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PubMed1993

Plasmapheresis for the preparation of HIV free cryoprecipitate.

Single donor cryoprecipitate was prepared by blood cell separator for treatment of hemophilia A and von Willebrand patients to reduce a risk of transfusion associated HIV infection. A total of 7 plasmapheresis (range 1-1.5 plasma volume) was performed in 4 donors. Then fresh frozen plasma (FFP) was processed to cryoprecipitate and cryoprecipitate removed plasma (CRP). Donors were replaced with 0.9% normal saline solution (NSS) and 5% albumin for the first donation or their own CRP and 5% albumin for the second and third donation. After plasmapheresis total protein, albumin, IgG, IgA and IgM were below normal level in 71.43% (5/7), 14.3% (1/7), 28.57% (2/7), 14.3% (1/7) and 28.57% (2/7), respectively. All of these parameters returned to normal level within 3 days. Factor VIII:C was decreased after plasmapheresis in all donors and the low level of F VIII:C returned to normal within 24 hours. The donor was not exposed to any harmful effect. Donor reactions observed were mild. One donor was chilled due to unwarmed replacement solution. When this donor donated for the second time and was replaced with prewarmed replacement solution, no reaction was observed. We conclude that a preparation of single donor cryoprecipitate by plasmapheresis is safe and can reduce a risk of transfusion associated HIV infection. The donors are not at risk as the result of changes in the measured plasma protein and factor VIII:C level following plasmapheresis.

Adult↗
PubMed1994

Elimination of an artificial immune complex by plasmapheresis in rabbits.

The behaviour of an artificial immune complex was investigated in 15 rabbits. The immune complex was labelled with iodine-125 (125I). The advantage was that the immune complex could not be metabolized without being eliminated by the kidney. This artificial immune complex was injected in different dosages (0.8 micrograms-40 micrograms/rabbit) on 2 consecutive days. One group (n = 9) was treated with plasmapheresis: the other (n = 6) was a control group that did not undergo plasmapheresis. A miniaturized plasmapheresis system eliminated the immune complex very effectively. The increasing concentration of the immune complex in the blood before the next plasmapheresis treatment was probably an expression of mobilization of the immune complex from different organs. The animals of the plasmapheresis group were in better condition than the control group.

Animals↗
PubMedDate not supplied

[Synthesis of cell membrane "signal" ATP in human erythrocyte membranes stimulated by insulin as criteria of the efficacy of therapeutic plasmapheresis].

Insulin-stimulated synthesis of plasma membraneous "signal" ATP (psATP) from ADP and P(i) in oxidation coupled with that of NADH was detected in a preparation of plasma membranes from human erythrocytes; psATP was formed at concentrations of 10(-8)-10(-9) M. Effect of medicinal plasmapheresis on ability of erythrocyte membranes to produce psATP was studied. The rate of psATP biosynthesis was estimated in healthy volunteers and in patients with various diseases: nonspecific aortic arteritis, bronchial asthma, peritonitis, myasthenia before and after plasmapheresis. Distinct values of basal content of ATP (without insulin) and insulin-stimulated biosynthesis of ATP were detected in volunteers. Elevation of ATP biosynthesis, in response to insulin effect, was equal to 8.029 +/- 0.163 nmol/mg of membrane protein per min. Estimation of the psATP biosynthesis rate in patients with various pathological states enabled to detect markedly that psATP content tends to increase after plasmapheresis. Absolute values of psATP content were distinctly lower in these patients than those in healthy volunteers, while after plasmapheresis these parameters approached the normal level. Estimation of the insulin-stimulated synthesis of psATP may serve as a valid criterion of plasmapheresis efficiency.

Adenosine Diphosphate↗
PubMed1977

[Plasmapheresis in the elimination of toxic substances with marked plasma protein-binding properties (author's transl)].

Plasmapheresis is a method used to eliminate toxic substances with high plasma protein-binding properties. Poisoning by strongly plasma protein-binding substances cannot be treated by haemodialysis or peritoneal dialysis. Hence, an attempt was made to hasten the elimination of phenylbutazone, a suitable model substance (plasma protein binding affinity 98%), by plasmapheresis. Some of the experiments were performed with oxygen under high pressure (OHP). A singly plasmapheresis of the total blood volume or triple plasmapheresis of half of the blood volume, performed at 20 min intervals accelerated the elimination of phenylbutazone significantly and all animals survived. A single plasmapheresis of the threefold blood volume had the greatest effect in lowering the concentration of phenylbutazone in the blood, but only one of three animals survived. OHP had no influence on the half-life of phenylbutazone and did not increase the survival rate.

Animals↗
PubMed1996

[Double filtration and immunoadsorption plasmapheresis in Guillain-Barré syndrome].

We studied the effect of double filtration and immunoadsorption plasmapheresis in Guillain-Barré syndrome retrospectively in 70 patients. Thirty three patients had plasmapheresis, of whom 23 had double filtration and 10 immunoadsorption. The rest of 37 patients consisted of a control group. Clinical disability was evaluated using the functional grading scale by Hughes. In patients having a maximum disability of grade 4 and 5, the double filtration plasmapheresis group showed statistically significant improvement at 3 months after the treatment. There was no significant difference in prognoses between the immunoadsorption plasmapheresis and control groups. In mildly-illed patients having grade 2 and 3, the prognoses were not different between the three groups. In Guillain-Barré syndrome, double filtration plasmapheresis, as well as well-established plasma exchange, had benefit for severely-illed patients.

Adult↗
PubMed1996

Management of plasmapheresis in Spain.

In Spain, there is no specific regulation for plasmapheresis. At the present time, there are two decrees issued by the central government that regulate blood donation and blood banks operation. The seventeen autonomous regions have independent powers including health care. Regulation at this level is possible, but not currently in place. In 1993, 1,266,704 units of whole blood were collected in Spain. This whole blood donation was enough to cover the need for red blood cells, but not to cover the needs of plasma derivatives. It has been calculated that in order to fulfil the requirements of factor and albumin about 400,0001 of plasma are needed. In 1994, there were over 10 centres in Spain where there were ongoing plasmapheresis programmes. Other centres are preparing plasmapheresis programmes scheduled to start in 1995. Spain needs an extra amount of plasma in between 250,000 and 300,0001 to cover the needs of plasma derivatives. It is concluded that it is probably best to meet plasma derivatives requirements with plasma obtained from a plasmapheresis programme. This approach has mainly two advantages: -the plasma generated is of the best quality available in order to produce coagulation factor concentrates; -it does not produce a "by-product" that in principle is not needed and would be unethical to throw away. We believe that to achieve self-sufficiency in plasma donation throughout a plasmapheresis programme requires flexibility in the current law and a substantial investment in promotion programmes.

Humans↗
PubMedDate not supplied

[Plasmapheresis and intraoperative hemodilution. Comparison of 2 methods].

Fifty patients undergoing cardiac surgery suffering from coronary artery disease and valvular incompetence or stenosis, were randomly divided into two groups of 25 patients to compare the plasmapheresis effects on bleeding, transfusion requirements, economicity and paramedical staff compliance versus intraoperative autotransfusion. Standardized anesthetics, perfusion, and surgical techniques were used. We used plasmapheresis with cell saver and haemodilution with bypass ultrafiltration. Platelet counts, haemoglobin concentration, haematocrit, fibrinogen, bleeding times were evaluated at fixed times for the patients on plasmapheresis and after surgical homologous transfusion. It was that these parameters did not change significantly in the two groups. Intraoperative plasmapheresis is more expensive and less accepted into an operating room than autotransfusion. Intraoperative plasmapheresis will be a good alternative to haemodilution for selected patients.

Adult↗
PubMed1992

Platelet-leukocyte plasmapheresis attenuates the deleterious effects of cardiopulmonary bypass.

A method of harvesting a high yield of concentrated platelet- and leukocyte-rich plasma was developed with the goal of attenuating some of the deleterious effects of cardiopulmonary bypass. The study involved 32 patients who underwent coronary artery bypass grafting with plasmapheresis before cardiopulmonary bypass and a control group of 32 patients who did not have plasmapheresis. A volume of 857 +/- 359 mL of platelet- and leukocyte-rich plasma was concentrated from 4.6 +/- 1.5 L of blood, and red cells and plasma were returned to the patient. The platelet- and leukocyte-rich plasma contained yields of 3.5 +/- 1.4 x 10(11) platelets and 3.4 +/- 1.9 x 10(9) leukocytes. There were no differences in age, sex, duration of cardiopulmonary bypass, and major risk factors between groups. However, total mediastinal chest tube drainage was 788 +/- 542 mL in the controls and 425 +/- 207 mL in the plasmapheresis group (p less than 0.01). Homologous units transfused were 3.9 +/- 2 in controls and 1.6 +/- 2 in the plasmapheresis group (p less than 0.01). Arterial oxygen tension on extubation was 94 +/- 32 mm Hg in controls and 119 +/- 25 mm Hg in the plasmapheresis group (p less than 0.01). This technique of platelet and leukocyte protection results in reduced postoperative bleeding, a decreased need for homologous blood products, and improved pulmonary function.

Aged↗
PubMed1981

Plasmapheresis in idiopathic inflammatory myopathy. Experience with 35 patients.

Thirty-five patients with idiopathic inflammatory myopathy (IM) were treated with plasmapheresis. They had had inadequate clinical responses to prednisone or to prednisone and cytotoxic immunosuppressive drug therapy. All patients received cyclophosphamide or chlorambucil in addition to plasmapheresis; 33 also received prednisone. Strength increased in 32 patients during combined therapy; patients with the most active disease experienced substantial improvement that approached clinical remission in some cases. Clinical improvement was documented by muscle testing, forced vital capacity, electromyography, muscle biopsy, and serum creatine phosphokinase activity. The major side effect of treatment was herpes zoster. Primary biliary cirrhosis improved in one patient. Although the effects of plasmapheresis cannot be dissociated from those of the concomitantly administered immunosuppressive drugs, the improvement seen in patients with active disease suggests that plasmapheresis with immunosuppressive drug therapy may find a place in their treatment and implicates circulating factors in the pathogenesis of IM.

Adolescent↗
PubMed1990

Rapid improvement of thrombotic thrombocytopenic purpura with vincristine and plasmapheresis.

Many patients with thrombotic thrombocytopenic purpura (TTP) fail to respond to daily plasmapheresis and the results of alternative treatments have been inconsistent. Vincristine was given weekly with continued plasmapheresis to eight patients who were refractory to plasmapheresis, antiplatelet agents, and/or corticosteroids. A rapid response to the vincristine occurred in all eight patients in 5 days with a marked rise in the platelet count and resolution of symptoms. The results in these patients suggest that early initiation of vincristine therapy in conjunction with plasmapheresis is useful in TTP.

Adult↗
PubMed1990

The role of plasmapheresis in childhood Guillain-Barré syndrome.

Plasmapheresis has been advocated in the treatment of childhood Guillain-Barré syndrome under the assumption that the results of adult series can be extrapolated to children. To test this assumption, we retrospectively evaluated the medical charts of all children who were admitted to The Children's Hospital of Philadelphia between January 1984 and March 1989, with the diagnosis of Guillain-Barré syndrome. Of the 30 patients identified, 7 were excluded because they had mild disease. Of the remaining 23, 9 underwent plasmapheresis and 14 served as historic control subjects. The two groups were similar with respect to age, presenting symptoms, findings on initial physical examination, and antecedent illnesses at the time of diagnosis. The mean time to recover to Grade 2 (independent ambulation) was significantly shorter in the plasmapheresis-treated group, 24.0 +/- 25.4 days, compared to 60.2 +/- 43.6 days in control subjects (mean +/- 1 SD). Our results indicate that plasmapheresis diminishes morbidity in childhood Guillain-Barré syndrome by shortening the interval until recovery of independent ambulation.

Adolescent↗
PubMed2002

Management of membranoproliferative glomerulonephritis type II with plasmapheresis.

Membranoproliferative glomerulonephritis type II (MPGN II) is a rare kidney disease identified microscopically by electron-dense deposits surrounded by complement component C3 in glomerular basement membranes. MPGN II usually leads to renal failure, and patients with MPGN II experience a high rate of recurrence following renal transplantation. No treatment modalities have been proven successful if recurrence does occur. The sera of most patients with MPGN II contain complement C3 nephritic factor (C3NF), an IgG autoantibody directed against C3 convertase (C3bBb) that results in constitutive breakdown of C3. C3NF may be important in the pathogenesis of the disease. Since C3NF is IgG, we predicted that C3NF could be removed from the serum through plasmapheresis. We describe the use of long-term plasmapheresis to maintain good renal function in a 15-year-old girl with rapidly progressive recurrent MPGN II. After 73 plasmapheresis procedures over 63 weeks, her serum creatinine remained stable, and her creatinine clearance trended upward. Serial biopsies of the transplanted kidney demonstrated persistent MPGN II but no development of tubular atrophy. During the course of therapy, serum C3NF activity decreased; furthermore, C3NF activity was detected in the removed plasma. We have shown that plasmapheresis is a safe and effective method for delaying the onset of chronic renal failure in recurrent MPGN II. The efficacy may be due to the removal of serum C3NF.

Adolescent↗
PubMed2004

Plasmapheresis in the treatment of hyperthyroidism associated with agranulocytosis: A case report.

Plasmapheresis, also known as therapeutic plasma exchange, is used in the treatment of several disorders. Temporary improvement after plasmapheresis in cases with thyrotoxicosis has been reported. A 55-year-old woman presented with agranulocytosis induced by propylthiouracil and clinical signs of heart failure. Three sessions of plasmapheresis were performed. We observed an improvement of thyroid hormone levels and clinical findings as well. Plasmapheresis can be an option when drug treatment of thyrotoxicosis fails.

Agranulocytosis↗
PubMed1987

Effects of plasmapheresis on peripheral blood mononuclear cell populations from patients with macroglobulinemia.

Effects of plasmapheresis on peripheral blood T-cell, B-cell, monocyte, and natural-killer-cell populations were studied in ten macroglobulinemia patients with hyperviscosity syndrome. Following plasmapheresis, there was a transient decrease in the number of T4+ helper cells and a longer-lasting decrease in the number of Leu-7+ natural killer cells and Mo2+ monocytes. In addition, there was a greater than 50% decrease in the in vitro ingestion capacity of monocytes. Although no significant changes in the numbers of IgM+, B1+, B4+, or PCA+ B cells (P greater than .05) were detected, there was a highly significant (P less than .01) increase in I2 antigen density on the surface of IgM+ B cells and in the bromodeoxyuridine uptake by these cells 7-9 days after plasmapheresis. These findings suggest that following plasmapheresis, IgM+ B cells are activated. Using flow cytometry to determine when maximum IgM+ B cell activation occurs by measuring I2 antigen density on the cell surface may be useful in determining the postplasmapheresis timing of chemotherapy in macroglobulinemia patients with hyperviscosity syndrome who require more aggressive treatment.

B-Lymphocytes↗
PubMedDate not supplied

Plasmapheresis therapy in myasthenia gravis.

Plasmapheresis in the treatment of myasthenia gravis has led to disparate results when applied by different investigators because of considerable differences in the volume, number, and tempo of plasmaphereses and in the type and amount of concomitant immunosuppressive drug therapy. Used as short-term crisis intervention, plasmapheresis produces temporary clinical improvement and reduction in titer of antibody to acetylcholine receptor, even without accompanying drug therapy. When applied as long-term primary therapy under optimal conditions, plasmapheresis is capable of generating stable improvement in most patients. This response appears to result from a synergistic action with immunosuppressive drugs, since it is characterized by a sustained reduction in titer of antibody to acetylcholine receptor. Where clinical circumstances warrant cytotoxic immunosuppression in patients with myasthenia gravis, consideration should be given to the simultaneous employment of plasmapheresis, in order to maximize benefit to the patient from a given exposure to drug therapy.

Adult↗
PubMed1992

Effects of plasmapheresis on short-term variability of blood pressure in healthy donors.

The acute effect of mild central hypovolaemia induced by plasmapheresis on the short-term variability of blood pressure and heart rate was evaluated in ten healthy donors. Indirect finger blood pressure was measured by a non-invasive device (Finapres). Analogue-to-digital conversion of the blood pressure was used to determine systolic, diastolic and mean blood pressure and heart rate every second. The equidistant sampling allowed a direct spectral analysis using a fast Fourier transform algorithm. Blood pressure and heart rate were maintained while an increased overall variability of blood pressure was observed after plasmapheresis. The increased total area under the curve of the systolic and diastolic blood pressure spectra was documented with the selective analysis of the three main components of the spectra: the increase in the oscillations of blood pressure following plasmapheresis predominated in the 66-129 mHz region, corresponding to Mayer waves. The spectral profile of HR was unaffected by plasmapheresis. The significant increase in the 10-s period oscillations of blood pressure after the mild central hypovolaemia could result from the unloading of cardiopulmonary (and arterial) baroreceptors which in turn could buffer the arterial pressure through sympathetic activation, detected on the systolic and diastolic pressure spectra in the low-frequency range.

Adult↗
PubMed2002

Short-term cardiovascular effects of plasmapheresis in norepinephrine-refractory septic shock.

OBJECTIVE: To examine the short-term cardiovascular effects of plasmapheresis in seven patients (six surgical, one medical) with norepinephrine-refractory septic shock. DESIGN AND SETTING: Retrospective observational study in a secondary community hospital. INTERVENTIONS: Plasmapheresis was performed as follows: blood flow, 120 ml/min; exchange volume, 10 fresh frozen plasma (ca. 2200 ml) at rate of 13 ml/min; anticoagulation, unfractionated heparin 200-300/IU/h. Five patients received one separation and two patients three separations. All patients received norepinephrine intravenously (0.6+/-0.7 micro g/kg per minute) to achieve a mean arterial pressure of 77+/-12 mmHg. All patients received ventilatory support; two had acute oligoanuric renal failure treated by continuous hemodiafiltration. MEASUREMENTS AND RESULTS: We recorded heart rate, mean arterial pressure, central venous pressure, catecholamine dose, gas exchange, acid-base status, diuresis, C-reactive protein, white blood cell count, and Simplified Acute Physiological Score II. Except for transitory decreases in central venous pressure no changes were found in any variable. Six of seven patients died 5+/-3 days after the last plasmapheresis. CONCLUSIONS: In patients with norepinephrine-refractory septic shock no directional changes in measured variables were found in the first 24 h after a plasmapheresis. Thus, regarding the cost (ca. 1000 euros per separation) and possible risks the procedure needs rigorous evaluation even as "rescue therapy" in patients with septic shock.

APACHE↗
PubMed1997

Replacement fluids in plasmapheresis: cross-over comparative study.

OBJECTIVE: To compare the tolerance and the cost of three replacement fluids in plasmapheresis: albumin 4% alone, albumin 4% + dextran 40, or albumin 4% + hydroxyethylstarch 6%. DESIGN: A one center randomized, cross-over, comparative study designed to explore the tolerance and the colloid oncotic pressure in patients undergoing plasmapheresis. PATIENTS: 225 plasmapheresis procedures were performed in 27 patients. MEASUREMENTS AND RESULTS: Hemodynamic tolerance was good in the three treatment groups. Serum protein concentration after plasmapheresis was significantly lower in the albumin + hydroxyethylstarch group, followed by albumin + dextran 40, versus albumin alone. Colloid oncotic pressure before and after exchange was similar in the three groups. CONCLUSIONS: The clinical use of 25-30% of hydroxyethylstarch 6% or dextran 40 with albumin 4% was clinically well tolerated and associated with a 12% decrease of the cost of substitution solutions.

Adult↗