as nephrologists engaged in the care of patients undergoing the procedure.
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Affiliation(s)
- C Elena Cervantes
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C John Sperati
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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Zhang L, Zhuang Y, Liu X, Xu Q, Zhou L, Zou L, Jiang Y, Tian J, Yao H, Chi H, Qiu X, Yang T, Wang D, Yu Y. The efficacy of therapeutic apheresis in patients with refractory neuromyelitis optica spectrum disorders: a single-center retrospective study. Ann Palliat Med 2021; 10:3105-3114. [PMID: 33752428 DOI: 10.21037/apm-21-177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/01/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are associated with recurrent episodes of optic neuritis and transverse myelitis, often resulting in high attack-related disability. Therapeutic apheresis has been recommended as a second-line treatment for steroid-refractory NMOSD. To assess the efficacy and safety of two apheresis techniques, lymphoplasmapheresis (LPE) and therapeutic plasma exchange (TPE), in refractory NMOSD and to provide a new treatment option for patients with refractory NMOSD. METHODS This retrospective study examined NMOSD patients who had undergone either LPE or TPE treatment between January 2015 and January 2018. The patients were monitored for improvements in disabilities, incidences of adverse reactions, and safety of the procedure over a one-year follow-up period. The primary outcome measures included changes in the visual outcome scale (VOS) score, the expanded disability status scale (EDSS), and the annualized relapse rate (ARR). RESULTS Neurological function and objective response rates were significantly improved in 76.5% of patients treated with LPE and 83.3% of patients treated with TPE. There were no significant differences in the two treatment groups (P=0.392). Similarly, there were no differences in the reduction in the relative relapse rate between the two groups (P=0.494). Adverse reactions, mostly of mild or moderate intensity, were recorded in 9.3% of procedures in 38% of patients. The most commonly observed adverse events (AEs) were similar between the two treatment cohorts. CONCLUSIONS Patients treated with LPE showed improved neurological function comparable to that reported with TPE treatment. No superiority was shown for either of the apheresis techniques.
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Affiliation(s)
- Leiying Zhang
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yuan Zhuang
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaomin Liu
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Quangang Xu
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Lingling Zhou
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Liyang Zou
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Jiang
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Tian
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huan Yao
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongxu Chi
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xuede Qiu
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tianxin Yang
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Deqing Wang
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Yang Yu
- Department of Blood Transfusion Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China.
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Shah YD, Eksambe P, Fomani K, Louie J, Shefali K, Kothare S. Feasibility & safety of plasma exchange in paediatric neuro-immunology: A single center experience. Eur J Paediatr Neurol 2020; 27:94-97. [PMID: 32307218 DOI: 10.1016/j.ejpn.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/10/2020] [Accepted: 04/04/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is limited data available on the safety of therapeutic plasma exchange (TPE) for paediatric neuro-immunological disorders (PNID). In this study, we report our data on safety and feasibility of TPE for these disorders. METHODS Retrospective chart review was performed to include all patient who received TPE for four major PNID conditions: autoimmune encephalitis (AIE), acute disseminated encephalomyelitis (ADEM), Neuromyelitis optic spectrum disorder (NMOSD) and transverse myelitis (TM). We recorded minor and major adverse effects (AEs) associated with each TPE procedure. Secondary analysis also looked at the efficacy data of TPE on these patients. RESULTS Thirty-two patients with PNID received a total of 186 TPE cycles. Out of these, only 1 cycle (0.89%) in AIE subgroup, 1 (4.3%) in NMOSD and 1 (4.5%) in TM had adverse effects. No patients had major side effects. CONCLUSION TPE was safe and well tolerated in our PNID patients.
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Affiliation(s)
- Yash D Shah
- Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Padmavati Eksambe
- Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Katayoun Fomani
- Division of Transfusion Medicine Service Northwell Health, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - James Louie
- Division of Transfusion Medicine Service Northwell Health, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Karkare Shefali
- Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Sanjeev Kothare
- Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA.
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Fei F, Boshell N, Williams LA 3rd. Predictability and efficacy of therapeutic plasma exchange for hypertriglyceridemia induced acute pancreatitis. Transfus Apher Sci. 2020;59:102699. [PMID: 32085931 DOI: 10.1016/j.transci.2019.102699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypertriglyceridemia induced acute pancreatitis is associated with more severe clinical course than acute pancreatitis caused by other etiologies. Therapeutic plasma exchange (TPE) is a potential treatment for patients with severe hypertriglyceridemia induced acute pancreatitis due to its rapid effect in lowering triglycerides (TG) levels and reducing inflammatory cytokines. However, clinical data regarding the effectiveness and safety of TPE is limited. METHODS We retrospectively reviewed eight cases of hypertriglyceridemia induced acute pancreatitis and treated with TPE. Patients' demographic data, personal history, clinical course, laboratory results, apheresis data and clinical outcome were collected and analyzed. RESULTS At initial presentation, the average TG levels for the eight patients was 3381.6 mg/dl (SD: 1491.6 mg/dl). Twelve procedures were performed on the eight patients in the study, and TG levels decreased by an average of 2673.2 mg/dl (SD: 2306.3 mg/dl) with a corresponding average reduction rate of 60.3 % (SD:21.1 %), ranging from 14.6%-84.9%. A 60 % or greater reduction was achieved in 66.7 % of all the procedures; however, the degree of reduction for each procedure was not predictable, even among repeat procedures on the same patient. CONCLUSIONS Our study indicates that TPE is an effective and safe treatment option for patients with hypertriglyceridemia induced acute pancreatitis. However, due to the unpredictability of TG removal, repeat procedures may be necessary for some patients.
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Chang JC. Sepsis and septic shock: endothelial molecular pathogenesis associated with vascular microthrombotic disease. Thromb J 2019; 17:10. [PMID: 31160889 PMCID: PMC6542012 DOI: 10.1186/s12959-019-0198-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/26/2019] [Indexed: 12/15/2022] Open
Abstract
In addition to protective “immune response”, sepsis is characterized by destructive “endothelial response” of the host, leading to endotheliopathy and its molecular dysfunction. Complement activation generates membrane attack complex (MAC). MAC causes channel formation to the cell membrane of pathogen, leading to death of microorganisms. In the host, MAC also may induce channel formation to innocent bystander endothelial cells (ECs) and ECs cannot be protected. This provokes endotheliopathy, which activates two independent molecular pathways: inflammatory and microthrombotic. Activated inflammatory pathway promotes the release of inflammatory cytokines and triggers inflammation. Activated microthrombotic pathway mediates platelet activation and exocytosis of unusually large von Willebrand factor multimers (ULVWF) from ECs and initiates microthrombogenesis. Excessively released ULVWF become anchored to ECs as long elongated strings and recruit activated platelets to assemble platelet-ULVWF complexes and form “microthrombi”. These microthrombi strings trigger disseminated intravascular microthrombosis (DIT), which is the underlying pathology of endotheliopathy-associated vascular microthrombotic disease (EA-VMTD). Sepsis-induced endotheliopathy promotes inflammation and DIT. Inflammation produces inflammatory response and DIT orchestrates consumptive thrombocytopenia, microangiopathic hemolytic anemia, and multiorgan dysfunction syndrome (MODS). Systemic inflammatory response syndrome (SIRS) is a combined phenotype of inflammation and endotheliopathy-associated (EA)-VMTD. Successful therapeutic design for sepsis can be achieved by counteracting the pathologic microthrombogenesis.
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Affiliation(s)
- Jae C Chang
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA USA
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Abstract
During pregnancy physiological changes occur in the lipid metabolism due to changing hormonal conditions: the LDL cholesterol (LDL-C), triglycerides (TG) and lipoprotein(a) [Lp(a)] increase throughout pregnancy. Common lipoprotein disorders are associated in pregnancy with two major clinical disorders: severe hypertriglyceridemia (SHTG) is a potent risk factor for development of acute pancreatitis and elevated cholesterol due to greater concentrations of LDL and remnant lipoproteins and reduced levels of HDL promote atherosclerosis. The combination of homozygous Familial Hypercholesterolemia (HoFH) and pregnancy can be a fatal condition. Therapeutic plasma exchange (TPE) may be used for an urgent need of a fast and effective lowering of TG levels in order to prevent a severe pancreatitis episode or hypertriglyceridemia-induced complications during pregnancy. LDL apheresis can decrease LDL-C and prevent complications and can be considered in the treatment of pregnancies complicated by high LDL-C. These conditions are configured in patients with HeFH who were taking statins before pregnancy (selected cases), patients already receiving apheresis before pregnancy suffering from HoFH, patients suffering from hypertriglyceridemia due to familial hyperlipoproteinemia types I and V, and cases of hypertriglyceridemia secondary to diabetes.
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Affiliation(s)
- Gianpaolo Russi
- Transfusion Medicine Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia (RE), Italy.
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Erdoğan S, Sorgun MH, Yalçındağ N, Atilla H, Yücesan C. Bilateral optic neuritis in a patient with Behçet's disease who respond to therapeutic plasma exchange. Saudi J Ophthalmol 2015; 29:298-300. [PMID: 26586983 PMCID: PMC4625189 DOI: 10.1016/j.sjopt.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/15/2015] [Accepted: 05/06/2015] [Indexed: 11/15/2022] Open
Abstract
Bilateral optic neuritis has been reported very rarely as a manifestation of neuro-Behçet’s disease. We present a 50 year old woman who had 20-year history of Behçet’s disease presented with acutely blurred vision associated with orbital pain in both eyes. Visual acuity was 0.4 in the right eye and light perception in the left eye; afferent pupillary defect was detected in the left eye. Bilateral swelling of the optic disk was found. The cerebrospinal fluid sample tests were within normal limits. Brain magnetic resonance imaging, magnetic resonance venography and fundus fluorescein angiography were normal. She was diagnosed with bilateral optic neuritis and treated with intravenous methyl prednisolone for 10 days. As there was no response to the treatment, therapeutic plasma exchange was started and the patient’s visual acuities improved moderately. We suggest that when high dose steroid is failed to treat ON in BD, treatment with TPE may be considered.
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Affiliation(s)
- Seyda Erdoğan
- Department of Neurology, Faculty of Medicine, Ankara University, Turkey
| | | | - Nilüfer Yalçındağ
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Turkey
| | - Huban Atilla
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Turkey
| | - Canan Yücesan
- Department of Neurology, Faculty of Medicine, Ankara University, Turkey
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