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PubMed1995

Plasmapheresis as preparatory method for thymectomy in myasthenia gravis.

To study the effects of plasmapheresis in preparation for thymectomy, two groups of 40 patients were selected from a sample of 286 patients with myasthenia gravis examined by the first author Group 1 included patients (15 male and 25 female; age range 8-64 yrs) who underwent thymectomy without previous plasmapheresis, whereas patients in group 2 (17 male and 23 female; age range 11-61 yrs) were thymectomized after plasmapheresis. We required patients to have a minimum follow-up period of 12 months to be included in the study. A clinical evaluation protocol composed of 76 items was developed for the study. We found significant improvement in respiratory function and muscular strength in patients thymetomized after plasmapheresis. Furthermore, the combined treatment reduced cost and length of hospital stay. Therefore, we conclude that plasmapheresis should be considered as a coadjuvant to thymectomy in the treatment of myasthenia gravis.

Adolescent↗
PubMed1995

The steroid-sparing effect of long-term plasmapheresis in pemphigus.

Glucocorticoids and immunosuppressive agents can induce remission in most patients with pemphigus, but mortality remains at 5 to 15% due to complications from these drugs. We reviewed the adjunctive effect of long-term plasmapheresis in 8 patients with pemphigus. Four cases had been resistant to conventional therapy. One or two large-volume plasmapheresis treatments were given monthly for 5 to 73 months. All patients were in clinical remission within 2 months after the addition of plasmapheresis. Relapses of pemphigus seldom occurred, and the patients stayed in remission 90% (40-100%) (median and ranges) of the plasmapheresis period. In all cases the daily dose of glucocorticoid was reduced. The prednisone level could be decreased significantly from 38 (15-80) mg/day to 10 (5-35) mg/day (p = 0.008). The overall level of other immunosuppressive agents remained unchanged, except in one patient where cyclosporine was introduced. This first report of long-term plasmapheresis demonstrates clinical efficacy in pemphigus and a considerable steroid-sparing effect.

Adult↗
PubMedDate not supplied

Benefit of modified plasmapheresis in the management of myasthenia gravis: a case report.

BACKGROUND: Myasthenia gravis is an autoimmune disease condition caused by the generation of antibodies against the acetylcholine receptor sites at the neuromuscular junction. The treatment modalities include anticholinesterase drugs, corticosteroids, immunotherapy, thymectomy and plasmapheresis. However, because of the poor financial state of our patients and the dearth of appropriate equipment in our centres modifications are made to standard treatment modalities including plasmapharesis. METHOD: We report a case of myasthenia gravis who was on various occasions on neostigmine, pyridostigmine and prednisolone. After about 18 months of treatment, he developed myasthenic crises on two occasions. He was admitted in the ICU for respiratory support where he also had modified plasmapheresis. RESULTS: The patient had remarkable improvement following the modified plasmapheresis with reversal of symptoms of the myasthenic crises. CONCLUSION: In the absence of facilities for standard plasmapheresis in this environment, the use of modified plasmapheresis is hereby recommended.

Adult↗
PubMed2003

[Plasmapheresis therapy in systemic sclerosis].

BACKGROUND: Systemic sclerosis (SSc) is a polysystemic autoimmune disorder characterized by excessive production of extracellular matrix and vascular abnormalities, involving the skin and internal organs. There is currently no real disease-modifying therapy of SSc and there are only few reports on the use of plasmapheresis in SSc. OBJECTIVES: Authors present 4 cases of SSc treated with plasmapheresis within one year from disease onset. All patients had diffuse cutaneous form of SSc with rapid progression and with different internal organ manifestations. METHODS: The patients were treated with plasmapheresis performed every 3 months besides symptomatic drug treatment. Clinical symptoms, Rodnan skin score, immunolaboratory markers (serum immunoglobulin, complement, several autoantibodies, leukocyte CD markers) and soluble adhesion molecules (E-selectin, intercellular adhesion molecule 1, vascular cell adhesion molecule, which were showed as the markers of disease activity in previous works) were determined before and after the plasmapheresis. RESULTS: The progression of the disease slowed down significantly in all patients, no more new clinical manifestation appeared, Rodnan skin score significantly decreased. There was a reduction in CD4/CD8 ratio (approaching normal ratio), in expression of CD69, as early activation marker. There was a significant suppression of soluble adhesion molecules also in all patients. CONCLUSION: In patients with diffuse cutaneous form of SSc, plasmapheresis may be effective with decreasing progression of the disease and improving clinical symptoms (especially skin manifestation) in the early phase of the disease.

Adult↗
PubMed2004

[Plasmapheresis in the treatment of septic shock].

BACKGROUND: Sepsis is an increasingly common cause of morbidity and mortality and the leading cause of death in intensive care units. In recent years many new therapies for sepsis have been tested in randomised clinical trials, but most of them have failed to reduce mortality. Plasmapheresis is a nonselective method by which plasma is separated from the blood and replaced with donor plasma and/or albumin. The theoretical rationale is that plasmapheresis removes the harmful mediators and replenishes the consumed plasma factors, thus restoring the homeostatic milieu. MATERIALS AND METHODS: This article is based upon own research and a review of the current literature found in PubMed. RESULTS: Over the last 30 years, several experimental and clinical studies have reported a beneficial effect of plasmapheresis in the treatment of patients with severe sepsis and septic shock. Most of the studies have focused on Gram-negative sepsis. Only a few of the clinical studies are prospective, randomised trials with appropriate control groups. INTERPRETATION: There is not sufficient evidence to justify the use of plasmapheresis as standard treatment of patients with severe sepsis and septic shock. However, plasmapheresis should be considered for fulminant Gram-negative septic shock. If applied, it should be started urgently and repeated in unresponsive patients and when a patient's clinical condition is deteriorating.

Animals↗
PubMed1991

[Plasmapheresis in combined treatment of severe generalized myasthenia].

Experience in the application of plasmapheresis in various stages of treatment is analysed. It was conducted in 52 patients with severe forms of generalized myasthenia; 12 of them were males and 40 were females. It is noted that plasmapheresis is very effective in the preoperative period for the preparation of patients for operation and is ineffective in medicamentous therapy. In the late-term periods after thymectomy plasmapheresis is mainly recommended for arresting crises and precritical conditions because of the rapid and short effect of the method. In patients who underwent thymectomy and splenectomy the effect of plasmapheresis in the late-term period after the operation was of a longer duration. Research must be continued and clinical experience accumulated to identify exactly the mechanism of the effect of plasmapheresis on the myasthenic status and the immune and neuroendocrine systems and to determine the place of the method in the complex of therapeutic measures.

Adult↗
PubMedDate not supplied

[Combined therapy of multiple myeloma: cytostatics and plasmapheresis].

In 11 patients with III A stage multiple myeloma in every week before new course of cytostatics started, three times plasmapheresis therapy had been performed. There was no difference in reducing of plasma cell mass, plasma immunoglobulins concentration and proteinuria or disappearance of osteolytic bone lesions between the group of patients treated with combination chemotherapy and plasmapheresis and chemotherapy alone. However there was visible disparity in the disappearance of bony pains: rapidly in the plasmapheresis group. One serious complication after plasmapheresis therapy was notified: gastric haemorrhage. The remaining plasmapheresis complications: tetany, nausea, vomiting, chills and bradycardia were related to citrate toxicity.

Adult↗
PubMed1989

Total and antigen-specific serum immunoglobulin isotype concentrations in hyperimmunized cattle that have undergone plasmapheresis.

The effects of prolonged plasmapheresis of cattle on total and antigen-specific immunoglobulin production were evaluated. Five adult cows were hyperimmunized by repeated IV administration of live, logarithmic-phase Pasteurella haemolytica A1 organisms. Three of the cows underwent plasmapheresis daily for 3 weeks. From 2 cows, serum was only obtained periodically. Anti-P haemolytica antibody was assayed by indirect hemagglutination and a kinetic-augmented, antigen-capture ELISA for capsular polysaccharide and lipopolysaccharide/outer membrane protein antigens. Total serum immunoglobulin concentration was determined for IgM, IgG1, and IgG2 by primary radial immunodiffusion. Anti-P haemolytica A1 activity increased rapidly after immunization. After beginning plasmapheresis, the antigen-specific antibody activities remained nearly constant. In general, antilipopolysaccharide/outer membrane protein activity (in terms of concentration) was higher than anti-capsular polysaccharide activity and was not affected as much by the plasmapheresis. Total serum Ig concentration decreased transiently by a small amount after beginning plasmapheresis.

Animals↗
PubMed1988

[Use of plasmapheresis in the treatment of patients with severe arterial hypertension refractory to drug therapy].

Thirty patients with severe and malignant arterial hypertension (AH) received 1-4 sessions (in most cases 2) of plasmapheresis to overcome refractiveness to drug therapy. Stable BP reduction, improvement of the vascular picture of the fundus of the eye and raised sensitivity to antihypertensive therapy were noted in 26 patients. Though antihypertensive drug dosages were reduced, the antihypertensive effect of plasmapheresis could be observed within 3-8 mos (an average of 5.3 +/- 0.5 mos). The efficacy of plasmapheresis was approximately equal both in symptomatic AH and in essential hypertension. Plasmapheresis was shown to be a method of overcoming refractiveness to antihypertensive therapy which could not be used alone for therapy of refractory AH. Possible mechanisms of BP reduction after plasmapheresis were discussed.

Adult↗
PubMed1987

[Treatment of gastroduodenal ulcer by plasmapheresis and transfusion of thawed-out autologous plasma].

Curative plasmapheresis was performed in 21 patients with duodenal ulcer (DU) and in 3 patients with gastric ulcer (12 DU patients and 3 patients with gastric ulcer were taken as controls). The controls were treated by common pharmaceuticals (except Tagamet). Altogether 117 sessions of plasmapheresis were performed (an average of 5 sessions for each patient 2-3 times a week). Fibrogastroscopy was performed before and after a series of plasmapheresis (2-3 weeks after the start of therapy). In the DU patients treated by plasmapheresis ulcer cicatrization occurred in 18 days, in the controls in 27 days (p less than 0.001). In 3 patients with gastric ulcer treated by plasmapheresis cicatrization occurred on the 24th day, in the controls on the 41st day (p greater than 0.2). This method was proposed for patients with severe conditions due to the fact that a positive effect was also obtained in persons with persistently recurrent ulcers.

Adult↗
PubMed1980

Plasmapheresis as immunotherapeutic modality in the treatment of the canine venereal tumor.

Plasmapheresis was evaluated as a treatment modality for the transmissible venereal tumor (TVT) of the dog. The TVT is a unique tumor because of its capability for transplantation as a homograft between untreated randomly bred dogs and is characterized by the presence of dog leukocyte antigen (DLA) determinants on its tumor cells and reactivity in the mixed leukocyte tumor cell culture (MLTC). In the progressing phase, high titers of blocking antibodies measurable in the MLTC were noted. The purpose of this study was to evaluate the influence of plasmapheresis on the growth of established TVT and to correlate tumor response with the removal of blocking factors. Six pairs of DLA-identical dogs were used as experimental and control animals. Plasmapheresis was performed by discontinuous centrifugation using the Hemonetics model 30. An average of 1100 +/- 120 ml of plasma was exchanged on consecutive days during the third week after tumor injection. Consistently lower growth rates were observed in 2 experimental dogs, but there was no early rejection. Sera taken at day 14 of tumor growth contained significant blocking activity in all 12 dogs. Sera obtained post-plasmapheresis showed a decrease of blocking activity in all 6 experimental dogs, P less than 0.001. The TVT appears to be a suitable model for preclinical studies of plasmapheresis alone and in combination with other modalities.

Animals↗
PubMed1984

[Plasmapheresis in the treatment of diseases caused by immunologic pathology].

The authors discuss the results of the use of therapeutic plasmapheresis (290 sessions) in 56 patients with immunity-mediated diseases: hemorrhagic vasculitis, Goodpasture's syndrome, multiple sclerosis, Guillain-Barre's syndrome, rheumatoid arthritis, partial red cell aplasia, etc. Demonstrate the possibilities of the attainment of positive results provided plasmapheresis is included into the complex of therapeutic measures. Discuss the indications, criteria of the efficacy, and contraindications to plasmapheresis administration. Infer that the clinical data play the decisive role in the appraisal of the plasmapheresis efficacy. Recommend that intermittent plasmapheresis be widely used for the treatment of internal diseases.

Adolescent↗
PubMed1984

[Changes in fibronectin concentration during therapeutic plasmapheresis. Therapeutic effectiveness of selective removal of fibronectin in immune complex pathology].

Variation in the concentration of plasma fibronectin (FN) seen during 65 sessions of therapeutic plasmapheresis was studied in 20 inpatients with the following diagnoses: acute leukemias (4), paraproteinemic hemoblastoses (5), Sjögren's syndrome (2), protracted septic endocarditis (1), systemic lupus erythematosus (17), acute polyradiculoneuritis (1), multiple sclerosis (3). The patients' age ranged within 19 to 64 years. There were 10 men and 10 women. The concentration of FN in 218 plasma samples was measured by the ELISA. It was discovered that plasma of healthy donors contained 200 to 400 micrograms/ml FN (M +/- 1.5 sigma). Prior to plasmapheresis the glycoprotein content in all the patients was on the average within normal (300 micrograms/ml). After the session the concentration of FN decreased almost two-fold (130 micrograms/ml); after 6 hours it was 175 micrograms/ml on the average, whereas after 24-48 hours it reached the initial level. Repeated plasmapheresis sessions carried out once every 3-4 days did not lead to the depletion of the FN pool, since its level reached the initial one over the first 24-48 hours. Such a mechanism was unchanged regardless of the initial level of FN recorded in the patients blood (high, normal or low). No relationship was found between FN deficiency which developed after plasmapheresis and infectious complications. It is assumed that FN deficiency per se cannot be responsible for the patients' decreased resistance to infection. Three patients received a series of selective plasmapheresis. Sjögren's syndrome and immune complex vasculitis was diagnosed in one female patient, hemorrhagic vasculitis due to chronic hepatitis in another female patient, the third female patient manifested gammapathy with cryoglobulinemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Role of plasmapheresis in preparing myasthenic patients for thymectomy: initial results.

Between 1976 and 1981, one of the authors operated on 16 patients for myasthenia gravis. Plasmapheresis was carried out preoperatively on seven patients, while nine patients were operated upon without previous plasmapheresis. The seven patients who underwent plasmapheresis had a smooth course pre- and postoperatively. In the other group, there were two postoperative myasthenic complications. Both patients improved with medication and plasmapheresis. Also, the degree of myasthenia gravis was slightly more severe in this group. From their experience, the authors conclude that plasmapheresis is a worthwhile and safe adjuvant in the preparation of myasthenic patients for thymectomy, especially those in Osserman class IV.

Adolescent↗
PubMed1980

Infectious complications with plasmapheresis in rapidly progressive glomerulonephritis.

We recently used plasmapheresis to treat eight patients with rapidly progressive glomerulonephritis. Life-threatening infections developed in five patients, three of which were caused by opportunistic pathogens. In contrast, only two infections occurred in 21 patients with similar renal disease treated with immunosuppressive drugs but not with plasmapheresis. Although infectious complications of plasmapheresis therapy have not been amphasized previously, our experience, coupled with that of previous reports, suggests that serious infections will develop in one third of patients undergoing plasmapheresis for renal disease. Plasmapheresis should be used with caution in patients with rapidly progressive glomerulonephritis.

Adolescent↗
PubMed1978

Immunological and plasma protein changes in cancer patients following a single plasmapheresis.

Serial serum protein determinations and immunological monitoring were performed prior to and following a single 4 to 5 liter plasma exchange in 10 patients with disseminated cancer. The most consistent changes were observed for two initially elevated alpha globulins, acid glycoprotein and haptoglobin, which declined rapidly in all patients 1 hour after plasmapheresis and began to rise again as early as 24 hours post-plasmapheresis to reach initial levels by 72 hours. Among the immunological parameters T and B cell counts, and phytohemaglutinin-induced lymphocyte transformation showed little change. In 4 out of 10 patients C3 levels dropped at 1 hour post-plasmapheresis and continued to decline to 24 hours, suggesting that consumption of C3 possibly by macrophages may have occurred. In view of our earlier reports that repeated plasmapheresis induced partial tumor regressions in patients with disseminated cancer and that these regressions may have been related to depletion of immunosuppressive serum proteins, it is suggested that to maintain levels of these rapidly renewed proteins at a minimum for as long as possible, it is most appropriate to perform plasmapheresis every 48 hours rather than every 72 or 96 hours as was the case in the earlier study.

Adult↗
PubMedDate not supplied

[Plasmapheresis in the treatment of complicated forms of acute suppurative pyelonephritis in pregnant women].

Plasmapheresis was carried out in the course of treatment of 46 19-28-year-old females (gestation 13-37 weeks) suffering from complicated acute purulent pyelonephritis (APP) versus 50 controls treated conventionally without plasmapheresis. Nonconventional scheme included antibacterial therapy, infusions, plasmapheresis, surgical interventions. The number of plasmapheresis sessions ranged from 3 to 6 per 1 patient depending on APP severity and efficacy of the treatment. Plasma removal reached 600-900 ml of plasma per session, a total of 2000-2600 ml per course of treatment. Introduction of plasmapheresis made it easier to manage pyoseptic intoxication, to achieve clinico- laboratory remission. The efficacy of treatment increased by 20%.

Acute Disease↗
PubMed1994

[An epidemiological study on malaria infection in plasmapheresis donors].

Epidemiological studies showed incidence of malaria in 8391 plasmapheresis donors of five villages was 4.14%, higher than in those donating whole blood and non--donors. Case--control studies revealed plasmapheresis was a risk factor for malaria infection. Incubation period of plasmapheresis--associated malaria was 16.5 days. Investigation on the blood bank showed there existed cross infection in plasmapheresis. After the close of the blood bank, epidemic of malaria caused by cross infection in plasmapheresis was under control.

Adult↗