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PubMedDate not supplied

Influence of long-term plasmapheresis on blood coagulation.

The influence of serial, double plasmapheresis on blood coagulation was evaluated in two groups of plasma donors that had undergone from 3 to 306 plasmapheresis sessions. Averages of 375 and 660 ml of plasma, respectively, were harvested weekly from the donors. No statistically significant changes were observed in platelet count, activities of factor V and factor VIII, fibrinogen, plasminogen, alpha 2-macroglobulin, antithrombin III and prothrombin time, irrespectively of the frequency and the number of the plasmapheresis sessions. The concentration of alpha 1-antitrypsin was already increased after seven plasmapheresis sessions in both groups of donors. The kaolin-cephalin clotting time was progressively shortened with the increasing volume of harvested plasma (p less than 0.05) and the thrombin time was prolonged (p less than 0.05).

Adult↗
PubMed1984

Improved survival in multiple myeloma with combination chemotherapy and plasmapheresis.

The relation of different cytostatic regimens and plasmapheresis to survival time was studied in patients with stage III myeloma. The median survival time for 23 melphalan-prednisolone treated patients was 9 months. Nine melphalan-prednisolone treated patients, who were in addition treated with plasmapheresis survived longer (median 23 months), but the difference was not significant. Twenty-five patients, treated with plasmapheresis and cytostatic combination (melphalan, cyclophosphamide, BCNU, vincristine, prednisolone) survived significantly longer, for 61 months (median). Cytostatic combination therapy seems to prolong survival in stage III myeloma. Plasmapheresis may also have a favourable effect.

Adult↗
PubMed1984

[Plasmapheresis in multiple sclerosis].

8 patients suffering from multiple sclerosis were treated with plasmapheresis. Other methods of management such as cortisone or azathioprine therapy were discontinued one month before plasmapheresis. The patients were investigated before, and on the 1st, 2nd and 3rd day after plasmapheresis using the Kurtzke Disability Score and the Hamilton Rating Scale. No improvement in neurological or psychiatric symptoms or signs was detected following plasmapheresis.

Adult↗
PubMed1980

[Plasmapheresis. A review (author's transl)].

In the light of a review of the literature the possible lesions due to plasmapheresis reported by individual authors are pointed out, the individual protein groups being given particular attention. The effect of plasmapheresis on the platelet count and the danger of pneumatic ischemia is discussed. The possibilities of establishing plasmapheresis in Germany, except for therapeutic measures, are pointed out. Finally, our own current observations on the application of plasmapheresis are presented.

Blood Platelets↗
PubMed1981

[Rapidly progressive glomerular disease treated with plasmapheresis (author's transl)].

A case of rapidly progressive glomerular disease with 100% of epithelial crescents completely enveloping each glomerulus, prolonged anuria and renal failure requiring dialysis. There were no indications of either streptococcal etiology or systemic disease. Improvement in renal function in response to plasmapheresis and immunosuppressants was spectacular. During two subsequent episodes of renal failure with diminished diuresis response to plasmapheresis was again striking. Assay for circulating immune-complex was always negative. No anti-basement membrane antibodies were found. Due to the lack of an adequate vascular access plasmapheresis was discontinued and the patient died 7 months after onset. Tendency to interstitial glomerular sclerosis was established with three renal biopsy specimens taken during progression of the disease. Intense metabolic acidosis suggestive of tubular acidosis, disproportionate to renal insufficiency presented during the last months. Pathologic and prognostic aspects as well as possible access for plasmapheresis are discussed.

Acidosis, Renal Tubular↗
PubMed1981

[Therapeutic plasmapheresis in the treatment of plasmacytoma].

In high concentrations of paraproteins in the plasma in the plasmocytoma a hyperviscosity syndrome appears which is characterized by severe disturbances of circulation in various organs. Apart from the usual intermittent cytostatic therapy with melphalan and prednisone in the phase of the primary treatment the therapy of the hypoviscosity syndrome is of particular importance. In these cases in our clinic the therapeutic plasmapheresis stood the test. It is reported on three patients with plasmocytoma and hyperviscosity syndrome, in whom in 1979 apart from the cytostatic treatment repeatedly plasmapheresis were carried out. Furthermore, references to the practical performance of the plasmapheresis with reinfusion of the autologous erythrocytes are given. On the basis of the impressionable improvement of the hyperviscosity syndrome, the slight cost and expenditure of time as well as of the minimum load of the patients the plasmapheresis is recommended as a firm constituent of the therapy of the plasmocytoma.

Aged↗
PubMed1981

Patients with high titers of circulating immune complexes are most likely to benefit from plasmapheresis treatment.

Intermittent flow centrifugation system was utilized in the management of 17 patients with IC diseases. 14 out of 14 patients that had high levels of ICs prior to plasmapheresis showed both clinical and immunochemical evidence of improvement with plasmapheresis. 3 patients had no evidence of circulating ICs prior to plasmapheresis: in these cases no apparent result was achieved after the apheretic therapy. Although the striking correlation between IC removal and clinical result is not a formal proof of responsibility of CIC in the pathogenesis of the disease, it is suggested that quantitative determination of CICs (utilizing several different recognition units) may be a useful parameter in the decision to apply plasmapheresis in the therapy of selected autoimmune diseases.

Adolescent↗
PubMed1994

Cerebral blood flow velocity during high volume plasmapheresis in fulminant hepatic failure.

High volume plasmapheresis has previously been found to improve neurological statuses in patients with fulminant hepatic failure. We investigated the relationship between the neurological status and cerebral blood flow velocity (Vmean) during high volume plasmapheresis in 18 consecutive patients (ten females and eight males) with fulminant hepatic failure, with a mean age of 43 (range 9 to 57) years. The mean arterial pressure (MAP) and intracranial pressure (ICP) were also recorded. A total of 16% of body weight was exchanged with fresh frozen plasma per day. Thirty-six plasma exchanges wer performed with a median of 2 (range 1 to 8) per patient. Eleven of the patients survived (61%), nine after liver transplantation. Following the first high volume plasmapheresis, the coma score improved from 6 (1-8) to 2 (0-8) (p < 0.05), Vmean increased from 40 (14-152) to 62 (16-186) cm s-1 (p < 0.05), and MAP from 72 (35-118) to 94 (47-138) mmHg (p < 0.05). The intracranial pressure (ICP) was monitored and remained unchanged in nine patients whereas the cerebral perfusion pressure (MAP minus ICP) increased in the surviving group from 55 (40-74) to 80 (50-91) mmHg (p = 0.07) in contrast to no changes in the non survival group. In conclusion this study suggests that the neurological status, may improve during high volume plasmapheresis as MAP and Vmean increase the cerebral oxygen delivery.

Adolescent↗
PubMed1994

[Plasmapheresis in the combined therapy of progressive forms of glomerulonephritis].

29 patients aged 6-16 with glomerulonephritis lasting 4-5 years received multimodality treatment with plasmapheresis as a component. The majority of the patients suffered from primary glomerulonephritis in mesangio- or membrano-proliferative morphological variants. Previous long-term conventional therapy (prednisolone, cytostatics, anticoagulants and antiaggregation drugs) failed. The test course comprised 1-3 plasmapheresis sessions (centrifuge method on [symbol: see text] apparatus), cyclophosphamide or maintenance methyl-prednisolone pulse therapy, heparin and curantil. One-third of the patients achieved remission lasting from 5 months to 3 years, in the other one-third the improvement was as short as 2-4 weeks, and the last one-third appeared non-responders. Improvement of clinical indices occurred in parallel with trends to reduction in the levels of CIC, IgG, B-lymphocytes, T-helpers, inhibition of lymphocyte succinate dehydrogenase activity, better phagocytosis. No complications which may prohibit plasmapheresis use in glomerulonephritis were observed. Adjuvant plasmapheresis use in glomerulonephritis treatment needs further studies.

Adolescent↗
PubMed1993

[Ought plasmapheresis be used in the treatment of hypertension patients?].

The paper discusses the results of using plasmapheresis in the multimodality treatment of 51 patients with Stage II hypertensive disease. It has been found that the application of plasmapheresis results in the patient's clinical improvement as attenuation of headache and giddiness, cessation of cardialgia and better general condition. After plasmapheresis treatment, a dosage of antihypertensive agents could be reduced in most patients. The findings suggest that plasmapheresis opens up new fields of use in the treatment of hypertensives, exerting a substantial effect on immunological and hemorheological parameters and making the baseline changed hemodynamic parameters normal.

Adult↗
PubMedDate not supplied

[The clinical efficacy of plasmapheresis in the combined therapy of patients with chronic glomerulonephritis and nephrotic syndrome].

A clinical analysis of the effect of 64 plasmapheresis sessions in combined treatment of 16 chronic glomerulonephritis patients with nephrotic syndrome was made for 7 patients with mesangiocapillary, 1 with mesangioproliferative, 2 with mesangioproliferative with semilunums, 2 with fibroplastic glomerulonephritis. 12 of the patients had failed previous chemotherapy with prednisolone, curantil, cyclophosphamide. Each of the patients underwent 3-5 sessions of plasmapheresis. The domestic-made centrifuge pi phi-05 was employed. Plasmapheresis was combined with prednisolone (1.5 mg/kg/day) as early as session 1 in 6 patients, session 3 in 10 patients (pulse therapy with 1 mg). Plasmapheresis was followed by curantil and chlorbutin administration. The results evaluated 2 months after the treatment start showed that renal function became normal in 4 patients, proteinuria diminished by 50-80% in 9 cases, nephrotic syndrome transformed into the urinary one in 5 patients.

Adolescent↗
PubMed1993

[Intraoperative plasmapheresis in patients undergoing CABG surgery; effect on intraoperative and postoperative homologous blood transfusion requirements].

To evaluate the effect of intraoperative plasmapheresis on intraoperative and postoperative homologous blood transfusion requirements, we assigned 89 patients undergoing primary CABG procedure to either the experimental group (plasmapheresis, n = 31, A group) or the control group (traditional method, n = 58, B group). All patients underwent hemodilution by withdrawal of autologous blood before cardiopulmonary bypass. In A group, the average volume withdrawn during plasmapheresis was approximately 948 ml (platelet rich plasma (PRP) and red blood cells). We removed an average of 751 ml of whole blood in B group. The percentage of patients without homologous blood transfusion in A group was 40% versus 32% in B group. The difference was not statistically significant. It was concluded that our method of plasmapheresis was effective in reducing homologous blood transfusion, but it was not more effective than the traditional hemodilution method.

Aged↗
PubMedDate not supplied

[Plasmapheresis efficacy in the treatment of patients with chronic cholestatic hepatitis and primary biliary liver cirrhosis].

Effectiveness of plasmapheresis in a combined treatment of 46 patients with chronic cholestatic hepatitis and 30 with primary biliary cirrhosis of the liver was studied. Gratifying therapeutic results from plasmapheresis were achieved in 62 patients (81.5%). Time-related clinical manifestations of the illness, biochemical and immunological indices in the early post-plasmapheresis period were different in the groups studied. The mechanisms of therapeutic effect of plasmapheresis in patients with chronic cholestatic diseases of the liver were found to be chiefly due to its immunocorrective action, elimination of toxic products, returning to normal of rheological parameters of blood.

Adult↗
PubMed1995

[Marked clinical improvement by plasmapheresis in a patient with stiff-man syndrome: a case with a negative anti-GAD antibody].

We described a 56-year-old man with stiff-man syndrome, who was markedly improved after plasmapheresis therapy. He had a 12-year history of progressive painful stiffness of his back and limbs, muscle cramps and difficulty in walking. He had been taking oral diazepam and prednisolone. On examination the abdominal and paraspinal muscles and limbs were continuously contracting, confirmed by surface and needle electromyography. Antibodies against glutamic acid decarboxylase (GAD) and pancreatic islet cells in the serum were negative, but antinuclear antibody and anti-smooth-muscle antibody were present. The patient underwent a course of 4 double filtration plasma exchanges of 3,000 ml each in an 8-day period. Plasmapheresis resulted in marked clinical improvement. The disappearance of muscular cramps and a reduction of stiffness occurred within 24 hours after the first plasmapheresis, and he was able to walk unassisted. The patient's subjective improvement continued over 4 months after the plasma exchange. This case provides additional evidence of the autoimmune mechanism of stiff-man syndrome. Plasmapheresis is one choice in the management for stiff-man syndrome.

Antibodies, Antinuclear↗
PubMed1996

Management of plasmapheresis in France.

According to French law, the collection of blood and the separation of plasma by apheresis may only be carried out in ETS licensed by the AFS. The major objective of the recent law is to reinforce and control the safety of blood transfusion and drugs. Plasma donation is based on ethical principles of anonymity, non remuneration and voluntary agreement of the donor. In 1994, the plasma requirements for fractionation were satisfied, with plasmapheresis covering 28%. Since fractionation of French plasma is performed solely by the LFB, the evolution of the use of immunopurified factor VIII will govern future plasmapheresis activity. The number of plasmapheresis donors could potentially be increased in this country, especially if immunopurified factor VIII can be prepared under licence by the LFB. Thus collaboration between public and private industry will be essential to enable France in the future: i) to produce immunopurified factor VIII from plasma collected in the ETS instead of importing the same product prepared abroad from foreign plasma, ii) to contribute to European self-sufficiency and iii) to develop the collection by plasmapheresis of specific plasma for the production of specific immunoglobulins.

France↗
PubMed1996

[The use of plasmapheresis in treating Sjögren's disease (syndrome)].

The efficacy of treatment of stomatological manifestations and visceral diseases in patients with Sjogren's disease (syndrome) by therapeutic complexes including plasmapheresis is assessed. Plasmapheresis was administered to 7 inpatients in an intermittent mode with exfusion of up to 1 liter of plasma per session. A course consisted of one to three sessions, the total duration of treatment was three to four weeks. The efficacy of plasmapheresis in a complex of therapeutic measures was assessed from the time course of the clinical picture, results of studies of the function of salivary glands, and parameters of metabolic processes and immunity. Plasmapheresis helped attain long remissions and improved the general status of the patients, this being paralleled by a positive time course of local symptoms of the disease and the principal homeostasis parameters.

Adult↗
PubMed1997

[Association of plasmapheresis and high doses of intravenous immunoglobulins in the treatment of myasthenia gravis].

INTRODUCTION: In the past decade good therapeutic results have been reported with high dosage of intravenous immunoglobulins (Ig i.v.) in various autoimmune disorders, including myasthenia gravis (MG). Plasmapheresis has been used successfully in this disorder on indications similar to those described for the use of Ig i.v.. We have used sequential treatment of plasmapheresis followed by high doses of intravenous gammaglobulin in MG, seeking complementary benefits from the two kinds of treatment. MATERIAL AND METHODS: The sample included 10 patients with MG (7 of Osserman's grade II-B, 1 of II-A and 2 of III). We began treatment with plasmapheresis, and then continued with an i.v. infusion of Ig at a dose of 400 mg/Kg/day for 5 days. To evaluate the response to treatment, we used the classification system for muscle weakness based on the Virginia University modification of Osserman's grades, on the clinical involvement grade scales and on functional activity. RESULTS: All patients showed statistically significant improvement of the parameters studied. Improvement started between the first and sixth day, following administration of Ig i.v. and persisted for the following 16 weeks. CONCLUSIONS: We consider that combined treatment with plasmapheresis and Ig i.v. may synergically potentiate the immunological effects since they have different mechanisms of action. The indication for this is limited to serious clinical conditions resistant to other treatment, to speed recovery.

Adult↗
PubMed1998

[Treatment of Guillain-barre syndrome: immunoglobulins or plasmapheresis?].

The aim of this study was to compare the efficacy of IgIV versus plasmapheresis in the treatment of Guillain-Barré syndrome. Twenty-four Guillain-Barré patients were treated either with IgIV (n = 17), or plasmapheresis (n = 7). Evolution during the first year after onset were assessed using the motor functional scale of Hughes and nerve conduction studies. IgIV treated patients had better functional recovery than the plasmapheresis group (p < 0.05) and shorter hospital stays (p < 0.05). These differences were significant from day 30 after treatment. Complications occurred in 14 patients: 9 (58%) in the IgIV group, and 5 (71%) in the patients treated with plasmapheresis. IgIV treated patients had better functional recovery scores and shorter hospital stays. There were no differences in the complication rates. Therefore we believe that IgIV is the treatment of choice for Guillain-Barré syndrome in our clinical setting.

Adult↗