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PubMed1989

[Intensive plasmapheresis (programs, laboratory monitoring, complications)].

Experience gained with the use of plasmapheresis in 336 children with different diseases is described. In patients with bacterial and inflammatory processes, the effect was attained after the first plasmapheresis session. Acuity of the immunomediated processes decreased after exfusion of 2-3.5 volumes of the circulating plasma. The replacement of the exfused plasma by protein blood preparations was made only in patients with hepatodystrophy, bacterial and inflammatory diseases, and immune complex diseases combined with the signs of consumption coagulopathy. After a course of plasmapheresis there was a significant lowering of total protein, albumin and immunoglobulin G. The reduction of the content of hemoglobin and red blood cells was related to hemodilution Iron homeostasis remained unchanged. The use of plasmapheresis in atopic dermatitis without preventive administration of an antibiotic is associated with the risk of the development of post-catheterization thrombophlebitis.

Blood Volume↗
PubMed1989

[Immunocorrective treatment of idiopathic thrombocytopenic purpura by plasmapheresis].

Patients with idiopathic thrombocytopenic purpura (ITP) tolerated well plasmapheresis. In no cases hemorrhage intensification was observed. An immediate clinical effect was recorded in all patients that correlated with the immunological parameters improvement in most of them. The platelet count significantly rose only in one patient immediately after the plasmapheresis course. The follow-up of the patients during 11-20 months has enabled revealing not only immediate clinical but also late hematological effect of plasmapheresis, that was manifest in a delayed rise of the platelet levels in most patients, and abolished resistance to glucocorticoids in one of them. It has been concluded that plasmapheresis produces immunocorrecting effect and could be used for the treatment of ITP patients.

Adult↗
PubMed1989

[Plasmapheresis in the treatment of critical stages of ischemia in diabetic angiopathy of the lower extremities].

The authors have used gravitation plasmapheresis in the treatment of 26 patients with diabetic angiopathies of lower extremities. It was established that continuous gravitation plasmapheresis facilitated the immediate correction of most of the altered biochemical and coagulation parameters of blood, in patients with diabetes mellitus. The use of rheopolyglucinum is followed by stable central hemodynamics and stabilization of the general state of the patients during continuous plasmapheresis which allows to recommend rheopolyglucinum as the main plasma-substituting solution for fractionation of blood in patients with diabetic angiopathies. The gravitation plasmapheresis used in the treatment of critical degrees of ischemia in patients with diabetic angiopathies of lower extremities is thought by the authors to allow to preserve the extremity or to make the level of its amputation lower in most patients.

Aged↗
PubMed1986

[Plasmapheresis in the complex therapy of patients with acute pyelonephritis and urologic infection].

In 19 urological patients with pyointoxication and urosepsis 49 plasmaphereses for the purpose of detoxication were performed in the complex with other therapeutic measures. The causes for the pyoseptic complications were as follows: urolithiasis in connection with acute pyelonephritis, acute pyelonephritis (among others in pregnancy, cystic renal dysplasia, carcinoma of the urinary bladder), renal insufficiency in the terminal stage. The treatment of these diseases with haemodialysis and haemoperfusion was complicated by a pyosepsis. Two methods of the plasmapheresis were used: the intermitting plasmapheresis with use of a refrigeration centrifuge K-70 (GDR) and the permanent membrane plasma separation with the device A2008 RG of the firm "Fresenius" (FRG). The plasma perfusion was experimentally proved and in 5 cases used on 5 columns with activated charcoal. The efficacy of the plasmapheresis and the plasma perfusion was apart from the clinical condition judged according to the values of the middle molecules in the blood, or urea, creatinine and the normalisation of the hypoproteinaemia as well as of the humoral immunity. To this are added the increase of diuresis, the normalisation of the haematological parameters and the bacteriological findings of blood and urine. Furthermore, several pathogenetic mechanisms of the positive effect of the plasmapheresis were analysed (mechanic removal of bacteria and their toxins, effect of "deplasmation" with tissue dehydration, improvement of the functional state of the kidneys within the first 3-4 days: reduction of the azotaemic intoxication, the DWS-syndrome, improvement of the rheological properties of the blood and of the microcirculation, increase of the antitoxic function of the liver).(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1988

[Plasmapheresis in severe forms of suppurative-septic diseases in children].

Under analysis is the first experience with the application of discrete plasmapheresis in 44 children aged from 6 months to 14 years for detoxication of severe forms of pyo-septic diseases. The method of discrete plasmapheresis is described. The method was shown to have a favourable influence upon hemodynamics and some parameters of the cell and humoral immunity. The application of discrete plasmapheresis resulted in rapid liquidation of endotoxicosis, less lethality and shorter time of treatment at the hospital. Wider introduction of discrete plasmapheresis in children with pyo-septic diseases is recommended.

Adolescent↗
PubMed1987

[A positive effect of combined therapy (plasmapheresis in combination with pulse therapy) on the course of cryoglobulinemic glomerulonephritis and ulcerative-necrotic vasculitis in patients with Sjögren's disease].

The authors provided evidence of a positive effect of combined therapy (plasmapheresis in combination with pulse-therapy) on a course of cryoglobulinemic glomerulonephritis and ulcerative-necrotic vasculitis in patients with Sjögren's disease (SD). It was shown that plasmapheresis with double plasma filtration considerably decreased the cryoglobulin level in the blood whereas the level of alpha 2-globulins, C-P, RF and CIC did not change 16 hrs after the sessions of plasmapheresis. These indices significantly decreased after pulse-therapy with high doses of 6-methylprednisolone and cyclophosphamide following plasmapheresis. Combined therapy resulted in a complete epithelization of leg ulcers, regression of the symptoms of renal failure. Clinical improvement correlated with a decrease in indices of the inflammatory and immunological activity and with an increase in the cutaneous blood flow. Combined therapy can be an effective therapeutic method of SD complicated by cryoglobulinemic glomerulonephritis and ulcerative-necrotic vasculitis.

Acute Kidney Injury↗
PubMed1987

[Clinico-immunological assessment of the effectiveness of plasmapheresis in the combined therapy of patients with high arterial hypertension].

After several plasmapheresis procedures 25 out of 28 patients with high arterial hypertension revealed stable BP lowering, accompanied by elimination of their refractoriness to medical therapy. Enhanced sensitivity of lymphocytes to antihypertensive drugs has been established by lymphocyte rosette-formation with allogenic erythrocytes loaded with these preparations. Plasmapheresis was followed by moderate reduction in IgA, IgM and IgG levels with their subsequent recovery to baseline values within 3-7 days. In a number of patients with drug hypersensitivity plasmapheresis contributed to a considerable attenuation of drug-induced allergy and caused a decrease in the initially elevated IgE level. Possible mechanisms of eliminating refractoriness to medical therapy by plasmapheresis are discussed.

Adult↗
PubMed1987

[Hypotensive effect of plasmapheresis in patients with severe symptomatic arterial hypertension of renal origin].

The article presents the results of using plasmapheresis in 8 patients with high arterial hypertension refractory to drug therapy. After 2 plasmapheresis procedures a stable BP decrease was observed in all patients allowing a further decrease of hypotensive drug administration. The hypotensive effect of plasmapheresis was accompanied by an improvement of the eye fundus and of renal function, decreased proteinuria and increased sensitivity to hypotensive therapy. Possible mechanisms of post-plasmapheresis BP lowering are discussed.

Acute Disease↗
PubMed1987

[Cascade use of plasmapheresis and plasma filtration in the treatment of rheumatoid arthritis].

The effect of incorporation of cascade plasmapheresis and plasma filtration in multimodality therapy was studied in 4 patients with rheumatoid arthritis (RA). The result was estimated as "excellent" (complete disappearance of clinical symptoms of the articular syndrome and normalization of the activity laboratory indices) in one patient; "good" (the reduction of clinicolaboratory activity) in 2 patients and "satisfactory" (the reduction of symptoms of the articular syndrome without changes of a degree of general activity of disease) in one patient. Cascade plasmapheresis and plasma filtration significantly improved clinical and many laboratory indices of RA activity and humoral immunity indices during treatment. A long period of observation is required to assess long-term results of the effect of this method. A great advantage of the method is a possibility of decreasing substitution protein solutions without negative effects with relation to the blood total protein level. The absence of a necessity of catheterization of central vessels, more complete blood separation into plasma and erythrocytes make cascade plasmapheresis and plasma filtration more preferable. Good tolerance of the procedure, fast improvement, a chance to avoid side-effects of drug therapy, a lower risk of allergic reactions to plasma substitutes as compared to those in plasmapheresis and lymphocytoplasmapheresis make the method promising for RA treatment.

Aged↗
PubMed1987

[Intensive plasmapheresis--possible difficulties and complications].

The paper is concerned with an analysis of difficulties and complications resulting from various modes of conducting intensive plasmapheresis using mainly refrigerator centrifuges and plasticized resin containers in 462 patients (a total of 2435 procedures). Emphasis was placed on a necessity of a thorough choice of a vascular access with relation to a patient's condition, a more of plasmapheresis, and an assumed volume of plasma removal. Causes of hemodynamic and temperature reactions, "citrate intoxication" were analyzed; their prevention and therapy were described. Plasmapheresis was accompanied by insignificant variations in the level of leukocytes, platelets, normal immunoglobulins and fibrinogen. Complications during plasmapheresis were often related with the stage of plasmosubstitution.

Adult↗
PubMed1987

Preserved respiratory and phagocytic functions of phagocytes exposed to flat sheet plasmapheresis equipment.

Monocytes and polymorphonuclear leukocytes (PMN) were tested for functional integrity after exposure to flat sheet plasmapheresis equipment. Purified PMN were tested for chemiluminescence activity in response to a variety of triggers of the respiratory burst. Monocytes were assessed for their capacity to ingest erythrocytes sensitized with varying amounts of IgG antibodies. Both assays were demonstrated to be sensitive hallmarks of functional modulation. However, no functional differences were noted between phagocytes from blood collected prior to pheresis and those exposed to flat sheet plasmapheresis cylinders. These data suggest that plasmapheresis with the Autopheresis C system does not influence the respiratory and phagocytic function of phagocytes returned back to the donor and implies that contact of phagocytes with artificial surfaces and/or their exposure to surface-activated plasma factors generated in the collection cylinder are minimal when using this plasmapheresis method.

Humans↗
PubMed1985

Plasmapheresis in the treatment of severe meningococcal or pneumococcal septicaemia with DIC and fibrinolysis. Preliminary data on eight patients.

Plasmapheresis (50 ml fresh frozen plasma/kg body weight per session--total 9-11 liters) was performed within 36 hours of the onset of septicaemia in 7 patients (1 woman and 6 men, age 14-48 years). One 8 year old girl was treated with exchange blood transfusion (2 liters). All had symptoms of severe septic shock caused by Neisseria meningitidis (6) or by Streptococcus pneumoniae (2). All patients demonstrated signs of DIC and concomitant fibrinolysis with low platelet values, normal to low fibrinogen levels, circulating soluble fibrin and increasing amounts of FDP. Persistent extreme values were observed in 2 patients that died, whereas coagulation/fibrinolysis parameters frequently improved during plasmapheresis and gradually (more than 6 days) returned to normal values in the survivors. Although plasmapheresis was largely successful and signs of DIC and fibrinolysis were normalized, 2 patients died and 1 survived with severe sequelae. Thus, it remains to accumulate more data to conclude if plasmapheresis is beneficial in the treatment of severe septic shock and DIC.

Adolescent↗
PubMed1985

Plasmapheresis and acute Guillain-Barré syndrome. The Guillain-Barré syndrome Study Group.

We compared plasmapheresis with conventional therapy in 245 patients with the Guillain-Barré syndrome of recent onset. Statistically significant differences, favoring the plasmapheresis group, were found in terms of improvement at 4 weeks, time to improve one clinical grade, time to independent walking, and outcome at 6 months. Plasmapheresis was not effective for all patients, but was particularly effective for patients who received this treatment within 7 days of onset and for patients who required mechanical ventilation after entry into the study. Plasmapheresis appears to be of benefit in patients with Guillain-Barré syndrome of recent onset.

Acute Disease↗
PubMed1985

[Plasmapheresis in the treatment of pemphigus].

The results of small-volume plasmapheresis were favorable in cases of severe pemphigus vulgaris and foliaceus if applied simultaneously together with corticosteroids and cyclophosphamide, both on lowered doses. The patients went into long-lasting remission. A special indication for this therapy are cases that do not allow the application of large doses of prednison because of severe side-effects of steroids. The effect of plasmapheresis does not appear to depend on the removal large quantity of antibodies. Small-volume plasmapheresis as a supplementary therapy of the combined treatment with steroids and immuno-suppressors showed better effects than large-volume plasmapheresis.

Adult↗
PubMed1979

Goodpasture's syndrome--effects of plasmapheresis.

Two patients with Goodpasture's syndrome, who underwent plasmapheresis are presented. One patient received prednisone but the other patient received no concomitant cytotoxic therapy. Results indicate that plasmapheresis reduces morbidity in patients with Goodpasture's syndrome. The possible mode of action of plasmapheresis is discussed. The use of cytotoxic therapy as an adjunct to plasmapheresis may not be necessary since the anti-GBM production appears to be a self-limiting process.

Adult↗
PubMed1982

Effect of plasmapheresis on T anc B lymphocyte functions in patients with systemic lupus erythematosus: a double blind study.

Nine patients with active systemic lupus erythematosus entered a double-blind randomized trial to study the therapeutic effect of vigorous versus sham reinfusion plasmapheresis. Four of them received real plasmapheresis while five received sham reinfusion plasmapheresis. In the present communication we report the effects of these procedures on T lymphocytes in peripheral mononuclear cells, proliferative response to mitogens, allogeneic mixed lymphocyte reaction and cell-mediated lympholysis, as well as the effect of plasmapheresis on the spontaneous and pokeweed mitogen induced immunoglobulin secreting cells in peripheral blood. Several mononuclear cell functions were abnormal at the beginning of the study but no significant changes related to plasmaphersis occurred in any of the parameters studied.

B-Lymphocytes↗
PubMed1983

[Treatment of arterial hypertension by plasmapheresis].

Plasmapheresis may induce transient hypotension in some patients. It may also be beneficial to patients presenting Raynaud's phenomenon where its effect may be explained by an improvement in the microcirculation due to decreased blood viscosity. Intrarenal microcirculation may be altered in patients who have impaired renal function, high plasma renin activity values and hypertension. Two such patients have been treated by plasmapheresis after unsuccessful multiple drug treatment. Blood pressure decreased to normal values after 2 or 3 plasmaphereses and drug treatment could be reduced. Twelve months after this treatment the blood pressure was still normal. Renal function was improved in one patient and unchanged in the other. Plasma renin activity, which was high before plasmapheresis, decreased dramatically but was not within normal limits after 8 exchanges. These two observations are preliminary but they render certain hypotheses possible. The decrease in plasma renin activity and improvement in renal function may be due to improved microcirculation. When blood pressure is not controlled by multiple drug antihypertensive treatment, plasmapheresis may be considered as an alternative therapeutic procedure.

Adult↗
PubMedDate not supplied

The rationale for plasmapheresis in renal graft rejection.

The present study reports on 15 transplanted patients with acute vascular rejection unresponsive to high-dose steroids, who underwent plasmapheresis treatment. Cyclophosphamide was combined with plasmapheresis in 11 patients in whom specific anti-HLA antibodies against the donor's mismatched antigens were detected. The treatment proved effective in removing the antibodies from circulation and in improving the graft function. Nine of these patients have a well-functioning graft 3 to 24 months after treatment. Plasmapheresis failed to reverse rejection in two out of the four patients where anti-HLA antibodies were not found, while the remainder have a satisfactory renal function after 18 and 32 months respectively. We conclude that in transplanted patients plasmapheresis associated with an appropriate immunosuppressive therapy may be of value in the treatment of acute vascular rejection that is unresponsive to high-dose steroids, particularly when specific anti-HLA antibodies are detected.

Antibodies, Anti-Idiotypic↗