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Crowe EP, Diaz-Arias LA, Habis R, Vozniak SO, Geocadin RG, Venkatesan A, Tobian AAR, Probasco JC, Bloch EM. Suspected autoimmune encephalitis: A retrospective study of patients referred for therapeutic plasma exchange. J Clin Apher 2024; 39:e22112. [PMID: 38634442 DOI: 10.1002/jca.22112] [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: 01/17/2024] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Autoimmune encephalitis (AE) comprises a heterogeneous group of autoantibody-mediated disorders targeting the brain parenchyma. Therapeutic plasma exchange (TPE), one of several first-line therapies for AE, is often initiated when AE is suspected, albeit prior to an established diagnosis. We sought to characterize the role of TPE in the treatment of suspected AE. METHODS A single-center, retrospective analysis was performed of adults (≥18 years) who underwent at least one TPE procedure for "suspected AE." The following parameters were extracted and evaluated descriptively: clinicopathologic characteristics, treatment course, TPE-related adverse events, outcomes (e.g., modified Rankin scale [mRS]), and diagnosis once investigation was complete. RESULTS A total of 37 patients (median age 56 years, range 28-77 years, 62.2% male) were evaluated. Autoimmune antibody testing was positive in serum for 43.2% (n = 16) and cerebrospinal fluid for 29.7% (n = 11). Patients underwent a median of five TPE procedures (range 3-16), with 97.3% (n = 36) via a central line and 21.6% (n = 8) requiring at least one unit of plasma as replacement fluid. Fifteen patients (40.5%) experienced at least one TPE-related adverse event. Compared with mRS at admission, the mRS at discharge was improved in 21.6% (n = 8), unchanged in 59.5% (n = 22), or worse in 18.9% (n = 7). Final diagnosis of AE was determined to be definite in 48.6% (n = 18), probable in 8.1% (n = 3) and possible in 27.0% (n = 10). Six (16.2%) patients were ultimately determined to have an alternate etiology. CONCLUSION Empiric TPE for suspected AE is generally well-tolerated. However, its efficacy remains uncertain in the absence of controlled trials, particularly in the setting of seronegative disease.
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Affiliation(s)
- Elizabeth P Crowe
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Luisa A Diaz-Arias
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ralph Habis
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sonja O Vozniak
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Romergryko G Geocadin
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arun Venkatesan
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John C Probasco
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Mehrabyan A, Traub RE. Retrospective review of patients with myasthenia gravis switched from plasma exchange therapy to efgartigimod treatment. Muscle Nerve 2024; 69:467-471. [PMID: 38284651 DOI: 10.1002/mus.28042] [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: 03/17/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION/AIMS Therapeutic plasma exchange (TPE) is sometimes used as maintenance therapy for the treatment of myasthenia gravis (MG). Efgartigimod is a newly approved monoclonal antibody targeting the neonatal Fc receptor, effectively reducing immunoglobulin G levels in the treatment of MG. The aim of this study was to describe the clinical experience of switching patients from maintenance TPE treatment to efgartigimod infusions. METHODS A retrospective review of medical records was performed on patients previously treated with maintenance TPE for the diagnosis of MG and subsequently switched to efgartigimod infusions. Clinical characteristics and response to treatment switch were described. RESULTS Five of seven patients demonstrated improvement on Myasthenia Gravis Foundation of America-post intervention status, one was unchanged and one was in pharmacological remission. This was reflected in pre- and postswitch MG activities of daily living and MG manual muscle testing scores. All patients have continued on efgartigimod therapy. The duration of treatment with efgartigimod at the time of this review ranged from 1 to 13 months. Recurrent uncomplicated infections were noted in two patients on efgartigimod therapy. Maintenance dosing regimens of efgartigimod varied based on clinical response to treatment and side effects. DISCUSSION In this series, efgartigimod appeared effective and well tolerated in patients switched from TPE.
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Affiliation(s)
| | - Rebecca E Traub
- University of North Carolina, Chapel Hill, North Carolina, USA
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Fessler J, Le Guen M, Pascreau T. Bleeding risks in preoperative plasmapheresis. J Heart Lung Transplant 2024; 43:693-694. [PMID: 38220123 DOI: 10.1016/j.healun.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024] Open
Affiliation(s)
- Julien Fessler
- Department of Anesthesiology and Pain Medicine, Hôpital Foch, 92150 Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
| | - Morgan Le Guen
- Department of Anesthesiology and Pain Medicine, Hôpital Foch, 92150 Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
| | - Tiffany Pascreau
- Department of Clinical Biology, Foch Hospital, Suresnes, France; Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITH U1176, Le Kremlin-Bicêtre, France.
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Lee JH, Lee H, Kim K, Lee SW, Song JH, Hwang SD. Effect of Plasmapheresis on the Efficacy of Rituximab in Antibody-Mediated Rejection Patients. Transplant Proc 2024; 56:723-725. [PMID: 38383260 DOI: 10.1016/j.transproceed.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Rituximab and plasmapheresis (PP) suppress and eliminate antibody production in patients experiencing antibody-mediated rejection (AMR). Herein, we discuss a case where rituximab was less effective after PP for treating AMR. CASE A 55-year-old male patient underwent kidney transplantation. His renal function remained normal for 1 year. Subsequently, renal function declined, and (donor-specific antibodies showed positive results. A biopsy of the transplanted kidney revealed AMR. On the day of the biopsy, the medical staff administered 200 mg of rituximab, followed by IV immunoglobulin (IVIg) and PP the next day. The time interval between PP + IVIg treatment and rituximab was 12 h. As a result, the B-cell markers CD19 and CD20 did not decrease sufficiently, and the patient's creatinine and glomerular filtration rate muscles did not recover adequately. CONCLUSION We report a case in which PP was administered shortly after rituximab injection, resulting in insufficient B-cell inhibition due to the removal of rituximab.
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Affiliation(s)
- Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea
| | - Heeryong Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea
| | - Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.
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Rami I, Zerrouki D, Assarrar I, Rouf S, Latrech H. Plasmapheresis in thyrotoxicosis: a single-center case series. J Med Case Rep 2024; 18:193. [PMID: 38553729 PMCID: PMC10981326 DOI: 10.1186/s13256-024-04480-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/28/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Plasmapheresis represent an alternative therapeutic option for hyperthyroidism with thyroid storm or refractory cases. It provides a rapid decrease in plasma thyroid hormones and anti-thyroid antibodies. The aim of this paper was to report our single center's experience in managing particular situations of hyperthyroidism using apheresis. CASES PRESENTATION The following case series describes three young African patients (two females, one male) aged 29, 37, and 25 years old, respectively, with Graves' disease who presented with drug ineffectiveness, drug-induced agranulocytosis, and thyroid storm with multi-organ failure. The three patients underwent plasmapheresis sessions leading to effective decline of thyroid hormone levels and offering a window for processing total thyroidectomy. DISCUSSION/CONCLUSION The standard management of thyrotoxicosis and thyroid storm was usually codified by the concomitant use of antithyroid medication, iodine, beta-blockers, and corticosteroids. This medical preparation can be effective in most cases. However, drug toxicity or ineffectiveness can limit the use of such therapeutics. Our paper supports the efficiency and safety of therapeutic plasma exchange in the preoperative management of thyrotoxicosis.
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Affiliation(s)
- I Rami
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital Center, University of Mohammed 1st, 4806, 60049, Oujda, Morocco
| | - D Zerrouki
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital Center, University of Mohammed 1st, 4806, 60049, Oujda, Morocco
| | - I Assarrar
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital Center, University of Mohammed 1st, 4806, 60049, Oujda, Morocco
| | - S Rouf
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital Center, University of Mohammed 1st, 4806, 60049, Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital Center, University of Mohammed 1st, 4806, 60049, Oujda, Morocco
| | - H Latrech
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital Center, University of Mohammed 1st, 4806, 60049, Oujda, Morocco.
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital Center, University of Mohammed 1st, 4806, 60049, Oujda, Morocco.
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Frederick R, Zolio L, Romas E, Ierino F. Eculizumab therapy and complement regulation in a case of resistant catastrophic antiphospholipid syndrome. BMJ Case Rep 2024; 17:e254449. [PMID: 38442982 PMCID: PMC10916160 DOI: 10.1136/bcr-2022-254449] [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] [Indexed: 03/07/2024] Open
Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a life-threatening form of antiphospholipid syndrome characterised by diffuse arterial and venous thrombosis, in the presence of positive antiphospholipid antibodies. The multiple sites of thrombosis in small, medium and large vessels progress to multiorgan failure, accounting for the high mortality rate associated with CAPS. Unregulated complement activation is increasingly recognised as critical to the pathogenesis of CAPS. Early diagnosis is essential to initiate prompt life-saving treatment with the triple therapy of anticoagulation, immunosuppression and either plasmapheresis or intravenous immunoglobulin. Among other immunosuppressive agents, eculizumab, a complement inhibitor has demonstrated efficacy in treatment-resistant cases.We report an instructive case of a woman presenting with both clinical and laboratory findings consistent with primary CAPS, resistant to initial treatment and responsive to eculizumab, with emphasis on genetic testing and implications for future therapy.
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Affiliation(s)
- Rachel Frederick
- Department of Nephrology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- Department of General Medicine, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Luigi Zolio
- Department of Rheumatology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Evange Romas
- Department of Rheumatology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Frank Ierino
- Department of Nephrology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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Alhussein RM, Alamri NA, Alhashem HM, Alarifi MI, Alyahya B. Successful management of massive digoxin overdose using DIGIFab and therapeutic plasma exchange: a case report. J Med Case Rep 2024; 18:135. [PMID: 38439066 PMCID: PMC10913407 DOI: 10.1186/s13256-024-04386-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Despite the efficacy and safety of DIGIFab, it is relatively expensive and has limited availability. In addition, alternative interventions, such as therapeutic plasma exchange, may need to be considered in massive digoxin overdoses. Although few case reports describe its efficacy. CASE PRESENTATION We report a case of a 17-year-old white male patient brought by family members to our emergency department in Riyadh, Saudi Arabia. After intentionally ingesting 48 mg of digoxin tablets to commit suicide, the patient's initial digoxin serum level was 8.04 ng/mL. The patient was resuscitated in the emergency department. After admission to the intensive care unit, the patient underwent therapeutic plasma exchange, because of insufficient DIGIFab doses. Afterward, the serum digoxin levels drastically decreased, and his symptoms reverted. The patient was successfully managed and discharged 7 days after admission. CONCLUSION Despite insufficient evidence and a limited number of case reports describing the use of extracorporeal treatment in digoxin overdose, we noted the significant impact of therapeutic plasma exchange on our patient. However, therapeutic plasma exchange's use in routine treatment requires stronger evidence to confirm its benefits.
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Affiliation(s)
- Reema M Alhussein
- Department of Emergency Medicine, King Saud University, Medical City, Riyadh, Saudi Arabia.
| | - Nawaf A Alamri
- Department of Emergency Medicine, King Saud University, Medical City, Riyadh, Saudi Arabia
| | - Hussain M Alhashem
- Department of Emergency Medicine, King Saud University, Medical City, Riyadh, Saudi Arabia
| | - Mohammed I Alarifi
- Department of Critical Care Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Bader Alyahya
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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8
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Fouad MM, Zawilla NH, Abdelsamie AA, Manawil M, Shehata RSA, Mohammed RS, Khalifa EM, Abdallah Ramadan M, Mourad BH. Successful Management of Severe Unresponsive Snake Bite Envenomation Using Plasmapheresis and Corticosteroid at Egyptian National Environmental and Clinical Toxicology Research Center: A Case Report. Wilderness Environ Med 2024; 35:82-87. [PMID: 38379491 DOI: 10.1177/10806032231225102] [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] [Indexed: 02/22/2024]
Abstract
Snakebite is a significant public health issue in which venom-induced consumption coagulopathy is a common and serious complication that results from the activation of the coagulation pathway by snake toxins. We report a male patient, 56 y old, who was thought to have been bitten by a snake on his left foot. He was transported to a nearby hospital where he received analgesics and 3 snake polyvalent antivenom vials, and then he was transported to our hospital after 12 h. He presented with 2 small puncture wounds, pain, blistering, and edema of the left foot. On the 2nd day, the patient developed gingival bleeding and hematuria. Laboratory investigations upon admission revealed prothrombin time (PT) of more than 3 min, prothrombin concentration (PC) of less than 2.5%, and an international normalized ratio (INR) of 23.43. Further investigation of urine showed more than 100 RBCs. Despite receiving 16 packs of plasma and 40 snake polyvalent antivenom vials manufactured by VACSERA over 3 days, hemoglobin concentration and platelet count decreased with the appearance of jaundice, lactate dehydrogenase was 520, and reticulocytes were 3.5%. PT was more than 300 s, and INR was still over range. Plasmapheresis and corticosteroids were provided, which improved the patient's general condition, PT, PC, and INR, and the patient was discharged after 6 days of hospital stay. This case report indicated that plasmapheresis and corticosteroids were clinically efficient approaches in the management of snake envenomation unresponsive to antivenom.
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Affiliation(s)
- Marwa Mohammed Fouad
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermin Hamdy Zawilla
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
- Head of National Environmental and Clinical Toxicological Research Centre (NECTR), Cairo University, Cairo, Egypt
| | - Aiesha Ashraf Abdelsamie
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marie Manawil
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Rateba Said Mohammed
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Mahmoud Khalifa
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Abdallah Ramadan
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Basma Hussein Mourad
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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9
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Raina R, Jothi S, Haffner D, Somers M, Filler G, Vasistha P, Chakraborty R, Shapiro R, Randhawa PS, Parekh R, Licht C, Bunchman T, Sethi S, Mangat G, Zaritsky J, Schaefer F, Warady B, Bartosh S, McCulloch M, Alhasan K, Swiatecka-Urban A, Smoyer WE, Chandraker A, Yap HK, Jha V, Bagga A, Radhakrishnan J. Post-transplant recurrence of focal segmental glomerular sclerosis: consensus statements. Kidney Int 2024; 105:450-463. [PMID: 38142038 DOI: 10.1016/j.kint.2023.10.017] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 12/25/2023]
Abstract
Focal segmental glomerular sclerosis (FSGS) is 1 of the primary causes of nephrotic syndrome in both pediatric and adult patients, which can lead to end-stage kidney disease. Recurrence of FSGS after kidney transplantation significantly increases allograft loss, leading to morbidity and mortality. Currently, there are no consensus guidelines for identifying those patients who are at risk for recurrence or for the management of recurrent FSGS. Our work group performed a literature search on PubMed/Medline, Embase, and Cochrane, and recommendations were proposed and graded for strength of evidence. Of the 614 initially identified studies, 221 were found suitable to formulate consensus guidelines for recurrent FSGS. These guidelines focus on the definition, epidemiology, risk factors, pathogenesis, and management of recurrent FSGS. We conclude that additional studies are required to strengthen the recommendations proposed in this review.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA; Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA
| | - Swathi Jothi
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Michael Somers
- Division of Nephrology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Guido Filler
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Prabhav Vasistha
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA
| | - Ronith Chakraborty
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA; Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA
| | - Ron Shapiro
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, New York, USA
| | - Parmjeet S Randhawa
- Department of Pathology, Thomas E Starzl Transplant Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rulan Parekh
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christopher Licht
- Division of Pediatric Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Timothy Bunchman
- Pediatric Nephrology and Transplantation, Children's Hospital of Richmond at Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Sidharth Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | - Guneive Mangat
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA
| | - Joshua Zaritsky
- Division of Pediatric Nephrology, Nemours, A.I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Franz Schaefer
- Department of Pediatric Nephrology, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Bradley Warady
- Division of Nephrology, University of Missouri-Kansas City School of Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Sharon Bartosh
- Department of Pediatrics, University of Wisconsin Medical School, Madison, Wisconsin, USA
| | - Mignon McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Khalid Alhasan
- Nephrology Unit, Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Kidney Transplant Division, Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Agnieszka Swiatecka-Urban
- University of Virginia Children's Hospital, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - William E Smoyer
- Center for Clinical and Translational Research and Division of Nephrology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Anil Chandraker
- Transplantation Research Center, Kidney and Pancreas Transplantation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hui Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Arvind Bagga
- Division of Pediatric Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Radhakrishnan
- Department of Medicine (Nephrology), Columbia University Medical Center, New York, New York, USA.
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Rodriguez-Pintó I, Espinosa G, Cervera R. What we know and what we don't know about catastrophic antiphospholipid syndrome. Rheumatology (Oxford) 2024; 63:SI46-SI53. [PMID: 38320593 DOI: 10.1093/rheumatology/kead556] [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: 06/29/2023] [Accepted: 08/16/2023] [Indexed: 02/08/2024] Open
Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a severe condition with high mortality. Since its description in 1992, an important effort has been made to improve and disseminate knowledge on CAPS. Most of our current knowledge comes from the studies performed using the CAPS Registry, a database created in 2000 to gather as many cases as possible in order to better define this disease. It has demonstrated that this condition has multiple faces and is often triggered by a precipitating factor that leads to a thrombotic microangiopathy and cytokine storm involving almost any organ of the body. Analysis of the CAPS Registry has also shown that patients receiving anticoagulation, glucocorticoids and plasma exchange and/or IVIG have a better prognosis. However, there are still many unresolved questions. In this review we summarize what is known and what is still a matter of research in this condition.
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Affiliation(s)
- Ignasi Rodriguez-Pintó
- Autoimmune Diseases Unit, Hospital Universitari Mútua de Terrassa, Terrassa, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC, CSUR) of the Catalan and Spanish Health Systems/Member of ERN-ReCONNET, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC, CSUR) of the Catalan and Spanish Health Systems/Member of ERN-ReCONNET, Hospital Clínic, Barcelona, Catalonia, Spain
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11
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Roganovic M, Erakovic J, Radulovic L, Perunicic S, Milikic D, Vujovic B, Idrizovic Z, Vujovic S, Debeljevic M, Gluscevic S. Plasma exchange in neurology patients-experience from single center in Montenegro. Ther Apher Dial 2024; 28:125-130. [PMID: 37641163 DOI: 10.1111/1744-9987.14062] [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: 06/21/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Plasma exchange (PE) is widely used in many immune-based neurological diseases. Our aim is to analyze characteristics of PE in neurological patients at the Clinical Center of Montenegro. METHODS Our study involved neurological patients treated with PE between January 2020 and April 2022. RESULTS In total, 246 PEs were performed in 43 patients. We divided patients into 4 groups according to indications. In 8/9 multiple sclerosis (MS) patients a decrease of Expanded Dysability Status Scale at least 0.5 was verified. In 14/20 Guillain Barre syndrome patients reduction of Hughes was observed. Four patients with myasthenia gravis (MG) were treated with PE. The most heterogeneous group (4) consisted of patients in whom the mechanism of disease development is assumed to be immune system dysregulation. Fourteen patients had any adverse event. CONCLUSION Our results show that PE is widely used and safe in the treatment of neurological diseases.
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Affiliation(s)
- Milovan Roganovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Jevto Erakovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Ljiljana Radulovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Slavisa Perunicic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Dragica Milikic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Balsa Vujovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Zilha Idrizovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Sandra Vujovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Mladen Debeljevic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Sanja Gluscevic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
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12
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Konno S, Fujioka T. Serum immunoglobulin G level reduction is a predictor of short-term improvement in patients with myasthenia gravis undergoing plasmapheresis. Ther Apher Dial 2024; 28:131-140. [PMID: 37731293 DOI: 10.1111/1744-9987.14065] [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: 09/06/2022] [Revised: 05/13/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES The aim of the study was to investigate the serological factors in predicting symptom improvement in myasthenia gravis (MG) patients who underwent plasmapheresis (PP). METHODS The relationship between symptom improvement and change in immunoglobin G (IgG) and acetylcholine receptor antibody (AchR-Ab) levels in 21 MG patients after PP was analyzed. RESULTS Patients were divided into two groups: the favorable (n = 11) or unfavorable (n = 10) response groups around the median MG composite improvement rate (50 [29, 56]%) 2 weeks after a PP course. In all patients, the IgG reduction rate before and after PP was higher in the favorable than the unfavorable response group. In AChR-Ab-positive patients, IgG and AChR-Ab reduction rates were higher in the favorable than the unfavorable response group. CONCLUSION IgG reduction rate is a predictor of symptom improvement in MG patients who underwent PP.
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Affiliation(s)
- Shingo Konno
- Department of Neurology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshiki Fujioka
- Department of Neurology, Toho University Ohashi Medical Center, Tokyo, Japan
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13
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Fjellbirkeland OW, Szpirt WM, Børresen ML. The role of plasmapheresis in severe acute disseminated encephalomyelitis with clinical findings of transverse myelitis. Ther Apher Dial 2024; 28:119-124. [PMID: 37646345 DOI: 10.1111/1744-9987.14059] [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: 06/21/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Acute disseminated encephalomyelitis is a rare acute demyelinating disease of the central nervous system (CNS). The pathogenesis remains unclear but is suspected to be autoimmune. High doses of methylprednisolone (HDMP) are currently considered standard of treatment. Plasmapheresis (PE) is typically given in steroid refractory cases. There is currently limited evidence supporting its use in ADEM. MATERIALS AND METHODS We report a 16-year-old girl with ADEM who improved rapidly after initiating PE. RESULTS The patient presented with acute onset of multifocal CNS symptoms, including encephalopathy, requiring intensive care unit management. Despite HDMP administration, her clinical condition continued to deteriorate. PE was therefore initiated on the same day as HDMP. Her clinical condition improved significantly following the first session. She was extubated and discharged from the intensive care unit the following day. CONCLUSION HDMP combined with PE may be an effective first-line treatment in patients with fulminant ADEM.
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Affiliation(s)
| | - Wladimir M Szpirt
- Department of Nephrology, Plasmapheresis Services, Copenhagen, Denmark
| | - Malene L Børresen
- Department of Pediatrics and Adolescent Medicine, Copenhagen, Denmark
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14
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Wan W, Pan Y, Chen Y, Bai S, Yao X, Lin Y, Wu J, Ni L, Mei Y, Qiu H, Zhou Y, Hao Y, Guan Y. The effect of double filtration plasmapheresis and corticosteroids on patients with anti-dipeptidyl-peptidase-like protein 6 encephalitis. Ther Apher Dial 2024; 28:141-151. [PMID: 37461148 DOI: 10.1111/1744-9987.14039] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 01/04/2024]
Abstract
INTRODUCTION Anti-dipeptidyl-peptidase-like protein 6 (DPPX) encephalitis is a rare condition with varied symptoms including gastrointestinal issues, weight loss, cognitive and mental dysfunction, and hyperexcitability of the central nervous system. METHODS We studied five patients with anti-DPPX encephalitis who received immunotherapy, specifically DFPP, at our hospital. We analyzed their clinical symptoms, lab results, electrophysiological and imaging findings, and outcomes with immunotherapy. RESULTS Patients presented with cognitive dysfunction, tremor, seizures, psychiatric disturbances, and cerebellar and brainstem dysfunction. Magnetic resonance imaging (MRI) showed brain abnormalities in one patient and elevated cerebrospinal fluid (CSF) protein levels in two patients. Antibodies against DPPX were detected in all patients and in CSF in two patients. One patient had antibodies against anti-CV2/contactin response mediator protein 5 (CRMP5). All patients responded well to DFPP and corticosteroids. CONCLUSION DFPP may be an effective treatment for anti-DPPX encephalitis. Further research is needed to understand disease progression and evaluate immunotherapy efficacy.
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Affiliation(s)
- Wenbin Wan
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yuanmei Pan
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ying Chen
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Shuwei Bai
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiaoying Yao
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yan Lin
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jun Wu
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Liping Ni
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yufang Mei
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Huiying Qiu
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yan Zhou
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yong Hao
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yangtai Guan
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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15
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Golsorkhi M, Norouzi S, Abdipour A. An increase in fibrinogen levels despite plasma exchange in a myasthenia gravis patient; a case report. Ther Apher Dial 2024; 28:162-163. [PMID: 37503708 DOI: 10.1111/1744-9987.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Mohadese Golsorkhi
- Department of Medicine, Division of Nephrology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Sayna Norouzi
- Department of Medicine, Division of Nephrology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Amir Abdipour
- Department of Medicine, Division of Nephrology, Loma Linda University Medical Center, Loma Linda, California, USA
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16
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LePage N, Soundar E. Anemia in patients undergoing chronic therapeutic plasma exchange. Transfus Apher Sci 2024; 63:103867. [PMID: 38199890 DOI: 10.1016/j.transci.2023.103867] [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: 09/26/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
Therapeutic plasma exchange is known to be an extracorporeal treatment procedure with few adverse effects. Anemia in chronically exchanged patients is not a well-recognized adverse effect. Our aim is to find if adult patients develop anemia while undergoing prolonged TPE treatments and to determine the time of onset of anemia. We retrospectively reviewed all outpatients that have undergone TPE at least once a week from July 2017 to March 2020. Kaplan-Meier time-to-event analysis was employed to calculate the time taken for development of anemia and time to reduction of hemoglobin by 1 g/dL from baseline in uncensored patients. A total of 14 patients met inclusion criteria receiving chronic TPE for neurological disorders including myasthenia gravis (MG). Eleven patients had once a week procedure. Study patients underwent a total of 113 (IQR, 84-227) TPE procedures and the duration of TPE was 4 (IQR, 2-6.5) years. Anemia was prevalent in 29% of this patient cohort before the initiation of TPE with a median hemoglobin of 9.4 (IQR, 8.1-11.0) g/dL. All patients regardless of hemoglobin levels prior to therapy had a decrease of 1 g/dL in hemoglobin in 6 (IQR, 3-8) weeks after initiation of chronic TPE. Anemia occurred in all non-anemic patients who underwent chronic TPE within a short period of ten weeks. Patients who were moderately anemic prior to initiation of TPE progressed to severe anemia within six weeks of TPE. Our results suggest that anemia is a consequence of chronic TPE. Baseline and follow-up laboratory studies are vital for early diagnosis.
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Affiliation(s)
- Nichole LePage
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Esther Soundar
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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17
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Zikou X, Vaia D, Vasiliki P, Panagiotis C, Stavros A. Use of Therapeutic Apheresis methods in ICU. Transfus Apher Sci 2024; 63:103853. [PMID: 38049358 DOI: 10.1016/j.transci.2023.103853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Apheresis is a modern medical approach in which plasma or cellular components are separated from the whole blood. Apheresis can be either diagnostic or therapeutic. Diagnostic apheresis is typically applied in hematology and cancer research. Therapeutic Apheresis (TA) includes a broad spectrum of extracorporeal treatments applied in various medical specialties, including Intensive Care Unit (ICU). Considering the complexity of the pathophysiologic characteristics of various clinical entities and in particular sepsis, apheresis methods are becoming increasingly applicable. Therapeutic Plasma Exchange (TPE) is the most common used method in ICU. It is considered as first line therapy for Thrombotic Thrombocytopenic Purpura (TTP) and Guillain Barre Syndrome, while the current data for sepsis are scarce. Over the last decades, technologic evolution has led to increasing application of new and more selective methods based on adsorptive techniques. In this review we will describe the current data of characteristics of different techniques, safety and clinical impact of apheresis methods used in ICUs.
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18
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Jia J, Meng D, Zhang X, Lai N, Zhou B, Wei H, Li X. Clinical application of blood purification in polymyositis/dermatomyositis. Ther Apher Dial 2024; 28:112-118. [PMID: 37853934 DOI: 10.1111/1744-9987.14072] [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: 06/25/2023] [Revised: 08/30/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION We investigated the clinical efficacy and safety of blood purification technology in patients with polymyositis/dermatomyositis. METHODS In a study of 22 patients, 10 cases received blood purification treatment (5 cases received plasma exchange, 5 cases received plasma HA280 immunoadsorption), and 12 cases served as the control group. A 3-month follow-up was conducted to compare the clinical manifestations and laboratory examination. RESULTS Symptoms and signs of patients in treatment group were significantly improved, and the hormone usage was lower than the control group. For patients with normal creatine kinase level and ferritin level below three times the upper limit of normal, there was a positive correlation between their N/L values and MDAAT scores. CONCLUSION The results of this study suggest that blood purification therapy, including plasma HA280 immunoadsorption and plasma exchange, is an effective and safe treatment for patients with polymyositis/dermatomyositis, offering assistance in reducing hormone usage in the long-term.
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Affiliation(s)
- Jieting Jia
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Defang Meng
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xuexiang Zhang
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Nalin Lai
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Beibei Zhou
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hua Wei
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiaocong Li
- Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
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19
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Sekhar JC, Rajitha B, Nagaraju C, Singh S, Sahni A, Lamba DS, Hans R, Vyas S, Angurana SK. Plasmapheresis in Acute Necrotizing Encephalopathy of Childhood Secondary to Dengue. Indian J Pediatr 2024; 91:200-201. [PMID: 37615825 DOI: 10.1007/s12098-023-04823-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Jerin C Sekhar
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - B Rajitha
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Chethan Nagaraju
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Shagun Singh
- Division of Pediatric Neurology, Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarushi Sahni
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divjot Singh Lamba
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rekha Hans
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sameer Vyas
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suresh Kumar Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
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20
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Cheng X, Zhan Y, Wang Z, Wang F, Zeng X, Mao Y, Liu Y. A single-center experience of non-bioartificial DFAPP support systems among Chinese patients with hyperlipidemic moderate/severe acute pancreatitis. Sci Rep 2024; 14:1128. [PMID: 38212524 PMCID: PMC10784462 DOI: 10.1038/s41598-024-51761-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
To assess the clinical efficacy of Double Filtration Plasmapheresis (DFAPP), a novel blood purification method, in treating hyperlipidemic moderate/severe pancreatitis (HL-M/SAP). A total of 68 HL-M/SAP patients were enrolled in this study. The observation group, comprising 34 patients, received DFAPP treatment, while the control group underwent CVVH + PA treatment. We compared the efficacy changes between the two groups post-treatment. Patients treated with DFAPP showed significant improvements in clinical outcomes. After 72 h of DFAPP treatment, HL-M/SAP patients exhibited notably lower multiple organ failure scores and a reduced mortality rate compared to those in the CVVH + PA group. Triglyceride levels in HL-M/SAP patients treated with DFAPP for 48 h averaged 3.75 ± 1.95, significantly lower than the 9.57 ± 3.84 levels in the CVVH + PA group (P < 0.05). Moreover, CRP levels decreased markedly, IL-17 levels diminished, IL-10 levels increased, and the decline in IL-35 levels was significantly less pronounced compared to the CVVH + PA group. The recurrence rate of pancreatitis was also significantly lower after 6 months. The early implementation of DFAPP in HL-M/SAP patients effectively reduces triglyceride levels, suppresses pro-inflammatory factors, enhances anti-inflammatory factors, and mitigates cytokine storm-induced sepsis damage. Consequently, this leads to a decrease in the incidence of multiple organ failure, improved patient survival rates, and a reduce the recurrence rate of lipogenic pancreatitis.Trial registration: Chinese Clinical Trial Registry, ChiCTR2300076066.
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Affiliation(s)
- Xianwen Cheng
- Ankang Hospital of Traditional Chinese Medicine, Ankang, 725000, Shaanxi, China.
| | - Yanrong Zhan
- Shaanxi University of Chinese Medicine, Xianyang, 712000, Shaanxi, China.
| | - Zhendong Wang
- Ankang Hospital of Traditional Chinese Medicine, Ankang, 725000, Shaanxi, China
| | - Feng Wang
- Ankang Hospital of Traditional Chinese Medicine, Ankang, 725000, Shaanxi, China
| | - Xia Zeng
- Ankang Hospital of Traditional Chinese Medicine, Ankang, 725000, Shaanxi, China
| | - Ya Mao
- Ankang Hospital of Traditional Chinese Medicine, Ankang, 725000, Shaanxi, China
| | - YaoShun Liu
- Ankang Hospital of Traditional Chinese Medicine, Ankang, 725000, Shaanxi, China
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Giudicissi A, Vetrano D, Morresi S, Bruno PF, Neri L, Signorotti S, Sgarlato V, Ruggeri M, Zanchelli F, Longoni M, Buscaroli A. [Therapeutic Plasma Exchange in a Patient with Chronic Hemodialysis and a New Diagnosis of Myasthenia Gravis]. G Ital Nefrol 2023; 40:2023-vol6. [PMID: 38156541] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Case ReportC.S.T. (♂, 71 years old) is a patient with multiple and severe comorbidities, undergoing thrice-weekly chronic hemodialysis since 2008 due to the progression of post-lithiasic uropathy. Over the past 2 months, the patient had been experiencing progressive ptosis of the eyelids, muscle weakness, and ultimately dysphagia and dysarthria that emerged in the last few days. Urgently admitted to the Neurology department, electromyography (EMG) was performed, leading to a diagnosis of predominant cranial myasthenia gravis (with borderline anti-acetylcholine receptor antibody serology). Prompt treatment with pyridostigmine and steroids was initiated. Considering the high risk of acute myasthenic decompensation, therapeutic plasma exchange (TPE) with centrifugation technique was promptly undertaken after femoral CVC placement. TPE sessions were alternated with hemodialysis. The patient's condition complicated after the third TPE session, with septic shock caused by Methicillin-Sensitive Staphylococcus Aureus (MSSA). The patient was transferred to the Intensive Care Unit (ICU). Due to hemodynamic instability, continuous veno-venous hemodiafiltration (CVVHDF) with citrate anticoagulation was administered for 72 hours. After resolving the septic condition, intermittent treatment with Acetate-Free Biofiltration (AFB) technique was resumed. The patient completed the remaining three TPE sessions and, once the acute condition was resolved, was transferred back to Neurology. Here, the patient continued the treatment and underwent a rehabilitation program, showing significant motor and functional recovery until discharge. Conclusions. The multidisciplinary interaction among Nephrologists, Neurologists, Anesthesiologists, and experts from the Immunohematology and Transfusion Medicine Service enabled the management and treatment of a rare condition (MG) in a high-risk chronic hemodialysis patient.
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Affiliation(s)
- A Giudicissi
- Unità Operativa di Nefrologia e Dialisi, Ospedale "M. Bufalini", Cesena, Italia
| | - D Vetrano
- Unità Operativa di Nefrologia, Dialisi e Trapianto, IRCCS Azienda Ospedialiero Universitaria di Bologna, 40138, Bologna, Italia
| | - S Morresi
- Unità Operativa di Neurologia e Stroke Unit, Ospedale "M. Bufalini", Cesena, Italia
| | - P F Bruno
- Unità Operativa di Nefrologia e Dialisi, Ospedale "M. Bufalini", Cesena, Italia
| | - L Neri
- Unità Operativa di Nefrologia e Dialisi, Ospedale "M. Bufalini", Cesena, Italia
| | - S Signorotti
- Unità Operativa di Nefrologia e Dialisi, Ospedale "M. Bufalini", Cesena, Italia
| | - V Sgarlato
- Unità Operativa di Nefrologia e Dialisi, Ospedale "M. Bufalini", Cesena, Italia
| | - M Ruggeri
- Unità Operativa di Nefrologia e Dialisi, Ospedale "M. Bufalini", Cesena, Italia
| | - F Zanchelli
- Unità Operativa di Nefrologia e Dialisi, Ospedale "M. Bufalini", Cesena, Italia
| | - M Longoni
- Unità Operativa di Neurologia e Stroke Unit, Ospedale "M. Bufalini", Cesena, Italia
| | - A Buscaroli
- Unità Operativa di Nefrologia e Dialisi, Ospedale "M. Bufalini", Cesena, Italia
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Igarashi S, Kamikawa Y, Ono S, Maekawa G, Kishigami H, Kawamura K, Oonogi T, Nagano T. Experience with pre-diluted plasma exchange therapy for hyperviscosity syndrome. Ther Apher Dial 2023; 27:1035-1039. [PMID: 37605348 DOI: 10.1111/1744-9987.14053] [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: 01/06/2023] [Accepted: 02/09/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Plasma exchange therapy (PE) is useful for patients with primary macroglobulinemia and multiple myeloma who present with hyperviscosity syndrome. However, hyperviscous blood may coagulate in the circuit during treatment, and in that case necessitate discontinuation of the treatment. This time, we report that we were able to prevent coagulation in the circuit by adding some ideas during the membrane separation method. METHODS Physiological saline is injected in front of the plasma separation membrane to pre-dilute the blood, followed by filtration through the plasma separation membrane. RESULTS As a result of pre-diluting with physiological saline to reduce the viscosity entering the separation membrane, it was possible to process the planned target amount. CONCLUSION In patients with hyperviscosity syndrome who showed intracircuit coagulation during plasma exchange therapy, devising a predilution method should be considered as one of the ways to continue treatment.
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Affiliation(s)
- Shigeyuki Igarashi
- Department of Clinical Engineering, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Yasutaka Kamikawa
- Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Syuji Ono
- Department of Clinical Engineering, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Gakuya Maekawa
- Department of Clinical Engineering, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Hiroyuki Kishigami
- Department of Clinical Engineering, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Kazuki Kawamura
- Department of Clinical Engineering, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Takumi Oonogi
- Department of Clinical Engineering, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Toshihiko Nagano
- Department of Clinical Engineering, Fukui-ken Saiseikai Hospital, Fukui, Japan
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23
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Vrielink H, Le Poole K, Stegmayr B, Kielstein J, Berlin G, Ilhan O, Seval GC, Prophet H, Aandahl A, Deeren D, Bojanic I, Blaha M, Lanska M, Gasova Z, Bhuiyan-Ludvikova Z, Blahutova S, Hrdlickova R, Audzijoniene J, Griskevicius A, Glatt T, Strineholm V, Ott M, Nilsson T, Newman E, Derfler K, Witt V, Toss F. The world apheresis association registry, 2023 update. Transfus Apher Sci 2023; 62:103831. [PMID: 37827962 DOI: 10.1016/j.transci.2023.103831] [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] [Indexed: 10/14/2023]
Abstract
The WAA apheresis registry contains data on more than 140,000 apheresis procedures conducted in 12 different countries. The aim is to give an update of indications, type and number of procedures and adverse events (AEs). MATERIAL AND METHODS: The WAA-registry is used for registration of apheresis procedures and is free of charge. The responsible person for a center can apply at the site www.waa-registry.org RESULTS: Data includes reported AEs from 2012 and various procedures and diagnoses during the years 2018-2022; the latter in total from 27 centers registered a total of 9500 patients (41% women) that began therapeutic apheresis (TA) during the period. A total of 58,355 apheresis procedures were performed. The mean age was 50 years (range 0-94). The most common apheresis procedure was stem cell collection for which multiple myeloma was the most frequent diagnosis (51%). Donor cell collection was done in 14% and plasma exchange (PEX) in 28% of patients; In relation to all performed procedures PEX, using a centrifuge (35%) and LDL-apheresis (20%) were the most common. The main indication for PEX was TTP (17%). Peripheral veins were used in 56% as the vascular access. The preferred anticoagulant was ACD. AEs occurred in 2.7% of all procedures and were mostly mild (1%) and moderate 1.5% (needed supportive medication) and, only rarely, severe (0.15%). CONCLUSION: The data showed a wide range of indications and variability in apheresis procedures with low AE frequency.
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Affiliation(s)
- Hans Vrielink
- Unit of Transfusion medicine of Sanquin Blood Supply, Sanquin Blood Supply Foundation in Amsterdam, the Netherlands
| | - Kaatje Le Poole
- Unit of Transfusion medicine of Sanquin Blood Supply, Sanquin Blood Supply Foundation in Amsterdam, the Netherlands
| | - Bernd Stegmayr
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Jan Kielstein
- Academic Teaching Hospital Braunschweig, Medical Clinic V - Nephrology, Rheumatology, Blood Purification, Germany
| | - Gösta Berlin
- Department of Clinical Immunology and Transfusion Medicine, and Department of Biochemical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Osman Ilhan
- Department Haematology, University Hospital, Ankara, Turkey
| | | | | | - Astrid Aandahl
- Dep of Immunology and Transfusion Medicine, Akershus University Hospital, Lorenskog, Norway
| | | | - Ines Bojanic
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Croatia
| | - Milan Blaha
- IV. Internal Hematological Klinik, Fakultni Nemocnice, Hradec Králové, Czech Republic
| | - Miriam Lanska
- IV. Internal Hematological Klinik, Fakultni Nemocnice, Hradec Králové, Czech Republic
| | - Zdenka Gasova
- Apheresis Department, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | - Sarka Blahutova
- Blood Centre, University Hospital Ostrava, Ostrava, Czech Republic
| | | | - Judita Audzijoniene
- Therapeutic apheresis unit, Vilnius university hospital Santariskiu clinics, Vilnius, Lithuania
| | - Antanas Griskevicius
- Therapeutic apheresis unit, Vilnius university hospital Santariskiu clinics, Vilnius, Lithuania
| | - Tanya Glatt
- South African National Blood Service, Johannesburg, South Africa
| | | | - Michael Ott
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thomas Nilsson
- Department of Nephrology, University Hospital, Uppsala, Sweden
| | - Elizabeth Newman
- Bone Marrow Transplant & Apheresis, Apheresis & Cell Therapies Unit, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Kurt Derfler
- The Institute for the Diagnosis and Therapy of Atherosclerosis and Fat Metabolism Disorders, Athos, Vienna, Austria
| | - Volker Witt
- St. Anna Kinderspital, University Hospital, Vienna, Austria
| | - Fredrik Toss
- Department of Clinical Microbiology, Division of Clinical Immunology, Umeå University, Umeå, Sweden
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24
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Shao J, Song X. Double filtration plasmapheresis: A new road for donor-specific antibody desensitization in allogeneic stem cell transplantation. Br J Haematol 2023; 203:708-709. [PMID: 37798856 DOI: 10.1111/bjh.19136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Jie Shao
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xianmin Song
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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25
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Chowdhry M, Sharma A, Agrawal S, Vohra R, Kumar K, Goyal N, Kumar V A, Jerath N, Malhotra S, Sibal A, Mishra M. Efficacy of therapeutic plasma exchange in pediatric cases of acute liver failure as an extracorporeal liver support system. Transfus Apher Sci 2023; 62:103835. [PMID: 37996345 DOI: 10.1016/j.transci.2023.103835] [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: 05/09/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Acute liver failure in the pediatric population is often accompanied by deranged metabolism, severe encephalopathy and coagulopathy. A liver transplant is the most viable option for the management of such patients. Therapeutic plasma exchange (TPE) is helpful in improving the liver biochemistry profile, thereby, increasing their likelihood of undergoing a liver transplant METHOD: The study was conducted over a period of 3 years (January 2018 to December 2021). Indications mainly consisted of ALF with hepatic encephalopathy, worsening liver parameters in spite of medical management, and candidacy for undergoing a liver transplant. Plasma exchange was performed daily or alternatively until the patient recovered, succumbed, or was stable enough to undergo a transplant. Biochemical parameters serum bilirubin, ALT, AST serum ammonia serum urea, serum creatinine were recorded before and after TPE sessions. RESULTS The study group comprised 14 patients of which a total of 28 TPE was performed. There were a total of 5 cases of cryptogenic ALF, 4 of Wilson disease, 2 cases each of infection-related ALF and autoimmune hepatitis, and a single case of drug-induced hepatitis. A total of 5 out of 14 patients underwent a liver transplant and amongst the 9 who did not undergo a transplant, 4 patients expired due to septic shock syndrome; the remaining 5 were discharged in a stable condition following TPE sessions. The disease-free survival was 78.9% and the transplant-free survival was 35.71%. CONCLUSION TPE plays a crucial role in improving the biochemistry profile of the liver in children with liver failure.
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Affiliation(s)
- Mohit Chowdhry
- Department of Transfusion Medicin & Transplant Immunology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India.
| | - Ankita Sharma
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India
| | - Soma Agrawal
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India
| | - Rohit Vohra
- Department of Pediatric, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India
| | - Karunesh Kumar
- Department of Pediatric Gastroenterology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India
| | - Neerav Goyal
- Department of Liver transplant and hepatic-biliary-pancreatic Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India
| | - Arun Kumar V
- Department of Liver transplant and hepatic-biliary-pancreatic Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India
| | - Nameet Jerath
- Department of Pediatric, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India
| | - Smita Malhotra
- Department of Pediatric Gastroenterology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India
| | - Anupam Sibal
- Department of Pediatric Gastroenterology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India
| | - Manoj Mishra
- Department of Transplant Immunology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi 110076, India
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26
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Sever A, Stein J, Kalo A, Pearl-Yafe M, Kadmon G, Weissbach A, Nahum E, Kaplan E. Therapeutic plasma exchange for neonatal hepatic failure. Transfus Apher Sci 2023; 62:103810. [PMID: 37718217 DOI: 10.1016/j.transci.2023.103810] [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: 05/24/2023] [Revised: 08/14/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
We report a case of therapeutic plasma exchange in a neonate with fulminant liver failure. A six-day old, 2800-gram baby was referred to our medical center for evaluation and treatment of fulminant hepatic failure. The working diagnosis at admission was gestational alloimmune liver disease, and therapeutic plasma exchange was proposed. A double volume plasma exchange was successfully performed, using the Spectra Optia apheresis system, primed with packed red blood cells. Access was obtained via a radial artery catheter and a peripheral intravenous line. On hospital D-14 a diagnosis of E3 deficiency was confirmed, and disease-specific therapy was started. Automated TPE using peripheral arterial and venous catheters may be safely performed in neonates, and should be considered in the treatment of a variety of disorders including neonatal fulminant hepatic failure.
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Affiliation(s)
- Aviv Sever
- Department of Pediatrics C, all in Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
| | - Jerry Stein
- Pediatric Bone Marrow Transplantation Unit, all in Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Kalo
- Pediatric Apehresis Unit, all in Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Michal Pearl-Yafe
- Pediatric Apehresis Unit, all in Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Gili Kadmon
- Pediatric Intensive Care Unit, all in Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avichai Weissbach
- Pediatric Intensive Care Unit, all in Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elhanan Nahum
- Pediatric Intensive Care Unit, all in Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eytan Kaplan
- Pediatric Intensive Care Unit, all in Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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27
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Kawahira H, Fujii K, Higashi Y, Yamada Y, Mitsuke A, Enokida H, Kanekura T. Double filtration plasmapheresis for bullous pemphigoid: Outcomes from the evaluation of eight patients. Ther Apher Dial 2023; 27:1048-1050. [PMID: 37583277 DOI: 10.1111/1744-9987.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/12/2023] [Indexed: 08/17/2023]
Affiliation(s)
- Hisao Kawahira
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazuyasu Fujii
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuko Higashi
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yasutoshi Yamada
- Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Akihiko Mitsuke
- Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Hideki Enokida
- Department of Urology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takuro Kanekura
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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28
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Banerjee P, Mohan AK, Baid H, Kaeley N, Khiamniungan CB, Prasanth V, Jain A, Kaur D, Negi G. Off with the blues: Therapeutic plasma exchange in a case of copper sulphate poisoning. Transfus Apher Sci 2023; 62:103811. [PMID: 37730446 DOI: 10.1016/j.transci.2023.103811] [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: 06/05/2023] [Revised: 08/19/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
CuSO4 (Copper sulphate) poisoning though rare, is associated with high mortality. It involves multiple organ systems and if not dealt with promptly can lead to death. Supportive care and chelation therapy along with TPE (therapeutic plasma exchange), whole blood exchange or red cell exchange can be employed in management. We report such a case where swift clinical improvement was seen after TPE.
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Affiliation(s)
- Pradip Banerjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India
| | - Aswin K Mohan
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India.
| | - Himanshi Baid
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, India
| | - Nidhi Kaeley
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, India
| | - Chanchi B Khiamniungan
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India
| | - Vaidehi Prasanth
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India
| | - Ashish Jain
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India
| | - Daljit Kaur
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India
| | - Gita Negi
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India
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29
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Van Remoortel H, van den Hurk K, Compernolle V, O'Leary P, Tiberghien P, Erikstrup C. Very-high frequency plasmapheresis and donor health-absence of evidence is not equal to evidence of absence. Transfusion 2023; 63:2358-2361. [PMID: 37982361 DOI: 10.1111/trf.17601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Hans Van Remoortel
- Centre for Evidence-Based Practice, Belgian Red Cross, Brussels, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Katja van den Hurk
- Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Veerle Compernolle
- Blood Services, Belgian Red Cross, Brussels, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | | | - Pierre Tiberghien
- European Blood Alliance, Brussels, Belgium
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- EFS, INSERM, UMR Right, Université de Franche-Comté, Besançon, France
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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30
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Hayes EA, Walczak AB, Goodhue Meyer E, Nicol K, Deitemyer M, Duffy V, Moore Padilla M, Gajarski RJ, Nandi D. An in vitro comparison of intra-operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantation. J Extra Corpor Technol 2023; 55:189-193. [PMID: 38099633 PMCID: PMC10723569 DOI: 10.1051/ject/2023034] [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] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Highly sensitized pediatric patients awaiting heart transplantation experience longer wait times and thus higher waitlist mortality. Similarly, children less than 2 years of age have increased waitlist times and mortality when compared to their older peers. To improve the likelihood of successful transplantation in these patients, various strategies have been utilized, including peri-operative plasmapheresis. However, limited data exists comparing plasmapheresis techniques for antibody reduction. This study's aim was to compare the in vitro magnitude of isohemagglutinin titers (IT) and human leukocyte antigen (HLA) antibody removal and the time required between membrane-based plasmapheresis (MP) and centrifuge-based plasmapheresis (CP) incorporated into the extracorporeal (EC) circuit. METHODS Two MP (Prismaflex) and two CP (Spectra Optia, Terumo BCT) circuits were incorporated into four separate EC circuits primed with high titer, highly sensitized type O donor whole blood. Assays were performed to determine baseline IT and anti-HLA antibodies and then at 30-minute increments until completion of the run (two plasma volume exchanges) at two hours. RESULTS There was a decrease in anti-A and anti-B IgM and IgG titers with both MP and CP. Mean anti-A and anti-B titer reduction was by 4.625 titers (93.7% change) and 4.375 titers (93.8% change) using MP and CP, respectively. At 2 h of apheresis, CP reduced 62.5% of all ITs to ≤ 1:4, while MP reduced 50% of ITs to ≤ 1:4. Additionally, reduction of anti-HLA class II antibody to mean fluorescence intensity (MFI) <3000 was achieved with both MP and CP. At 2 h of apheresis, CP reduced MFI by 2-3.5 fold and MP reduced MFI by 1.7-2.5 fold. Both demonstrated similar hemolytic and thrombotic profiles. CONCLUSIONS In this in vitro plasmapheresis model of IT and anti-HLA antibody reduction, both MP and CP incorporated into the EC circuit can be used quickly and effectively to reduce circulating antibodies. While CP may have some greater efficiency, further study is necessary to verify this in vivo.
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Affiliation(s)
- Emily A. Hayes
- The Heart Center, Nationwide Children’s Hospital Columbus OH 43205 USA
| | - Ashley B Walczak
- The Heart Center, Nationwide Children’s Hospital Columbus OH 43205 USA
| | - Erin Goodhue Meyer
- Department of Hematology/Apheresis, Nationwide Children’s Hospital Columbus OH 43205 USA
| | - Kathleen Nicol
- Department of Pathology, Nationwide Children’s Hospital Columbus OH 43205 USA
| | - Matthew Deitemyer
- The Heart Center, Nationwide Children’s Hospital Columbus OH 43205 USA
| | - Vicky Duffy
- The Heart Center, Nationwide Children’s Hospital Columbus OH 43205 USA
| | - Michelle Moore Padilla
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine Atlanta GA 30322 USA
| | | | - Deipanjan Nandi
- The Heart Center, Nationwide Children’s Hospital Columbus OH 43205 USA
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31
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Liu L, Ji X, Zhu P, Yang L, Shi J, Zhao Y, Lai X, Yu J, Fu H, Ye Y, Wu Y, Ying J, Huang H, Luo Y. Double filtration plasmapheresis combined with rituximab for donor-specific antibody desensitization in haploidentical haematopoietic stem cell transplantation. Br J Haematol 2023; 203:829-839. [PMID: 37621146 DOI: 10.1111/bjh.19046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
Donor-specific anti-HLA antibodies (DSA) are a major cause of engraftment failure in patients receiving haploidentical haematopoietic stem cell transplantation (Haplo-HSCT). Double filtration plasmapheresis (DFPP) avoids the unnecessary loss of plasma proteins and increases the efficiency of purification. To investigate the effectiveness of the desensitization protocol including DFPP and rituximab, we conducted a nested case-control study. Thirty-three patients who had positive DSA were desensitized by the protocol and 99 patients with negative DSA were randomly matched as control. The median DSA mean fluorescence intensity values before and after DFPP treatment were 7505.88 ± 4424.38 versus 2013.29 ± 4067.22 (p < 0.001). All patients in DSA group achieved haematopoietic reconstitution and the median neutrophils and platelets engraftment times were 13 (10-21) and 13 (10-29) days respectively. Although the cumulative incidence of II-IV aGVHD (41.4% vs. 28.1%) and 3-year moderate to severe cGVHD (16.8% vs. 7.2%) were higher in DSA cohort than in the control, no statistical significance was observed. The 3-year non-relapse mortality and the overall survival were 6.39% and 72.0%, respectively, in the DSA cohort, which were comparable to the negative control. In conclusion, DFPP and rituximab could be effectively used for desensitization and overcome the negative effects of DSA in Haplo-HSCT.
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Affiliation(s)
- Lizhen Liu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Xinyu Ji
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Panpan Zhu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Luxin Yang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Jimin Shi
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Yanmin Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Xiaoyu Lai
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Jian Yu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Huarui Fu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Yishan Ye
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Yibo Wu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Jinping Ying
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Yi Luo
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
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Odish MF, Garimella PS, Crisostomo H, Yi C, Owens RL, Pollema T. Using Cardiohelp, Quadrox, and Nautilus Extracorporeal Membrane Oxygenators as Vascular Access for Hemodialysis, Continuous Renal Replacement Therapy, and Plasmapheresis: A Brief Technical Report. ASAIO J 2023; 69:e455-e459. [PMID: 37399278 PMCID: PMC10602218 DOI: 10.1097/mat.0000000000002005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
The use of intermittent hemodialysis (iHD), and continuous renal replacement therapy (CRRT), along with extracorporeal membrane oxygenation (ECMO) in patients with acute kidney injury (AKI) and end-stage renal disease (ESRD) is very common. In this technical report, we describe the methods to perform these dialytic therapies safely and effectively using the ECMO circuit in lieu of a separate dialysis catheter. Specifically, we describe in detail how to connect these kidney replacement therapy modalities to a Quadrox, Nautilus, and Cardiohelp HLS (combined oxygenator and pump) oxygenator. The dialysis (iHD or CRRT) inlet is attached to the post-oxygenators Luer-Lock, whereas the return is attached to the pre-oxygenator Luer-Lock, both with a dual lumen pigtail. We also discuss the technical aspects of performing plasmapheresis in conjunction with ECMO and iHD or CRRT. Finally, we highlight the fact that the reported technique does not require modifying the ECMO cannulas/tubing which helps maximize safety.
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Affiliation(s)
- Mazen F. Odish
- From the Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, UC San Diego Department of Medicine, La Jolla, California
| | - Pranav S. Garimella
- Division of Nephrology-Hypertension, UC San Diego Department of Medicine, La Jolla, California
| | | | - Cassia Yi
- UC San Diego Health Department of Nursing, La Jolla, California
| | - Robert L. Owens
- From the Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, UC San Diego Department of Medicine, La Jolla, California
| | - Travis Pollema
- Division of Cardiovascular and Thoracic Surgery, UC San Diego Department of Surgery, La Jolla, California
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McLendon LA, Gambrah-Lyles C, Viaene A, Fainberg NA, Landzberg EI, Tucker AM, Madsen PJ, Huh J, Silver MR, Arena JD, Kienzle MF, Banwell B. Dramatic Response to Anti-IL-6 Receptor Therapy in Children With Life-Threatening Myelin Oligodendrocyte Glycoprotein-Associated Disease. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200150. [PMID: 37582615 PMCID: PMC10427143 DOI: 10.1212/nxi.0000000000200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/08/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an immune-mediated neuroinflammatory disorder leading to demyelination of the CNS. Interleukin (IL)-6 receptor blockade is under study in relapsing MOGAD as a preventative strategy, but little is known about the role of such treatment for acute MOGAD attacks. METHODS We discuss the cases of a 7-year-old boy and a 15-year-old adolescent boy with severe acute CNS demyelination and malignant cerebral edema with early brain herniation associated with clearly positive serum titers of MOG-IgG, whose symptoms were incompletely responsive to standard acute therapies (high-dose steroids, IV immunoglobulins (IVIGs), and therapeutic plasma exchange). RESULTS Both boys improved quickly with IL-6 receptor inhibition, administered as tocilizumab. Both patients have experienced remarkable neurologic recovery. DISCUSSION We propose that IL-6 receptor therapies might also be considered in acute severe life-threatening presentations of MOGAD.
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Affiliation(s)
- Loren A McLendon
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - Claudia Gambrah-Lyles
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - Angela Viaene
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - Nina A Fainberg
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - Elizabeth I Landzberg
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - Alexander M Tucker
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - Peter J Madsen
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - Jimmy Huh
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - Maya R Silver
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - John D Arena
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - Martha F Kienzle
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
| | - Brenda Banwell
- From the Division of Neurology (L.A.M., C.G., M.R.S., B.B.), Department of Pediatrics, Children's Hospital of Philadelphia; Department of Neurology, Perelman School of Medicine, University of Pennsylvania; Department of Pathology (A.V.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Division of Critical Care Medicine (N.A.F., E.I.L., J.H., M.F.K.), Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; and Division of Neurosurgery (A.M.T., P.J.M., J.D.A.), Children's Hospital of Philadelphia; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania.
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Mitsuishi A, Miura Y, Saeki K, Nomura Y, Yoshifumi K, Yoshida K. Total arch replacement for an aortic arch aneurysm with cold agglutinin disease after rituximab and plasmapheresis. J Cardiothorac Surg 2023; 18:281. [PMID: 37817219 PMCID: PMC10566192 DOI: 10.1186/s13019-023-02388-x] [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: 02/06/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Cold agglutinin disease can lead to significant complications, especially for patients undergoing arch repair requiring hypothermic circulatory arrest. Rituximab and plasmapheresis are treatments for cold agglutinin disease. However, its use in patients with Stanford type A dissection has not been reported. Therefore, after consultation with hematologists, we used rituximab and plasmapheresis before mild hypothermic aortic arch surgery to maintain the body temperature above the thermal altitude. CASE PRESENTATION This report describes an 86-year-old male patient with acute type A aortic dissection who received outpatient treatment for rheumatoid arthritis and a 55-mm thoracic aortic aneurysm. The patient was scheduled to undergo urgent surgery for a type A intramural hematoma and progressive aortic aneurysm; however, laboratory test results indicated blood clotting and cold agglutinin. Consequently, urgent surgery was rescheduled. After consulting with hematologists, rituximab was initiated 3 months before surgery, and plasmapheresis was performed 2 days before surgery for cold agglutinin disease. Under mild hypothermia conditions, total arch replacement using the frozen elephant trunk technique was performed while maintaining cerebral and lower body perfusion. The postoperative course was uneventful. On postoperative day 42, the patient was discharged without any neurological deficits. CONCLUSIONS This case involving total arch replacement with mild hypothermia for an aortic arch aneurysm with cold agglutinin disease after rituximab treatment and plasmapheresis resulted in a successful outcome.
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Affiliation(s)
- Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery Kochi Medical School, 185-1, Kohasu, Nankoku-shi, Okohcho, Kochi Prefecture, 783-8505, Japan.
| | - Yujiro Miura
- Department of Cardiovascular Surgery Kochi Medical School, 185-1, Kohasu, Nankoku-shi, Okohcho, Kochi Prefecture, 783-8505, Japan
| | - Kyosuke Saeki
- Department of Hematology Ehime Prefectural Central Hospital, Matsuyama-shi, Ehime Prefecture, Kasugamachi, 790-0024, 83, Japan
| | - Yoshinori Nomura
- Department of Clinical Engineering Kochi Medical School, 185-1, Kohasu, Nankoku-shi, Okohcho, Kochi Prefecture, 783-8505, Japan
| | - Katsumata Yoshifumi
- Department of Anesthesiology and intensive Care Medicine Kochi Medical School, 185-1, Kohasu, Nankoku-shi, Okohcho, Kochi Prefecture, 783-8505, Japan
| | - Keisuke Yoshida
- Department of Cardiovascular Surgery Kochi Medical School, 185-1, Kohasu, Nankoku-shi, Okohcho, Kochi Prefecture, 783-8505, Japan
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Elali I, Phachu D, Coombs N, Shah M, Dean J, Haider L, Wang Y, Kaplan AA. Membrane-based therapeutic plasma exchange: Proposed techniques for preventing filter failure. J Clin Apher 2023; 38:555-561. [PMID: 37287385 DOI: 10.1002/jca.22065] [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: 03/04/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Therapeutic plasma exchange (TPE) is commonly performed using membrane-based TPE (mTPE) and is prone to filter failure. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We report on 46 patients, with a total of 321 mTPE treatments using the NxStage machine. This was a retrospective study with an aim to evaluate the effect of heparin, pre-filter saline dilution and the impact of total plasma volume exchanged (< 3 L vs. ≥3 L) on the rate of filter failure. Primary outcome was the overall rate of filter failure. Secondary outcomes included factors that may have indirectly influenced the rate of filter failure, including hematocrit, platelet count, replacement fluid (Fresh Frozen Plasma vs. albumin), and access type. RESULTS We found that treatments that received both pre-filter heparin and saline had a statistically significant decrease in filter failure rate as compared to those that received neither (28.6% vs. 5.3%, P = .001), and compared to the treatments that received pre-filter heparin alone (14.2% vs. 5.3%, P = .015). In treatments that received both pre-filter heparin and saline predilution, we noted a significantly higher filter failure rate when the plasma volume exchanged was ≥3 L as compared to those that had <3 L exchanged (12.2% vs. 0.9%, P = .001). CONCLUSIONS Rate of filter failure in mTPE can be reduced by implementing several therapeutic interventions including pre-filter heparin and pre-filter saline solution. These interventions were not associated with any clinically significant adverse events. Despite the above-mentioned interventions, large plasma volume exchanges of ≥3 L can negatively impact filter life.
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Affiliation(s)
- Ibrahim Elali
- UConn Health, Department of Medicine, Division of Nephrology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Deep Phachu
- UConn Health, Department of Medicine, Division of Nephrology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Nick Coombs
- UConn Health, Department of Medicine, Division of Nephrology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Mamta Shah
- UConn Health, Department of Medicine, Division of Nephrology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jordan Dean
- Division of Nephrology/Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Lalarukh Haider
- UConn Health, Department of Medicine, Division of Nephrology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Yanlin Wang
- Division of Nephrology/Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Andre A Kaplan
- Division of Nephrology/Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Durak C, Sahin EG, Yusuf Can Y, Varol F, Cam H. Why has plasma exchange failed in TRACK syndrome? Lessons from a new variant of the atypical hemolytic uremic syndrome. J Clin Apher 2023; 38:647-650. [PMID: 37338178 DOI: 10.1002/jca.22070] [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: 04/11/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a rare and life-threatening form of thrombotic microangiopathy, associated with high mortality and morbidity. Most cases present with hemolytic anemia, thrombocytopenia, and renal insufficiency. However, it can have unusual multiple end-organ injuries including extrarenal organ and system involvements such as neurologic, cardiac, gastrointestinal, and respiratory systems. We describe a 4-year-old girl who developed aHUS due to the TSEN2 mutation and had cardiac involvement. She did not benefit from plasma exchange, as stated in previous cases. It should be kept in mind that therapeutic plasma exchange may not be beneficial in some cases of aHUS, especially due to genetic mutations.
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Affiliation(s)
- Cansu Durak
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Ebru Guney Sahin
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Yasar Yusuf Can
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Fatih Varol
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Halit Cam
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Science, Istanbul, Turkey
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Magri SJ, Ugarte-Gil MF, Brance ML, Flores-Suárez LF, Fernández-Ávila DG, Scolnik M, Sato EI, de Souza AWS, Saldarriaga-Rivera LM, Babini AM, Zamora NV, Felquer MLA, Vergara F, Carlevaris L, Scarafia S, Guppy ERS, Unizony S. Role of plasma exchange in ANCA-associated vasculitis - Authors' reply. Lancet Rheumatol 2023; 5:e580-e581. [PMID: 38251482 DOI: 10.1016/s2665-9913(23)00235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 01/23/2024]
Affiliation(s)
| | | | | | - Luis Felipe Flores-Suárez
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Marina Scolnik
- Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Emilia Inoue Sato
- Medicine Department, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Natalia V Zamora
- Rheumatology Unit, Hospital San Jose, Pergamino, Buenos Aires, Argentina
| | | | | | | | - Santiago Scarafia
- Rheumatology Unit, Hospital Municipal San Cayetano, Buenos Aires, Argentina
| | | | - Sebastian Unizony
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Davies E, Khan S, Mo YD, Jacquot C, Dham N, Sinha P, Webb J. Modifications to therapeutic plasma exchange to achieve rapid exchange on cardiopulmonary bypass prior to pediatric cardiac transplant. J Clin Apher 2023; 38:514-521. [PMID: 37042579 PMCID: PMC10567986 DOI: 10.1002/jca.22053] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/08/2023] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Cardiac transplants increasingly occur following placement of ventricular assist devices (VADs). A strong association exists between human leukocyte antigen (HLA) sensitization and VAD placement; however, desensitization protocols that utilize therapeutic plasma exchange (TPE) are fraught with technical challenges and are at increased risk of adverse events. In response to increased VAD utilization in our pre-transplant population, we developed a new institutional standard for TPE in the operating room. METHODS Through a multidisciplinary effort, we developed an institutional protocol for intraoperative TPE immediately prior to cardiac transplantation after cannulation onto cardiopulmonary bypass (CPB). All procedures used the standard TPE protocol on the Terumo Optia (Terumo BCT, Lakewood, CO, USA), but incorporated multiple modifications to limit patients' bypass times, and to coordinate with the surgical teams. These modifications included deliberate misidentification of replacement fluid and maximization of the citrate infusion rate. RESULTS These adjustments allowed the machine to run at maximal inlet speeds, minimizing duration of TPE. To date, 11 patients have been treated with this protocol. All survived their cardiac transplantation operation. Hypocalcemia and hypotension were noted; however, none of these adverse events appeared to have clinical impact. Technical complications included unexpected fibrin deposition in the TPE circuit and air in the inlet line due to surgical manipulation of the CPB cannula. No thromboembolic complications occurred in any patient. CONCLUSION We feel that this procedure can be rapidly and safely performed in HLA sensitized pediatric patients on CPB to limit the risk of antibody mediated rejection of their heart transplant.
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Affiliation(s)
- Emily Davies
- Division of Pediatric Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Sairah Khan
- Division of Cardiology and Cardiac Transplant, Children's National Hospital, Children's National Heart Institute, Washington, District of Columbia, USA
| | - Yunchuan D Mo
- Division of Laboratory and Transfusion Medicine, Children's National Hospital, Washington, District of Columbia, USA
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, District of Columbia, USA
| | - Cyril Jacquot
- Division of Laboratory and Transfusion Medicine, Children's National Hospital, Washington, District of Columbia, USA
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, District of Columbia, USA
| | - Niti Dham
- Division of Cardiology and Cardiac Transplant, Children's National Hospital, Children's National Heart Institute, Washington, District of Columbia, USA
| | - Pranava Sinha
- Division of Pediatric Cardiac Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jennifer Webb
- Division of Laboratory and Transfusion Medicine, Children's National Hospital, Washington, District of Columbia, USA
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, District of Columbia, USA
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Traub R, Chaudhry V. Neuroprognostication: Guillain-Barré Syndrome. Semin Neurol 2023; 43:791-798. [PMID: 37788681 DOI: 10.1055/s-0043-1775750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Guillain-Barré syndrome is an immune-mediated disease of the peripheral nerves characterized by rapidly progressing symmetric weakness, areflexia, and albuminocytological dissociation. Most patients reach their nadir within 2 weeks. Disease severity can be mild to severe, with 20% of patients requiring mechanical ventilation. Intravenous immunoglobulin and plasma exchange are equally effective treatments. Monitoring strength, respiratory function, blood pressure, and heart rate, as well as pain management and rehabilitative therapy are important aspects of management. About 20% of patients require assistance to walk at 6 months. Older age, preceding diarrhea, and lower Medical Research Council (MRC) sum scores predict poor outcome. Death from cardiovascular and respiratory complications can occur in the acute or recovery phases of the illness in 3 to 7% of the patients. Risk factors for mortality include advanced age and disease severity at onset. Neuropathic pain, weakness, and fatigue can be residual symptoms; risk factors for these include axonal loss, sensory involvement, and severity of illness.
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Affiliation(s)
- Rebecca Traub
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | - Vinay Chaudhry
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
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Pimentel-Quiroz VR, Alarcón GS. Role of plasma exchange in ANCA-associated vasculitis. Lancet Rheumatol 2023; 5:e579-e580. [PMID: 38251481 DOI: 10.1016/s2665-9913(23)00234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Victor R Pimentel-Quiroz
- Department of Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Peru; Universidad Científica del Sur, Lima 42, Peru.
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, Max Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Yu F, Wang L, Yuan H, Gao Z, He L, Hu F. Wasp venom-induced acute kidney injury: current progress and prospects. Ren Fail 2023; 45:2259230. [PMID: 38376456 PMCID: PMC10512847 DOI: 10.1080/0886022x.2023.2259230] [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: 07/04/2023] [Accepted: 09/11/2023] [Indexed: 02/21/2024] Open
Abstract
Wasp venom can trigger local and systemic reactions, with the kidneys being commonly affected, potentially causing acute kidney injury (AKI). Despite of the recent advances, our knowledge on the underlying mechanisms of toxicity and targeted therapies remain poor. AKI can result from direct nephrotoxic effects of the wasp venom or secondary rhabdomyolysis and intravascular hemolysis, which will release myoglobin and free hemoglobin. Inflammatory responses play a central role in these pathological mechanisms. Noteworthily, the successful establishment of a suitable experimental model can assist in basic research and clinical advancements related to wasp venom-induced AKI. The combination of therapeutic plasma exchange and continuous renal replacement therapy appears to be the preferred treatment for wasp venom-induced AKI. In addition, studies on cilastatin and varespladib for wasp venom-induced AKI treatment have shown their potential as therapeutic agents. This review summarizes the available evidence on the mechanisms and treatment of wasp venom-induced AKI, with a particular focus on the role of inflammatory responses and potential targets for therapeutic drugs, and, therefore, aiming to support the development of clinical treatment against wasp venom-induced AKI.
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Affiliation(s)
- Fanglin Yu
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Ling Wang
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Hai Yuan
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Zhao Gao
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Li He
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Fengqi Hu
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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Yamahara N, Yoshikura N, Takekoshi A, Kimura A, Harada N, Mori Y, Shimohata T. Anti-N-methyl-d-aspartate receptor encephalitis preceded by meningitis lasting up to 60 days. J Neuroimmunol 2023; 382:578173. [PMID: 37572435 DOI: 10.1016/j.jneuroim.2023.578173] [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: 06/04/2023] [Revised: 07/27/2023] [Accepted: 08/06/2023] [Indexed: 08/14/2023]
Abstract
Long-lasting meningitis complicated by N-methyl-d-aspartate receptor (NMDAR) encephalitis has not been discussed widely in the literature. Herein, we present two cases of anti-NMDAR encephalitis preceded by meningitis. The patients had 60- and 22-day periods of preceding meningitis, which improved with intravenous methylprednisolone and plasmapheresis. No tumors were detected in either of the patients. Although meningitis preceding anti-NMDAR encephalitis is not rare, our patients, especially those who had it for a duration of 60 days, had longer durations of meningitis. This manuscript foregrounds that anti-NMDAR encephalitis might be included in the differential diagnosis of long-lasting meningitis.
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Affiliation(s)
- Naoki Yamahara
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu Prefecture 501-1194, Japan
| | - Nobuaki Yoshikura
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu Prefecture 501-1194, Japan
| | - Akira Takekoshi
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu Prefecture 501-1194, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu Prefecture 501-1194, Japan
| | - Naoko Harada
- Department of Neurology, Gifu Municipal Hospital, 7-1, Kashima-cho, Gifu City, Gifu Prefecture 500-8513, Japan
| | - Yu Mori
- Department of Neurology, Gifu Prefectural Tajimi Hospital, 5-161, Maebata-cho, Tajimi City, Gifu Prefecture 507-8522, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu Prefecture 501-1194, Japan.
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García Izquierdo B, Contreras Angulo M, Armengod Grao L, García García Á, Iglesias P. Role of plasmapheresis in the management of severe amiodarone-induced hyperthyroidism refractory to conventional medical treatment. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:68-71. [PMID: 37598006 DOI: 10.1016/j.endien.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/08/2022] [Indexed: 08/21/2023]
Affiliation(s)
- Belén García Izquierdo
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Macarena Contreras Angulo
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Laura Armengod Grao
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Álvaro García García
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Zubair AS, Rethana M, Ma A, McAlpine LS, Abulaban A, Munro BS, Patwa HS, Nowak RJ, Roy B. Plasmapheresis Versus Intravenous Immunoglobulin in Patients With Autoimmune Neuromuscular and Neuro-immunological Conditions. J Clin Neuromuscul Dis 2023; 25:11-17. [PMID: 37611265 DOI: 10.1097/cnd.0000000000000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Plasmapheresis (PLEX) and intravenous immunoglobulin (IVIg) are commonly used to treat autoimmune neuromuscular disorders, including myasthenia gravis, acute inflammatory demyelinating polyradiculoneuropathy, chronic inflammatory demyelinating polyradiculoneuropathy, and other autoimmune neurological disorders. The side effect profiles of these therapies vary, and concern has been raised regarding the safety of PLEX in the elderly population. In this study, we have examined the pattern of PLEX and IVIg use for autoimmune neurological disorders at a single facility and in a national database, focusing on the complications in elderly patients. METHODS We performed a retrospective chart review of adult patients at our institution receiving PLEX or IVIg for any autoimmune neuromuscular or neuro-immunological disease. Next, we analyzed the National Inpatient Sample database to confirm the trend in IVIg and PLEX use from 2012 to 2018 for a set of neuromuscular and neuro-immunological primary diagnoses. RESULTS IVIg was overall favored over PLEX. The adverse effects were similar among elderly patients (age ≥65 years) compared with younger patients (<65 years) in our institution, even after adequate matching of patients based on age, sex, and medical history. We examined the National Inpatient Sample dataset and noted increasingly higher frequency of IVIg use, consistent with the findings from our institution or facility. CONCLUSIONS Both PLEX and IVIg are safe therapeutic choices in adult patients with autoimmune neuromuscular disorders and other neuro-immunological diseases and can be safely administered in the appropriate clinical setting.
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Affiliation(s)
- Adeel S Zubair
- Department of Neurology, School of Medicine, Yale University, New Haven, CT
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Moranne O, Cristol JP. With Single Plasma Exchange, a Better Understanding of the Potential Clinical Effects of Albumin Replacement Is Required. Blood Purif 2023; 52:844-846. [PMID: 37611556 DOI: 10.1159/000531186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/18/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Olivier Moranne
- Service NDA, Centre Hospitalier Université de Nîmes, Nîmes, France
- IDESP, INSERM, Montpellier, France
| | - Jean-Paul Cristol
- Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
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46
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Yu N, Liu X, Liu C, Tian W, Li W, Liu Y. Rare acquired factor V inhibitors combined with positive lupus anticoagulant that successfully treated by plasmapheresis and prednisone acetate: a typical case report. Ann Hematol 2023; 102:2271-2273. [PMID: 37148311 DOI: 10.1007/s00277-023-05244-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/21/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Ning Yu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Xiaojun Liu
- Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Chao Liu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Wenbin Tian
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Weihao Li
- Department of Laboratory Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Ya Liu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei, 050000, People's Republic of China.
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Sachan D, Rajakumar A, Krishna G D, Rajalingam R, Rela M. Living Donor Liver transplantation in an alloimmunised patient: Immunological challenges and Management in Indian Settings. Transpl Immunol 2023; 79:101854. [PMID: 37210014 DOI: 10.1016/j.trim.2023.101854] [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: 11/01/2022] [Revised: 03/30/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Liver transplantation (LT) is often associated with hematological abnormalities with immune or non-immune etiologies and require timely diagnosis and interventions. We report a case of a patient suffering from non-alcoholic steato-hepatitis (NASH) related end stage liver disease (ESLD) with multiple red cell antibodies who underwent LT surgery. In postoperative phase, she developed immune hemolysis as well as acute antibody mediated rejection (AMR) which was managed with therapeutic plasma exchange and IVIG. The case highlights the need to develop an algorithm for red cell and HLA antibody screening in high-risk patients for timely detection and management.
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Affiliation(s)
- Deepti Sachan
- Department of Transfusion Medicine, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamilnadu, India
| | - Akila Rajakumar
- Liver Anesthesia & Intensive care, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamilnadu, India
| | - Deepthi Krishna G
- Department of Transfusion Medicine, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamilnadu, India.
| | - Rajesh Rajalingam
- HPB Surgery & Liver Transplantation, Institute of Liver Disease and Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamilnadu, India
| | - Mohamed Rela
- HPB Surgery & Liver Transplantation, Institute of Liver Disease and Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamilnadu, India
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Magri SJ, Ugarte-Gil MF, Brance ML, Flores-Suárez LF, Fernández-Ávila DG, Scolnik M, Sato EI, de Souza AWS, Saldarriaga-Rivera LM, Babini AM, Zamora NV, Felquer MLA, Vergara F, Carlevaris L, Scarafia S, Guppy ERS, Unizony S. Pan American League of Associations for Rheumatology Guidelines for the treatment of ANCA-associated vasculitis. Lancet Rheumatol 2023; 5:e483-e494. [PMID: 38251580 DOI: 10.1016/s2665-9913(23)00128-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 01/23/2024]
Abstract
Considerable variability exists in the way health-care providers treat patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in Latin America. The most frequently used treatments for ANCA-associated vasculitis are cyclophosphamide and prolonged glucocorticoid tapers; however, randomised controlled trials conducted over the past 30 years have led to the development of several evidence-based treatment alternatives for these patients. Latin America faces socioeconomic challenges that affect access to care, and the use of certain costly medications with proven efficacy ANCA-associated vasculitis is often restricted. For these reasons, the Pan American League of Associations for Rheumatology developed the first ANCA-associated vasculitis treatment guidelines tailored for Latin America. A panel of local vasculitis experts generated clinically meaningful questions related to the treatment of ANCA-associated vasculitis using the Population, Intervention, Comparator, and Outcome (PICO) format. Following the Grading of Recommendations Assessment, Development, and Evaluation methodology, a team of methodologists conducted a systematic literature review. The panel of vasculitis experts voted on each PICO question and made recommendations, which required at least 70% agreement among the voting members. 21 recommendations and two expert opinion statements for the treatment of ANCA-associated vasculitis were developed, considering the current evidence and the socioeconomic characteristics of the region. These recommendations include guidance for the use of glucocorticoids, non-glucocorticoid immunosuppressants, and plasma exchange.
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Affiliation(s)
- Sebastián Juan Magri
- Rheumatology Unit, Hospital Italiano de La Plata, La Plata, Buenos Aires, Argentina
| | | | | | - Luis Felipe Flores-Suárez
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Marina Scolnik
- Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Emilia Inoue Sato
- Medicine Department, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Santiago Scarafia
- Rheumatology Unit, Hospital Municipal San Cayetano, Virreyes, Argentina
| | | | - Sebastian Unizony
- Vasculitis and Glomerulonephritis Center, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Krečak I, Gverić-Krečak V. REFRACTORY GUILLAIN-BARRÉ SYNDROME IN A PATIENT WITH ASYMPTOMATIC MULTIPLE MYELOMA SUCCESSFULLY TREATED WITH LOW-DOSE RITUXIMAB. Acta Clin Croat 2023; 62:382-386. [PMID: 38549594 PMCID: PMC10969645 DOI: 10.20471/acc.2023.62.02.19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 09/03/2020] [Indexed: 04/02/2024] Open
Abstract
Despite being extremely rare, Guillain-Barré syndrome (GBS) has been recognized as a neurological complication of multiple myeloma, with variable responses to plasmapheresis (PEX), intravenous immunoglobulins (IVIG), and anti-myeloma therapies. In this paper, we report a case of a female patient with asymptomatic multiple myeloma (aMM) who initially presented as PEX- and IVIG-refractory GBS. After failure of PEX, IVIG, and anti-myeloma therapy (bortezomib, melphalan, and prednisone), the patient was eventually successfully treated with low-dose rituximab (100 mg/m2 per week in four doses). To the best of our knowledge, this is the first case to report successful treatment of refractory GBS potentially associated to aMM with low-dose rituximab. Additional studies are needed to elucidate the pathophysiological processes and the interplay between the dysregulated immune response, monoclonal immunoglobulin (MG), and neural tissue damage in GBS patients. Also, the potential role of rituximab in the treatment of MG-associated GBS warrants further exploration.
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Affiliation(s)
- Ivan Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Velka Gverić-Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia
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50
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Fox T, Hunt BJ, Ariens RA, Towers GJ, Lever R, Garner P, Kuehn R. Plasmapheresis to remove amyloid fibrin(ogen) particles for treating the post-COVID-19 condition. Cochrane Database Syst Rev 2023; 7:CD015775. [PMID: 37491597 PMCID: PMC10368521 DOI: 10.1002/14651858.cd015775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND The post-COVID-19 condition (PCC) consists of a wide array of symptoms including fatigue and impaired daily living. People seek a wide variety of approaches to help them recover. A new belief, arising from a few laboratory studies, is that 'microclots' cause the symptoms of PCC. This belief has been extended outside these studies, suggesting that to recover people need plasmapheresis (an expensive process where blood is filtered outside the body). We appraised the laboratory studies, and it was clear that the term 'microclots' is incorrect to describe the phenomenon being described. The particles are amyloid and include fibrin(ogen); amyloid is not a part of a thrombus which is a mix of fibrin mesh and platelets. Initial acute COVID-19 infection is associated with clotting abnormalities; this review concerns amyloid fibrin(ogen) particles in PCC only. We have reported here our appraisal of laboratory studies investigating the presence of amyloid fibrin(ogen) particles in PCC, and of evidence that plasmapheresis may be an effective therapy to remove amyloid fibrin(ogen) particles for treating PCC. OBJECTIVES Laboratory studies review To summarize and appraise the research reports on amyloid fibrin(ogen) particles related to PCC. Randomized controlled trials review To assess the evidence of the safety and efficacy of plasmapheresis to remove amyloid fibrin(ogen) particles in individuals with PCC from randomized controlled trials. SEARCH METHODS Laboratory studies review We searched for all relevant laboratory studies up to 27 October 2022 using a comprehensive search strategy which included the search terms 'COVID', 'amyloid', 'fibrin', 'fibrinogen'. Randomized controlled trials review We searched the following databases on 21 October 2022: Cochrane COVID-19 Study Register; MEDLINE (Ovid); Embase (Ovid); and BIOSIS Previews (Web of Science). We also searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov for trials in progress. SELECTION CRITERIA Laboratory studies review Laboratory studies that investigate the presence of amyloid fibrin(ogen) particles in plasma samples from patients with PCC were eligible. This included studies with or without controls. Randomized controlled trials review Studies were eligible if they were of randomized controlled design and investigated the effectiveness or safety of plasmapheresis for removing amyloid fibrin(ogen) particles for treating PCC. DATA COLLECTION AND ANALYSIS Two review authors applied study inclusion criteria to identify eligible studies and extracted data. Laboratory studies review We assessed the risk of bias of included studies using pre-developed methods for laboratory studies. We planned to perform synthesis without meta-analysis (SWiM) as described in our protocol. Randomized controlled trials review We planned that if we identified any eligible studies, we would assess risk of bias and report results with 95% confidence intervals. The primary outcome was recovery, measured using the Post-COVID-19 Functional Status Scale (absence of symptoms related to the illness, ability to do usual daily activities, and a return to a previous state of health and mind). MAIN RESULTS Laboratory studies review We identified five laboratory studies. Amyloid fibrin(ogen) particles were identified in participants across all studies, including those with PCC, healthy individuals, and those with diabetes. The results of three studies were based on visual images of amyloid fibrin(ogen) particles, which did not quantify the amount or size of the particles identified. Formal risk of bias assessment showed concerns in how the studies were conducted and reported. This means the results were insufficient to support the belief that amyloid fibrin(ogen) particles are associated with PCC, or to determine whether there is a difference in the amount or size of amyloid fibrin(ogen) particles in the plasma of people with PCC compared to healthy controls. Randomized controlled trials review We identified no trials meeting our inclusion criteria. AUTHORS' CONCLUSIONS In the absence of reliable research showing that amyloid fibrin(ogen) particles contribute to the pathophysiology of PCC, there is no rationale for plasmapheresis to remove amyloid fibrin(ogen) particles in PCC. Plasmapheresis for this indication should not be used outside the context of a well-conducted randomized controlled trial.
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Affiliation(s)
- Tilly Fox
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Robert As Ariens
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Greg J Towers
- Division of Infection and Immunity, University College London, London, UK
| | | | - Paul Garner
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Extraordinary Professor in Epidemiology and Biostatistics, Stellenbosch University, Stellenbosch, South Africa
| | - Rebecca Kuehn
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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