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PubMedDate not supplied

[Plasmapheresis in combined treatment of acute rejection crises after kidney transplantation].

The aim of the study was assessment of effectiveness and safety of extracorporeal procedures (plasmapheresis) in prevention and combined treatment of acute rejection crises (ARC) after kidney transplantation in patients at high risk to develop acute immunological conflicts in early postoperative period. 94 patients aged 21-56 years after allotransplantation of cadaver kidney (ATCK) entered the study. They were divided into two groups: group 1 patients (n = 47) received plasmapheresis procedures in combined preventive and therapeutic treatment of ARC; matched group 2 patients (n = 47, retrospective) received the same therapy but plasmapheresis. In both groups there were many patients with a high titer of pre-existing antibodies and massive hemotransfusions in the past. The analysis covered also recipients with the second ATCK (9 and 4 patients, respectively). After ATCK both groups received three-component immunosuppressive treatment (neoral, prednisolone, azatioprin and/or sell-cept). The analysis of the transplant and recipient 11-month survival has estimated that it was 93.6 and 91.5% for the recipients, respectively, and 91.5 and 76.5% for the transplanted kidney for group 1 and 2, respectively. The conclusion is that plasmapheresis in combined prevention and treatment of ARC by humoral type in sensitized patients (high titer of the pre-existing antibodies, repeat transplantations, hemotransfusions) is pathogenetically grounded and lowers the percentage of irreversible episodes of acute transplant rejection early after surgery.

Acute Disease↗
PubMed2001

[Tolerance to nitrates in patients with angina and effect of plasmapheresis].

AIM: To evaluate tolerance to isosorbide dinitrate (ID) in patients with angina pectoris functional class II-III and effect of plasmapheresis in this tolerance management. MATERIAL AND METHODS: 85 patients with angina pectoris functional class II-III taking long-acting ID. RESULTS: As shown by repeat transesophageal left atrial pacing, 24.7% patients have developed tolerance to nitrate while taking prolonged ID. Two methods of this tolerance elimination were compared: plasmapheresis + withdrawal of long-acting nitrate and withdrawal of the nitrates only. The former has shown some advantages: use of plasmapheresis reestablished ID efficiency in 4 days (two sessions) in 81.8% and in 7 days (3 sessions) in 100% patients without withdrawal syndrome. The latter method reestablished a marked antiischemic effect of ID in 7 days and 20% patients exhibited a variant of withdrawal syndrome--early negative aftereffect. CONCLUSION: When withdrawal of long-acting nitrates is combined with plasmapheresis in anginal patients to eliminate tolerance to nitrates, the effect is better.

Angina Pectoris↗
PubMed1992

Temporal effects of plasmapheresis on serum proteins in horses.

The temporal response of blood and serum proteins to chronic plasmapheresis was determined in 8 horses used in a commercial antibody enterprise. Plasmapheresis of between 4 and 11 L induced significant decreases in total protein, albumin, and IgG values. With the exception of a high hematocrit value for the first postplasmapheresis blood sample, there were no changes in erythrocyte or leukocyte measurements, and no changes in the proportions of serum protein in an electrophoretic profile. Regression equations generated for recovery of proteins after plasmapheresis indicated a return to preplasmapheresis values of total protein and albumin at approximately 1 month. Complications of repeated plasmapheresis were not detected when plasma extractions were done between 7 and 19 times at 30-day intervals.

Animals↗
PubMed2004

[Plasmapheresis in the multomodality treatment of active respiratory sarcoidosis].

Eighty-four patients with different stages of respiratory sarcoidosis (RS) were examined. Plasmapheresis was performed during pathogenetic and symptomatic therapy. A comparative analysis was made in the patients from a control group who had no plasmapheresis sessions. The findings have indicated that it is expedient to use plasmapheresis at all stages of active respiratory sarcoidosis. The best results were obtained in young patients with sarcoidosis of intrathoracic lymph nodes and the lung (Stage II). Plasmapheresis promoted a decreased process activity as improved health status in the patients, normalized laboratory parameters, a rapid involution of changes in the bronchopulmonary apparatus, which allowed the doses of corticosteroids to be substantially reduced in the basic therapy.

Adrenal Cortex Hormones↗
PubMed1991

[Effect of plasmapheresis with substitution by dextran solutions on hemostatic parameters in patients with ischemic heart disease].

Plasmapheresis on a continuous blood flow fractionator to remove 1,200-2,000 ml plasma and substitute for the same values of dextran solutions was employed in the multi-modality treatment of 25 patients with Functional Classes II-IV exertional angina and myocardial infarction. Plasma and thrombocyte hemostatic parameters were examined just before and 24 and 48 hours after plasmapheresis. The analysis of the baseline data revealed that hemostatic changes were directly related to the severity of a disease in the patients and there was a correlation between the increased platelet aggregability and the elevated levels of fibrin-monomeric complexes. Plasmapheresis along with substitution of removed plasma for dextran solutions was accompanied by a profound hypocoagulative effect, as evidenced by plasma and thrombocyte hemostatic parameters. In addition, in patients with baseline high values of platelet aggregability plasmapheresis resulted in its decrease, whereas in those with baseline low values, it led to its increase.

Adult↗
PubMed1991

A randomized trial of plasmapheresis and subsequent pulse cyclophosphamide in severe lupus: design of the LPSG trial.

A group of clinics cooperating as the Lupus Plasmapheresis Study Group (LPSG) is starting an international multicenter study of the treatment of severe systemic lupus erythematosus. The primary goal of this randomized and prospective trial is to establish whether treatment with plasmapheresis and subsequent pulse cyclophosphamide improves the outcome compared to treatment with pulse cyclophosphamide alone. The underlying rationale assumes that plasmapheresis: a) eliminates pathogenic autoantibodies and immune complexes and b) induces a compensatory activation of pathogenic lymphocyte clones through a feed-back between circulating antibodies and their respective antibody-producing clones. Synchronization of plasmapheresis with subsequent pulse cyclophosphamide should enhance the deletion of pathogenic clones during the period of greatest vulnerability. This overview reviews the first results of treatment approaches based on this concept and summarizes the design of the LPSG trial.

Combined Modality Therapy↗
PubMed1991

[Effects of gravitation plasmapheresis].

More than 400 gravitation plasmapheresis operations conducted in patients with coronary heart disease (CHD) have been analyzed. Plasmapheresis was combined with thrombocytapheresis, erythrocyte oxygenation, plasma sorption and plasma filtration. Removed plasma was substituted for rheologically active solutions and albumin. Gravitation plasmapheresis was used in critical cases when alternative therapeutic methods had failed to provide a favourable outcome. Inclusion of gravitation plasmapheresis into the combined treatment of CHD patients was conductive to decreasing lethality in complicated forms of acute myocardial infarction attended by circulatory insufficiency, stage III-IV, from 82 to 33%. Hypoxia and acytosis are eliminated as a result of normalization of blood circulation and the system of blood aggregation regulation, the functions of the lungs and other internal organs were improved, that was manifested in the clinical course of CHD: pain symptoms disappear, stress tolerance increases, sensitivity to drug therapy rises, lethality decreases.

Gravitation↗
PubMedDate not supplied

[Plasmapheresis in the therapy of insulin-dependent diabetes mellitus detected for the first time].

Heterogeneity of the metabolic syndrome in diabetes mellitus serves as an indication for plasmapheresis in therapy of disease. The effect of plasmapheresis on the indices of carbohydrate, lipid metabolism and immune homeostasis was studied in 30 patients with primary diabetes mellitus. Microstructure of the surface of dried blood serum drops was investigated in parallel with it. The control group included 20 patients who were not given plasmapheresis and 20 healthy subjects. A positive effect of plasmapheresis on the above indices was observed. Its approximate effect on the patients blood serum composition was shown.

Adolescent↗
PubMed1991

Plasmapheresis in Raynaud's phenomenon in systemic sclerosis: a microcirculatory study.

Microcirculatory and haemorheological parameters were investigated before and after plasmapheresis in eighteen patients with secondary Raynaud's phenomenon based on progressive systemic sclerosis. After 4 plasmaphereses, once a week, all patients claimed explicit improvement of their complaints. Raynaud's phenomenon and especially the reaction upon cold provocation had disappeared and skin ulcers healed. Red blood cell (RBC) velocity increased significantly (p less than 0.001) after 4 weeks plasmapheresis. RBC aggregation and plasma viscosity were significantly lower (p less than 0.001) after the last plasmapheresis than before treatment. After 3 years four patients were still free of complaints, but in 14 patients the symptoms of Raynaud's phenomenon had reappeared after 6 to 9 months. The skin ulcers, however, did not return in these patients. RBC aggregation and plasma viscosity returned to the initial values after 9 months, while skin capillary blood flow remained significantly enhanced for 24 months. The finding that restoration of RBC aggregation and plasma viscosity to normal level is associated with enhanced skin capillary blood flow, indicates that disturbed haemorheology plays a role in the diminished skin blood flow, as observed in patients with secondary Raynaud's phenomenon. In these patients, plasmapheresis can be considered to treat severe ischemia of the digits.

Adult↗
PubMed1991

The successful treatment of atypical hemolytic uremic syndrome with plasmapheresis.

A seven and a half-year-old boy presented with idiopathic atypical hemolytic uremic syndrome (HUS). He initially appeared to respond to plasma infusions. When he became refractory to plasma infusion, plasmapheresis was initiated. The treatment with plasmapheresis dramatically reversed the deterioration in glomerular filtration rate and platelet count. The use of plasma infusion and plasmapheresis in HUS is discussed. The authors advise the use of plasmapheresis in idiopathic atypical HUS.

Blood Transfusion↗
PubMed1991

[Plasmapheresis in the treatment of Crohn's disease].

Crohn's disease is a disease with unknown etiology of which immunological mechanisms participate. As standard treatment is sometimes ineffective, in 15 patients therapeutic plasmapheresis was used. Before plasmapheresis and immediately after it some immunological parameters were assessed. In the serum a significant drop of all immunoglobulins of the basic classes was recorded: (P less than 0.05) and of circulating immunocomplexes (P less than 0.02). Marked clinical improvement was observed in three patients, which as compared with data in the literature, is somewhat less. The cause is in the author's opinion in the selection of patients (plasmapheresis is usually most successful in patients with marked activity of the disease and non-intestinal symptoms) even in case of less active plasma exchange. Despite this plasmapheresis can be recommended in patients with a poor response to common conservative treatment and in some of them we may expect a marked therapeutic effect with a favourable influence on the prognosis of the disease.

Adolescent↗
PubMed1991

Selective removal of anti-DNA and anticardiolipin antibodies by adsorbent plasmapheresis using dextran sulfate columns in patients with systemic lupus erythematosus.

The effect of adsorbent plasmapheresis using dextran sulfate columns on anti-DNA and/or anticardiolipin antibodies (aCL) in 6 patients with systemic lupus erythematosus (SLE) was studied by multicenter clinical trials. The titers of anti-DNA (RI assay), IgG anti-dsDNA (ELISA), IgG and/or IgM anti-ssDNA, (ELISA), and IgG aCL (ELISA) significantly decreased or normalized after 4 treatments of plasmapheresis during a 2 to 4 week period. A patient with SLE with recurrent abortion and aCL who was successfully treated by adsorbent plasmapheresis is reported. We expect that adsorbent plasmapheresis will be an influential treatment for patients with not only SLE but aCL syndrome.

Adsorption↗
PubMedDate not supplied

Plasmapheresis: first year of experience at Humana Hospital-Alaska.

This report summarizes the first year of experience with therapeutic plasmapheresis at Human Hospital-Alaska. Eleven patients had plasmapheresis; 6 patients with the Guillain-Barré syndrome, and patients with thrombotic thrombocytopenic purpura (TTP), Eaton-Lambert syndrome, myasthenia gravis, post transfusion purpura, and multiple myeloma complicated by hyperviscosity and coagulopathy. Many of our patients appeared to benefit from plasmapheresis, but we also report a variety of complications. Our approach to establishing plasmapheresis in a community hospital setting is discussed.

Adolescent↗
PubMed1990

Treatment of renal failure associated with multiple myeloma. Plasmapheresis, hemodialysis, and chemotherapy.

The aims of this study were to examine in a prospective, randomized trial the efficacy of plasmapheresis in preventing irreversible renal failure in patients with multiple myeloma and to study the renal biopsy tissues from such patients. Twenty-one patients with active myeloma and progressive renal failure were randomized to one of two groups: group 1, forced diuresis and chemotherapy (10 patients), and group 2, forced diuresis, chemotherapy, and plasmapheresis (11 patients). Plasmapheresis and chemotherapy lowered the serum myeloma protein value much more rapidly than chemotherapy alone. Of 5 patients who were oliguric and undergoing dialysis at presentation, only 3 who were treated by plasmapheresis recovered. Of 16 polyuric patients, 5 in group 1 and 7 in group 2 showed improvement in renal function. The main factor that determined irreversibility of renal failure was the severity of myeloma cast formation.

Aged↗
PubMed1990

[State of lipid metabolism, platelet aggregation and microcirculation in patients with angina pectoris during plasmapheresis treatment].

The paper presents the changes found in the lipid spectrum in 48, platelet aggregation in 23 and microcirculation in 35 patients with coronary heart disease after plasmapheresis. In patients with Functional Classes III and IV angina, repeated procedures of plasmapheresis were found to result in a clinical improvement of its course in 92% of the patients and in conversion to a lower functional class of angina in 71%. Massive plasmapheresis performed by the developed methods caused a significant improvement in the lipid spectrum, blood rheology, and microcirculation, which persisted for 1 to 6 months after plasmapheresis in relation to the type of hyperlipoproteinemia.

Adult↗
PubMed1990

[Experiences with plasmapheresis in the treatment of vascular rejection following kidney transplantation].

In the first 6 weeks after kidney transplantation 15 patients suffering from vascular rejection were treated by 46 plasmapheres. In transplants with additional interstitial rejection the plasmapheresis was introduced after failure of ATG therapy. In 1 patient no histological confirmation was done. In 4 patients the plasmapheresis was successful and in 6 patients suffering from combined vascular and interstitial rejection the ATG therapy was successful only after initial plasmapheresis. In 4 cases the therapy failed to reverse rejection. The early use of plasmapheresis is recommended to obtain the best results.

Antilymphocyte Serum↗
PubMed1990

Clinical remission following plasmapheresis and corticosteroid treatment in a dog with acquired myasthenia gravis.

A 7-year-old sexually intact male Labrador Retriever with regurgitation and generalized muscular weakness resulting from acquired myasthenia gravis received 2 plasmapheresis treatments in combination with corticosteroid treatment. Plasmapheresis was performed in an attempt to rapidly lower serum acetylcholine receptor binding antibody (AChR Ab) concentration. Seven days after the second plasmapheresis treatment, the dog's muscular strength was normal, which coincided with a 70% decrease in serum AChR Ab concentration. Because the dog also received corticosteroids, it is impossible to determine how much of the clinical improvement resulted from plasmapheresis.

Animals↗
PubMed1987

[Effectiveness of plasmapheresis on the PF-0.5 blood separator in patients with paraproteinemic hemoblastoses].

Plasmapheresis on a Soviet-made PF-0.5 blood cell separator was performed in 20 PPH patients (altogether 33 sessions of plasmapheresis). 1600 to 3300 ml of plasma were removed during one session. Rheopolyglucin was mainly used as plasma-substituting liquid. The procedure was well tolerated by all the patients. After plasmapheresis biochemical indices were within normal. In multiple myeloma paraprotein was decreased by 42%. Waldenström's macroglobulinemia by 47%. Plasma viscosity was decreased 1.2- and 2-fold, respectively. The investigations showed a high efficacy and reliability of plasmapheresis with the help of the Soviet-made PF-0.5.

Adult↗