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PubMed1995

[Development of indications and techniques of plasma exchange. Contribution of the French Registry of Hemapheresis. Group Coopératif Français].

The French Registry for Haemapheresis created in 1985 allows an analysis of the changing indications and techniques of plasma exchange. The data collection system has been improved since 1991 with the development of a telematic network which greatly shortens the delay to data analysis. The 8-year report shows an increase in the use of the centrifugation technique, with citrate anticoagulation alone, a very sharp decline in the use of plasma substitution with albumin alone largely replaced by combined albumin, and no change in vascular access. Indications are now dominated by the constant increase in the use of plasma exchange for neurological diseases, a relative stability in the field of haematology and a drop in the number of indications for connective tissue diseases and nephrology. Advances in the technique have led to a decline in complications observed earlier. The French Registry for Haemapheresis is the world's largest data base on plasma phoresis. Participation via telematic access is essential for further extension of the registry.

Data Interpretation, Statistical↗
PubMed1997

Hepatic ICG removal in the pig depends on plasma protein and hematocrit: evidence of sinusoidal binding disequilibrium and unstirred water layer effects.

The influence of binding protein concentration and hematocrit on hepatic uptake of indocyanine green (ICG) was studied in anesthetized pigs during constant infusion of ICG. By exchange transfusions, we either substituted plasma protein with dextran 70 (n = 8) or changed hematocrit (n = 8). Intrinsic hepatic clearance of ICG, K, was calculated from plasma flow rate and concentrations in peripheral artery and liver vein after correction for extrahepatic distribution. By analyzing the relative change of K versus either the protein dilution factor or the change in plasma volume fraction (1-hct), we evaluated four current models for hepatic uptake of protein-bound substances even though a number of model parameters were unknown (parameter-free testing). Protein dilution factors (unitless) of 0.506 +/- 0.027, 0.673 +/- 0.011, and 0.749 +/- 0.028 were associated with inverse K ratios of 0.621 +/- 0.025, 0.758 +/- 0.021, and 0.817 +/- 0.013. These data rejected the traditional hypothesis that ICG uptake is proportional to the unbound concentration. They were compatible with development of binding disequilibrium along the sinusoidal lumen, an unstirred water layer close to the hepatocyte surface, or facilitated uptake from the bound pool. A plasma volume ratio [(1-hct2)/(1-hct1)] of 1.14 +/- 0.02 was associated with a K ratio of 1.07 +/- 0.02 (P = .01). Only sinusoidal binding disequilibrium predicted this finding, whereas an additional unstirred water layer effect could not be excluded. The observations could be simulated by a model that included both of these effects. Thus, neither the relative changes of K nor the absolute K values required the assumption of facilitated uptake from the bound pool. The parameter-free design presented may be useful with other ligands in intact animals.

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↗
PubMed1999

Pharmacokinetics of oxypolygelatine in healthy volunteers.

OBJECTIVE/METHODS: The pharmacokinetics of the plasma substitute oxypolygelatine (OPG) were studied in 12 healthy volunteers after single-dose administration of 27 ml x kg(-1) body weight, with a maximum of 2000 ml. OPG was determined in plasma and urine over 48 h after the infusion. Peak plasma OPG concentrations at the end of the infusion were determined to 4.600 (623) microg x ml(-1), the area under the plasma concentration/time curve (AUC(0-infinity)) was calculated to 70.135 (15.861) microg x h x ml(-1). RESULTS: The model-independently calculated volume of distribution came to 23.1 (4.8) 1 with a clearance total is (Cl(tot)) of 24.6 (6.8) ml x min(-1). The initial half-life according to a three-compartment model came to 0.3 (0.2) h, followed by a distribution half-life of 3.1 (2.6) h and a terminal elimination half-life of 13.4 (2.2) h. Cumulative urinary excretion of OPG was 64% after 48 h. CONCLUSION: This low recovery rate may be explained by the distribution of OPG into the extravascular space and subsequent degradation in tissue sites.

Contrast Media↗
PubMed1984

[Plasma exchange by cascade filtration. Clinical and biological study].

Nineteen double-filtration plasma exchanges were performed in 8 patients selected according to the presence or absence of disease-related and/or patient-related risk factors. The haemofiltration system consists of 2 filters with different pore sizes. The first filter, called plasma separator (Asahi plasmaflo HI-05), separates plasma from whole blood; the second filter, called plasma filter (Asahi XK-60; Kuraray Eval 2A or 4A), separates high molecular weight components from plasma. The filtrate from the second filter is returned to the patient mixed with blood cells and either a 4% albumin solution or Plasmion to replace the plasma discarded (about 0.5-0.8 I for a 1-1.5 plasma mass treated). The system (a) modulates venous pressure and transmembrane pressure in each of the two filters by means of pump velocity variations; (b) recirculates and concentrates the plasma extracted, and (c) provides information on the plasma mass extracted by the second filter. In our study, antihistaminics were always infused before each plasma exchange session, and blood pressure and electrocardiogram were monitored throughout the session. The selectivity of the second filter is relatively good for low and high molecular weight components (e.g. albumin and IgM respectively), but needs to be improved for those of intermediate molecular weight, such as IgG and immune complexes. The amounts of plasma substitute utilized are about 6 times less than with conventional methods; however, transmembrane pressure in the second filter is imperfectly controlled, and this too calls for improvement. A study is in progress to evaluate the ideal plasma mass to be extracted. Clinically, and taking into account the biological results obtained, diseases with high molecular weight mediators should benefit from the double-filtration technique, but this technique needs to be perfected for the treatment of IgG-mediated diseases.

Antigen-Antibody Complex↗
PubMed1984

Spontaneous plasma exchange by gravity.

Lysagth et al have reported a semplified model of spontaneous plasmapheresis by placing between an A-V shunt a conventional plasmafilter. On the basis of this experience we tried to make a further semplification of this apparatus using a single venous puncture, obtaining by gravity sufficient transmembrane pressure for plasma separation. By alternatively lowering and elevating the system, plasma is separated from the blood and packed red cells are reinfused after a new pass through the filter with FFP or plasma substitutes.

Acute Disease↗
PubMed1999

Anaphylactoid reaction to imiglucerase, but not to alglucerase, in a type I Gaucher patient.

Imiglucerase, the recombinantly produced enzyme, is gradually replacing the human placental derived alglucerase in the treatment of gaucher patients. We describe the first case, to the best of our knowledge, of an anaphylactoid reaction to imiglucerase in a patient who tolerated alglucerase. The patient was diagnosed at the age of 2 4/12 years with anemia and hepatosplenomegaly. Over the years he had suffered from marked splenomegaly, thrombocytopenia and recurrent bleeding episodes. At the age of 24 he started treatment with imiglucerase. After 3 months of treatment, immediately after starting an infusion, he experienced flushing, cough, tachycardia, palpitation, chest pain and excessive sweating, which reoccurred on a consecutive administration. Substitution with alglucerase was tolerated well, with only mild rash when he was premedicated with benadryl. Immediate skin tests to alglucerase, imiglucerase and gelatin were negative. IgG against alglucerase was undetectable. The in vitro mast cell degranulation test was positive for alglucerase, imiglucerase heamaccel (a gelatin based plasma substitute, which is a component of imiglucerase). This sensitivity to imiglucerase but not to alglucerase, raises the question of future treatment for this patient, since the production of alglucerase may cease, once imiglucerase production will cover the need for replacement enzyme.

Adult↗
PubMed1995

Dextran and hydroxyethyl starch interfere with fibrinogen assays.

We studied the haemostatic and volume effects of synthetic plasma substitutes and Ringer's solution in 48 surgical patients and found that the measured fibrinogen concentrations of patients receiving either dextran or hydroxyethyl starch (HES) were significantly higher than those predicted by the dilutional effects. The groups given Ringer's solution showed no apparent disproportion between fibrinogen concentration and plasma volume change. The results suggested that the presence of artificial colloids might interfere with the indirect fibrinogen assay used in the study. The method of analysis was based on light scattered from the reaction mixture during prothrombin time (PT) measurement. To test the hypothesis, plasma was obtained from nine volunteers to prepare 20, 40 and 60% dilutions in normal saline, 6% dextran 70, 6% HES 120/0.7 or 6% HES 200/0.5 solutions. Fibrinogen was measured on a ACL-300R coagulometer by two indirect methods, PT derived and the Clauss method. Relative concentrations were compared by analysis of variance and Sheffé's multiple comparisons. Dilutions containing either dextran or HES gave significantly higher values (P < 0.001) than samples diluted with normal saline. We conclude that the results of indirect fibrinogen assays should be interpreted cautiously, when HES or dextran is used for volume replacement. This may be particularly true when hypofibrinogenaemia is encountered after extensive use of synthetic colloids during massive transfusion.

Dextrans↗
PubMed2003

Plasma exchange in France: Epidemiology 2001.

The French plasma exchange registry created in 1985 lists the indications, techniques and complications of the French therapeutic haemapheresis. In 2001 it contains the data of more than 16,700 patients for a total of 153,641 sessions. The indications concern five groups of pathologies (neurology, haematology, nephrology, vasculitis, and endocrinology). Until 2000, the neurology represented the most important group but the use of the high dose IgIV for Guillain-Barre and myasthenia gravis decreased the indications. The haematology became most important group treated because of the increase of the TTP and HUS number treated. The endocrinology (familial hypercholesterolemia) represents at present 10% of the patients treated for 18.7% of the sessions. The vascular access little changed since 1985, the peripheral venous access being the most used. The plasma substitution initially based on the albumin alone was gradually replaced by an association albumin macromolecules, in particular hydroxyethylstarch since 1990. After the observation of the side effects due to starches we observed an increase of the albumin alone use. The immediate complications decreased in half in 15 years. The French plasma exchange registry is the largest world database of haemapheresis with the cooperation of about 80 centres, allowing numerous scientific studies.

Anticoagulants↗
PubMed1997

Effect of hemoglobin- and Perflubron-based oxygen carriers on common clinical laboratory tests.

Polymerized hemoglobin solutions (Hb-based oxygen carriers; HBOCs) and a second-generation perfluorocarbon (PFC) emulsion (Perflubron) are in clinical trials as temporary oxygen carriers ("blood substitutes"). Plasma and serum samples from patients receiving HBOCs look markedly red, whereas those from patients receiving PFC appear to be lipemic. Because hemolysis and lipemia are well-known interferents in many assays, we examined the effects of these substances on clinical chemistry, immunoassay, therapeutic drug, and coagulation tests. HBOC concentrations up to 50 g/L caused essentially no interference for Na, K, Cl, urea, total CO2, P, uric acid, Mg, creatinine, and glucose values determined by the Hitachi 747 or Vitros 750 analyzers (or both) or for immunoassays of lidocaine, N-acetylprocainamide, procainamide, digoxin, phenytoin, quinidine, or theophylline performed on the Abbott AxSym or TDx. Gentamycin and vancomycin assays on the AxSym exhibited a significant positive and negative interference, respectively. Immunoassays for TSH on the Abbott IMx and for troponin I on the Dade Stratus were unaffected by HBOC at this concentration. Tests for total protein, albumin, LDH, AST, ALT, GGT, amylase, lipase, and cholesterol were significantly affected to various extents at different HBOC concentrations on the Hitachi 747 and Vitros 750. The CK-MB assay on the Stratus exhibited a negative interference at 5 g/L HBOC. HBOC interference in coagulation tests was method-dependent-fibrometer-based methods on the BBL Fibro System were free from interference, but optical-based methods on the MLA 1000C exhibited interferences at 20 g/L HBOC. A 1:20 dilution of the PFC-based oxygen carrier (600 g/L) caused no interference on any of these chemistry or immunoassay tests except for amylase and ammonia on the Vitros 750 and plasma iron on the Hitachi 747.

Animals↗
PubMed2003

Combined antithrombin and protein C supplementation in meningococcal purpura fulminans: a pharmacokinetic study.

PURPOSE: To document in patients with meningococcal purpura fulminans (PF), the effects of a combined supplementation with antithrombin (AT) and protein C (PC) plasma concentrates and to estimate the pharmacokinetics and dose requirements of each inhibitor. DESIGN: Retrospective study of 15 patients. SETTING. One paediatric and one adult ICU in a university hospital. INTERVENTIONS: In addition to standard intensive care, all patients received a 100 IU/kg loading dose of AT and PC concentrates, followed by a continuous infusion (AT: 100-150 IU.kg.day; PC: 100 IU.kg.day in adults, and 400 IU/kg in infants). MEASUREMENTS: Clinical data, coagulation, and fibrinolysis parameters, AT and PC activities, and free protein S (PS) levels were sequentially measured. Restitution ratio, median increment after supplementation, and half-life of clearance from plasma were calculated for the two plasma substitutes. RESULTS. At admission, all patients had a severe decrease in AT, PC, and PS levels. The supplementation regimen induced a substantial increase in AT and PC activities, peaking at H18 and H48, respectively. The supplementation procedure did not modify free PS levels. The median values of AT and PC restitution ratio, increment in plasma activity observed after 100 IU/kg concentrate, and apparent half-life of clearance from plasma were 0.85 U.ml.U.kg and 0.59 U.ml.U.kg, 23% and 21%, 16 h and 6 h, respectively. CONCLUSION: If AT and PC concentrates are to be given in fulminant meningococcemia, the doses of supplementation should be at least 150 IU/kg AT and 250 IU/kg PC as loading dose and 150 IU/kg AT and 200 IU/kg PC as daily maintenance therapy. Taking into account the individual variability in inhibitor deficiency and restitution ratio, repeated measurements of plasma levels are mandatory to obtain a patient-based adjustment of the supplementation.

Antithrombins↗
PubMed1992

[The effect of 6% HES 200/0.6-0.66 on plasma volume and blood coagulation].

The main goal of the recent study was to evaluate changes in plasma volume due to the application of 6% HES 200/0.6-0.66. 12 patients according to the ASA physical status classification (I, II) undergoing minor surgical interventions received 500 ml of this artificial plasma substitute within 30 min. In a control group (n = 12), 500 ml of lactated Ringer's solution was given within the same period. A further question of the present investigation was the possible influence of 6% HES on coagulation during the following period (1st-3rd postoperative days). 6% HES 200/0.6-0.66 led to an additional augmentation of plasma volume measured via the mechanical oscillator technique of 200 ml (40% of the volume given) immediately at the end of infusion. A second increase in plasma volume of 100 ml (20% of the volume infused) could be observed 1 h later. With exception of the activity of factor VIII, the coagulation parameters had not been altered by infusion of 6% HES. The activity of factor VIII decreased to about 50% of the control level but showed a tendency to normalization within the following observation period. 6% HES 200/0.6-0.66 has a marked volume-expanding effect and exerts no influence on coagulation except a temporary decrease of factor VIII activity.

Adult↗
PubMed1987

Partial exchange transfusion in term, polycythemic neonates: absence of association with severe gastrointestinal injury.

Partial exchange transfusion is often used to treat neonatal polycythemia. Concern about the risk of necrotizing enterocolitis following the procedure has recently been raised. We report a retrospective analysis of 185 term, polycythemic neonates who received partial exchange transfusion. No evidence of severe gastrointestinal injury was found. The technique for partial exchange transfusion we report consists of removal of blood from the umbilical vein with reinfusion of a commercial plasma substitute through a peripheral vein. Based on our data and a literature review, we offer suggestions for future conduct of partial exchange transfusion in polycythemic neonates.

Gastrointestinal Diseases↗
PubMed1996

The routine use of fresh frozen plasma in operations with cardiopulmonary bypass is not justified.

BACKGROUND: The negative influence of cardiopulmonary bypass on hemostasis has been documented. Although abnormalities in platelet function are reported as the major cause of postoperative blood loss related to this hemostasis defect, fresh frozen plasma is often used in operations with cardiopulmonary bypass because it is thought to contribute to the reduction of postoperative bleeding complications. This study was designed to evaluate the effect of the administration of fresh frozen plasma after cardiopulmonary bypass on blood loss, transfusion requirements, and a number of coagulation parameters. METHODS: In a prospective, randomized, double-blind clinical trial 50 patients (mean age 63 years; 35 men/15 women) undergoing elective operation with cardiopulmonary bypass were randomly assigned to one of two groups: group I (n = 24) received 3 units of fresh frozen plasma after operation and group II (n = 26) received an equal amount of Gelofusine plasma substitute. At seven points before, during, and after operation hemoglobin concentration, hematocrit level, thrombocyte count, and coagulation parameters were analyzed. Study endpoints were the volume of blood loss and the transfusion requirement. RESULTS: There were no significant differences between the two study groups in blood loss, transfusion requirement, coagulation parameters, or thrombocyte counts. CONCLUSION: The routine use of fresh frozen plasma in operations with cardiopulmonary bypass cannot be recommended.

Aged↗
PubMed1988

Hydroxyethyl starch 120, dextran 70 and acetated Ringer's solution: hemodilution, albumin, colloid osmotic pressure and fluid balance following replacement of blood loss in pigs.

Twenty healthy pigs weighing 12-17 kg were anesthetized and the small intestines were exteriorized into saline-moistened gauze. During a 2-h period 4% of the animals' body weight was bled through an arterial cannula in six increments and replaced immediately by the fluid tested: hydroxyethyl starch 120 (HES, Plasmafusin, Orion Corp., Mw 120,000), dextran 70 (DEX) and Ringer's acetate (RA). The amount of fluid infused for replacement of blood loss was equal to the amount of blood withdrawn in the colloid groups but fourfold in the RA group. Five non-bled pigs served as controls. After the hemodilution the laparotomy was closed and the animals received only 5% dextrose (2 ml/kg/min) during a 5-h follow-up period. The synthetic colloids caused a more effective dilution of hemoglobin and albumin than did RA. The colloid osmotic pressure (COP) was well maintained by the plasma substitutes but decreased in the RA group to 64% of the initial values. A stable urinary output and no edema formation was found in the HES and DEX groups. The RA animals were unable to excrete the excess crystalloid, which resulted in a strikingly positive fluid balance persisting throughout the study. Thus, the synthetic colloids were superior to RA in expansion of the plasma volume, maintenance of the COP and prevention of fluid accumulation. The effect of the two colloids was similar except that COP was slightly better maintained during the follow-up period in animals which received HES 120.

Animals↗
PubMedDate not supplied

[Epidemiology and prevention of anaphylactoid reactions in heart surgery patients].

A retrospective analysis of the incidence, severity, and causes of anaphylactoid reactions (AR) in 1504 cardiosurgical patients operated on at Research Center of Surgery in 1995-1999 showed that AR occurred in 109 (7.4%) patients: 60% during aortocoronary bypass operations, 27.2% during correction of acquired heart diseases, and 12.8% during correction of congenital heart diseases. Skin symptoms predominated in the structure of AR (59.7%); cardiovascular episodes ranked second (38.5%), and the incidence of pulmonary reactions was lowest (1.8%). The causes of AR during anesthesia and surgery were platelet-rich plasma and fresh-frozen plasma (35.3%), antibiotics (12.1%), protamine (12.1%), myorelaxants (9.9%), colloid plasma substitutes (8.8%), dioxidine (3.3%), heparin (2.2%), aprotinin (1.1%), diazepam (2.2%), and other agents (7.6%). A history of AR and repeated interventions are risk factors of AR. The protocol of AR prevention in cardiosurgical patients includes determination of risk factors, selection of the least hazardous agents, strict adherence to the rate of infusion of histamine-releasing drugs, minimum utilization of donor blood components (platelets and plasma), use of H1 and H2 blockers, corticosteroids (celestone) during premedication and operation. Such treatment helped decrease the severity and incidence of AR in cardiosurgical patients to 4.7%.

Adult↗
PubMed1997

Therapeutic plasmapheresis.

Plasmapheresis is the process by which plasma containing components causing or thought to cause disease is removed from the circulation, and the remaining blood components are returned with plasma or a harmless plasma substitute to the donor. It primarily removes protein-bound solutes or high-molecular-weight solutes such as circulating protein-bound toxins, autoantibodies, immune complexes, or other abnormally occurring molecules. Plasmapheresis has been used in the treatment of more than 100 diseases in human medicine, including immune-mediated diseases, neoplasia, infectious diseases, sepsis, hyperlipidemia, thyrotoxicosis, and removal of toxins. In immune-mediated disease, it is most useful to rapidly decrease plasma concentrations of antibodies or immune complexes, whereas other immunosuppressive measures are used to prolong the effect.

Anemia, Hemolytic↗