Journal of Clinical Apheresis via MedWorm.com

Current status of additive solutions for platelets

Journal of Clinical Apheresis — Thu, 02 Feb 2012 05:00:00 +0100

AbstractThe storage of platelets in additive solution (PAS) had lagged behind red cell concentrates, especially in North America. The partial or complete removal of anticoagulated plasma and storage of platelet concentrates in AS presents many advantages. The PAS can be formulated to optimize aerobic metabolism or decrease platelet activation, thus abrogating the platelet storage lesion and potentially improving in vivo viability. Plasma removal has been shown to reduce allergic reactions and the plasma harvested could contribute to the available plasma pool for transfusion or fractionation. PAS coupled to pathogen reduction technology results in a platelet product of equivalent hemostatic efficacy to conventionally stored platelets. Given the above, the likely future direction of platelet...

The effective use of plerixafor as a real‐time rescue strategy for patients poorly mobilizing autologous CD34+ cells

Journal of Clinical Apheresis — Thu, 02 Feb 2012 05:00:00 +0100

AbstractPlerixafor enhances CD34+ cell mobilization, however, its optimal use is unknown. We hypothesized that plerixafor could “rescue” patients in the midst of mobilization when factors indicated a poor CD34+ yield. Of 295 consecutive autologous peripheral blood mobilization attempts at our center, 39 (13%) used plerixafor as rescue strategy due to a CD34+ cell concentration <10/μl (median 5.95/μl, n = 30), low CD34+ cell yield from prior apheresis day (median 1.06 × 106 CD34+ cells/kg, n = 7), or other (n = 2). Patients received a median of one plerixafor dose (range: 1–4). Thirty‐four (87%) collected =2 × 10 6 CD34+ cells/kg and 26 (67%) collected =4 × 10 6 CD34+ cells/kg. Median collections for lymphoma (n = 24) and myeloma (n = 15) patients were 4.1 × 106 and 8.3 × ...

Predictive factors for inadequate stem cell mobilization in Chinese patients with NHL and HL: 14‐year experience of a single‐center study

Journal of Clinical Apheresis — Thu, 02 Feb 2012 05:00:00 +0100

Conclusion: Our analysis showed that high amounts of chemotherapy, radiotherapy, low platelet count, chemosensitive recurrent patients, combination chemotherapy plus G‐CSF and low CD34+ cells in BM prior to mobilization could emerged as important predictive factors for mobilization failure in Chinese patients with NHL and HL. J. Clin. Apheresis, 2012. © 2012 Wiley Periodicals, Inc. (Source: Journal of Clinical Apheresis)

Abstracts From the American Society for Apheresis 33rd Annual Meeting, April 11–14, 2012 Atlanta, Georgia

Journal of Clinical Apheresis — Tue, 31 Jan 2012 05:00:00 +0100

(Source: Journal of Clinical Apheresis)

Kinetics of the soluble IL‐1 receptor type I during treatment with an LCAP filter in patients with inflammatory bowel disease

Journal of Clinical Apheresis — Fri, 20 Jan 2012 05:00:00 +0100

AbstractLeukocyte apheresis primarily used for treatment of inflammatory diseases such as inflammatory bowel disease (IBD). Beside an effect of the apheresis column, the plastic lines in the apheresis system might also have an effect due to interaction between the plastic surfaces and circulating leukocytes and plasma proteins. We recently reported generation of LL‐37 in the plastic lines during leukocyte adsorbing apheresis. This generation might have a positive impact on the immunologic tolerance and therefore be one operational mechanism by which the apheresis treatment executes its effect. In the present study, we report a significant generation of sIL‐1RI in the apheresis lines that is initially absorbed by the LCAP device. This finding, together with our previous data on IL‐1Ra...

Therapeutic plasma exchange in Streptococcus pneumoniae‐associated hemolytic uremic syndrome: A case report

Journal of Clinical Apheresis — Thu, 01 Dec 2011 05:00:00 +0100

Isovolemic hemodilution–red cell exchange for prevention of cerebrovascular accident in sickle cell anemia: The standard operating procedure

Journal of Clinical Apheresis — Thu, 01 Dec 2011 05:00:00 +0100

AbstractRed blood cell exchange is an accepted superior therapy to simple chronic transfusion, due to minimal risk of iron overload, for secondary prevention of cerebrovascular accidents in selected patients with sickle cell anemia. Recently, we described our experience of Isovolemic Hemodilution–Red Blood Cell Exchange (IHD‐RBCx), a two‐step modification of the conventional RBCx with several advantages, including cost reduction. We are describing our standard operating procedure for IHD‐RBCx with COBE Spectra apheresis system to make it widely available to the apheresis centers interested in implementing this procedure. J. Clin. Apheresis, 2012. © 2012 Wiley Periodicals, Inc. (Source: Journal of Clinical Apheresis)

ABO‐incompatible kidney transplantation using regenerative selective immunoglobulin adsorption

Journal of Clinical Apheresis — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: These data suggest that ABOi kidney transplantation can be performed safely and effectively with a selective regenerative immunoglobulin immunoadsorber. J. Clin. Apheresis, 2012. © 2012 Wiley Periodicals, Inc. (Source: Journal of Clinical Apheresis)

Long‐term strategies for the treatment of Refsum's disease using therapeutic apheresis

Journal of Clinical Apheresis — Thu, 01 Dec 2011 05:00:00 +0100

We report on the long‐term lipid apheresis treatment of four patients with severe Refsum's disease. Retinitis pigmentosa, peripheral polyneuropathy, cerebellar ataxia, anosmia, and sensorineural hearing loss were major symptoms exhibiting a progressive course. Lipid apheresis was performed for 5–13 years without severe complications. Maximum levels of phytanic acid before commencing chronic lipid apheresis were >300 mg/l. During steady state with lipid apheresis, mean phytanic acid before treatments was 87 mg/l and was reduced to 36 mg/l. Mean reduction rate was 59% per treatment. In all patients, abnormal motor nerve conduction velocity with signs of chronic denervation improved, morphological and functional stabilization of eye involvement was observed. Lipid apheresis prevented t...

Measuring the quality of therapeutic apheresis care in the pediatric intensive care unit

Journal of Clinical Apheresis — Thu, 17 Nov 2011 05:00:00 +0100

We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or “in control.” The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory ...

Rapid increase in parasitemia following red cell exchange for malaria

Journal of Clinical Apheresis — Fri, 11 Nov 2011 05:00:00 +0100

(Source: Journal of Clinical Apheresis)

Lenograstim with or without dexamethasone for neutrophil mobilization in healthy donors: Short‐term kinetics of white blood cells and effects of granulocyte apheresis

Journal of Clinical Apheresis — Wed, 09 Nov 2011 05:00:00 +0100

Conclusions: Single doses of lenograstim with or without DXM induced a PMN plateau that lasted 9 h (12–21 h after mobilization), with PMN counts suitable for neutrophil collection. Lenograstim plus DXM made it possible to perform NA twice, 12 and 36 h after mobilization. © 2011 Wiley Periodicals, Inc. (Source: Journal of Clinical Apheresis)

Collection of peripheral blood progenitor cells for autologous use: Performance enhancements of COBE spectra, auto‐PBSC

Journal of Clinical Apheresis — Tue, 13 Sep 2011 04:00:00 +0100

AbstractCollection of peripheral blood stem cells (PBSC) must be performed in a safe and effective manner. Issues like automation, collection efficiency (CE), and adverse events must be considered. Auto‐PBSC (COBE Spectra) is a fully automated program for PBSC collection. Changes in the protocol were made to achieve high CE, low product volume, and resulted in three groups of patients. Standard operating procedures (SOPs) were developed to reduce citrate toxicity and patients with central venous catheter. Twenty patients and 27 collections (Group 1), 88 patients and 112 collections (Group 2), and 158 patients and 194 collections (Group 3) were recorded. The protocol changes increased CE significantly from 31% (Group 1) to 57 and 59% (Group 2 and 3). Adjusting endpoint according to the pr...

The potential role of plasma exchange as a treatment for bilateral diffuse uveal melanocytic proliferation: A report of two cases

Journal of Clinical Apheresis — Sun, 04 Sep 2011 23:00:00 +0100

We describe the cases of two women with gynecologic malignancies who were treated with plasma exchange (PE) for BDUMP. After a course of five to seven procedures, their ocular disease stabilized. One patient has maintained her vision more than 1 year following the completion of the course of PE. The other patient, who also received treatment with corticosteroids, in addition to the PE, reported stable vision on telephone follow‐up 9 months after presentation. These cases suggest that PE may be a treatment option in this rare paraneoplastic syndrome which has otherwise been reported to invariably result in vision loss. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Selected questions and answers given by apheresis medicine experts at TAA 2010

Journal of Clinical Apheresis — Sun, 04 Sep 2011 23:00:00 +0100

(Source: Journal of Clinical Apheresis)

Extracorporeal photopheresis: How, when, and why

Journal of Clinical Apheresis — Sun, 04 Sep 2011 23:00:00 +0100

This article reviews scientific insights into its mechanism of action on the immune system, details of the clinical procedure, its clinical applications in various diseases, and the current evidence for its efficacy and place in medical therapeutics. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Therapeutic plasma exchange for the treatment of anti‐NMDA receptor encephalitis

Journal of Clinical Apheresis — Sun, 04 Sep 2011 23:00:00 +0100

AbstractAnti‐N‐methyl‐D‐aspartate receptor (NMDA‐R) encephalitis is thought to be one of the common paraneoplastic‐associated encephalitides. Between February 2001 and February 2011, nine patients were diagnosed with this disorder at Columbia University Medical Center: eight females (mean age 23 years) and one male (3 years of age). Four female patients had ovarian teratomas, which were removed as part of their treatment. Therapeutic plasma exchange (TPE) was used as one of the treatment modalities in addition to immunosuppressive therapy, including corticosteroids, intravenous immunoglobulin (IVIG), and/or rituximab. A total of 56 TPE procedures were performed in these patients on alternate days (range, 5–14 procedures/patient). Approximately 1 plasma volume (PV) was process...

Therapeutic apheresis: A review of complications and recommendations for Prevention and management

Journal of Clinical Apheresis — Sun, 04 Sep 2011 23:00:00 +0100

We present a representative case based review of common complications of therapeutic apheresis and suggestions about how to prevent or manage these as presented at the 2010 Therapeutic Apheresis Academy. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Apheresis medicine state of the art in 2010: American Society for Apheresis fifth special edition of the Journal of Clinical Apheresis

Journal of Clinical Apheresis — Tue, 30 Aug 2011 23:00:00 +0100

This article reviews the history of the ASFA guidelines, the changes that were made in the 2010 guidelines, and future directions and plans for these guidelines. The 2010 ASFA guidelines on the use of therapeutic apheresis in clinical practice represent the state of the art in apheresis medicine in 2010. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Conventional apheresis therapies: A review

Journal of Clinical Apheresis — Tue, 30 Aug 2011 23:00:00 +0100

This article reviews advances in the scientific basis and medical practice of plasmapheresis and cytapheresis therapies. Newly‐characterized autoantibodies in neuromyelitis optica, Guillain‐Barre variants, anti‐neutrophil cytoplasmic antibody (ANCA) vasculitides, etc., exemplify the modern molecular biology which now provides a rigorous framework of understanding for the clinical practice of plasmapheresis. Clinical trials continue to clarify the appropriate use of therapeutic plasmapheresis (TPE) in these and other diseases. Centrifugal (cTPE) and membrane filtration (mTPE) types of plasmapheresis are compared, with details of the plasmapheresis prescription, anticoagulation choices, replacement fluids and other practical considerations. Plasma removal is more efficient with cTPE; m...

Therapeutic plasma exchange and renal related vasculitis: Therapeutic apheresis academy 2010

Journal of Clinical Apheresis — Tue, 09 Aug 2011 23:00:00 +0100

AbstractTherapeutic plasma exchange (TPE), a form of extracorporeal therapy, has been used in the management of many systemic conditions some of which include the systemic vasculitides that affect the kidneys. The following is a mini review of what is known about renal related indications for TPE in such conditions and the evidence based literature available as presented at the Therapeutic Apheresis Academy in September 2010. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Therapeutic apheresis in critically ill patients

Journal of Clinical Apheresis — Tue, 09 Aug 2011 23:00:00 +0100

AbstractTherapeutic apheresis procedures in critically ill patients comprises of therapeutic plasma exchange in most cases but also less commonly, erythrocytapheresis (red cell exchange), thrombocytapheresis, or leukocytapheresis. These procedures present a number of challenges to the apheresis healthcare team, and there are myriad beneficial and adverse effects for patients. In this patient population, one has to weigh the risks against the benefits and especially in those situations where apheresis is requested as a treatment when other alternative therapies have failed. Therapeutic plasma exchange is capable of removing toxins, pathologic auto‐ and allo‐antibodies but will also remove beneficial medications, clotting factors and cations which are chelated by citrate anticoagulant. H...

Advantages of isovolemic hemodilution‐red cell exchange therapy to prevent recurrent stroke in sickle cell anemia patients

Journal of Clinical Apheresis — Thu, 21 Jul 2011 23:00:00 +0100

AbstractChronic simple hypertransfusion (every 3 to 4 weeks) effectively prevents secondary stroke in children with sickle cell anemia but leads to iron overload despite chelation therapy. Conventional red blood cell exchange (C‐RBCx) has advantages over simple transfusion: no net iron gain and less frequent hospital visits. However, C‐RBCx requires more red blood cell units, an apheresis instrument and skilled personnel; it is also more expensive. We developed a modified procedure where isovolemic hemodilution precedes RBCx (IHD‐RBCx) to decrease RBC units required and to increase the interval between procedures. Twenty patients underwent IHD‐RBCx over a period of 7 years. IHD‐RBCx required 11% fewer RBC units and increased inter‐procedure interval from 37 to 53 days compared ...

Outcomes of previously healthy pediatric patients with fulminant sepsis‐induced multisystem organ failure receiving therapeutic plasma exchange

Journal of Clinical Apheresis — Thu, 21 Jul 2011 23:00:00 +0100

Conclusions: > TPE may contribute to a better outcome in previously healthy pediatric patients with fulminant sepsis‐induced MSOF, especially if instituted early in the course of multiorgan failure. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Comparison of hematopoietic progenitor cell collections using the COBE Spectra version 7 and Amicus version 3.1 for patients with al amyloidosis

Journal of Clinical Apheresis — Wed, 25 May 2011 23:00:00 +0100

In this study, in a cohort of AL amyloid patients, we compared the Amicus version 3.1 to the Spectra version 7 MNC collections with regard to infused fluid volume, CD34+ cell yield, lymphocyte yield, cross‐cellular content, and adverse reactions. Both instruments used a 26:1 AC ratio but the Amicus delivered significantly less AC per procedure (Amicus 678 mL vs. Spectra 753 mL). With comparable baseline CD34+ cell counts (Amicus 33 cells/μL vs. Spectra 27 cells/μL); Amicus collected significantly more CD34+ cells (3.1 vs. 1.5 × 106/kg) and equivalent lymphocytes (18.7 vs. 14.5 × 109). Amicus collected significantly fewer WBC (51.8 vs. 72.7 × 109), granulocytes (15.1 vs. 27.5 × 109), and PLT (2.3 vs. 3.9 × 1011) per procedure with equivalent RBC content (26 vs. 30 mL). CD34+ cell (...

Use of plasma exchange in patients with heparin‐induced thrombocytopenia: A report of two cases and a review of the literature

Journal of Clinical Apheresis — Mon, 18 Apr 2011 23:00:00 +0100

We report two patients with HIT who underwent successful CPB with heparin anticoagulation following plasma exchange (PE) to reduce heparin/PF4 antibody titers. Case 1 is a 46‐year‐old male with cardiac amyloidosis who needed urgent placement of a left ventricular assist device. Case 2 is a 34‐year‐old woman with acute myocarditis who needed placement of a biventricular assist device. Both patients had positive enzyme‐linked immunosorbent assay assays for heparin/PF4 antibodies and clinical evidence of HIT before PE. Following PE and subsequent CPB, neither patient had clinical or laboratory evidence of HIT. The literature regarding the use of PE for the treatment of complications of HIT and as prophylaxis before CPB is reviewed. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc...

Successful treatment of patients with systemic lupus erythematosus complicated with autoimmune thyroid disease using double‐filtration plasmapheresis: A retrospective study

Journal of Clinical Apheresis — Thu, 31 Mar 2011 23:00:00 +0100

Conclusion:DFPP can effectively remove autoantibodies and may have an important adjuvant role in therapeutic options in the treatment of SLE patients with AITD complications. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Successful preoperative treatment of a Graves' disease patient with agranulocytosis and hemophagocytosis using double filtration plasmapheresis—Case report

Journal of Clinical Apheresis — Tue, 25 Jan 2011 00:00:00 +0100

We report a case of a patient with Graves' disease complicated with intravenous immunoglobulin responsive methimazole‐induced agranulocytosis/hemophagocytosis who underwent successful preoperative DFPP treatment in preparation for thyriodectomy. In addition to conventional apheresis using FFP replacement, DFPP may offer an effective adjunct option in the management of hyperthyroid patients needing emergent surgical interventions. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Manual color monitoring to optimize hematopoietic progenitor cell collection on the Fenwal Amicus

Journal of Clinical Apheresis — Tue, 25 Jan 2011 00:00:00 +0100

AbstractA technique was developed to improve consistency of MNC transfers from the centrifuge to the collection bag in the Fenwal Amicus. The operator assures that RBCs completely fill the cassette by the end of the transfer by adjusting the RBC offset in succeeding cycles. We compared yields and crosscellular content before and after implementation of the monitoring technique. Retrospective data from 400 consecutive HPC collection procedures (200 for each technique) were compared. In 40 monitored collections, the RBC offset was adjusted to 6–9 mL to ensure that RBCs completely filled the cassette. Collections requiring these adjustments were not associated with a specific diagnosis. Median values were compared between the 40 collections requiring offset adjustment and those performed be...

A randomized and controlled study comparing immunoadsorption and plasma exchange in myasthenic crisis

Journal of Clinical Apheresis — Sat, 01 Jan 2011 05:00:00 +0100

In conclusion, IA proved to be equally effective compared with PE treatment in patients with myasthenic crisis. Three to five treatment sessions using low plasma volume dosage of 20–25 ml/kg were adequate to improve clinically relevant symptoms significantly in most patients. J. Clin. Apheresis, 2011. © 2011 Wiley Periodicals, Inc. (Source: Journal of Clinical Apheresis)

Optimal apheresis treatment volume for the efficacy and safety of leukocytapheresis with cellsorba in patients with active ulcerative colitis

Journal of Clinical Apheresis — Sat, 01 Jan 2011 05:00:00 +0100

Conclusions: The outcomes of this investigation showed that the therapeutic efficacy of LCAP based on 30 mL/kg × BW is similar to the routine 3,000 mL per session LCAP. However, BWA‐LCAP should be favored if one is to see the full potential of LCAP without AE. © 2011 Wiley Periodicals, Inc. (Source: Journal of Clinical Apheresis)

Blood exchange and malaria

Journal of Clinical Apheresis — Sat, 01 Jan 2011 05:00:00 +0100

(Source: Journal of Clinical Apheresis)

The Italian registry of therapeutic apheresis: Granulocyte–monocyte apheresis in the treatment of inflammatory bowel disease. A multicentric study

Journal of Clinical Apheresis — Sat, 01 Jan 2011 05:00:00 +0100

In this study, laboratory data and clinical outcomes of 230 patients (148 males, mean age 43.5 years) affected with ulcerative colitis (UC, n = 194) or Crohn's disease (CD, n = 36) who underwent one or more cycles of GMA were analyzed. Each cycle consisted of five GMA treatments. The patients were followed up for a mean of 8.7 (min. 3 to max. 12) months. At 3 months, positive outcome was achieved in 77.7% of UC patients (72.0% remission, 5.7% clinical response) and 61.3% of CD patients (54.8% remission, 6.5% clinical response). The cumulative proportion of positive outcome at 12 months was 87.1% for UC patients (83.7% remission, 3.4% clinical response) and 77.4% for CD patients (74.2% remission, 3.2% clinical response). No single clinical or laboratory parameter among those analyzed (age, ...

Adjunct therapeutic plasma exchange for anti‐N‐methyl‐D‐aspartate receptor antibody encephalitis: A case report and review of literature

Journal of Clinical Apheresis — Sat, 01 Jan 2011 05:00:00 +0100

We report a case of a previously healthy 14‐year‐old girl with sudden‐onset paranoia, hallucinations, hyperactivity, increased speech, decreased sleep, seizures, and violent behavior deteriorating to catatonia. Her cerebrospinal fluid tested positive for anti‐NMDAR antibodies. She was treated with five sessions of therapeutic plasma exchange (TPE) after having failed therapy with antibiotics, intravenous steroids, intravenous immunoglobulin (IVIG), one dose of rituximab, and seven sessions of electroconvulsive therapy (ECT). The American Society for Apheresis assigns a Category III (Grade 2C) recommendation for TPE in paraneoplastic neurologic syndromes; however, apheresis specifically for anti‐NMDAR encephalitis has not been well studied. Literature review revealed two case repo...

Rapid increases in parasitemia following red cell exchange for malaria

Journal of Clinical Apheresis — Sat, 01 Jan 2011 05:00:00 +0100

We report a 20‐year‐female who developed cerebral malaria and 30% parasitemia after traveling to Africa. In addition to antimalarial treatment, red cell exchange (RCX) was begun emergently with an automated blood‐cell separator. Parasitemia dropped from 30 to 15% immediately after the procedure but rapidly increased to 25% after 50 min. The second procedure was performed 12 h after the first procedure. Her neurologic status returned to baseline on Day 2, and she was discharged on Day 6. Rapid increases in parasitemia can be observed after mechanical load reduction following RCX. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Therapeutic apheresis academy: A multidisciplinary educational conference

Journal of Clinical Apheresis — Sat, 01 Jan 2011 05:00:00 +0100

(Source: Journal of Clinical Apheresis)

Neurologic indications for therapeutic plasma exchange: An update

Journal of Clinical Apheresis — Sat, 01 Jan 2011 05:00:00 +0100

AbstractNeurologists commonly use therapeutic plasma exchange (TPE, also known as plasmapheresis or therapeutic apheresis) to treat a number of conditions. This concise review examines the most common neurologic indications for therapeutic plasma exchange. It focuses on Guillain‐Barrè syndrome and myasthenia gravis and also the role of TPE in chronic inflammatory demyelinating polyneuropathy, Lambert–Eaton syndrome, multiple sclerosis, neuromyelitis optica, paraproteinemic polyneuropathy, and Sydenham's chorea. As with any treatment, the proven efficacy, cost, side effects, and availability must be considered before initiation of therapy. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Therapeutic apheresis before and after kidney transplantation

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

AbstractKidney transplantation is considered the treatment of choice for most individuals with end‐stage kidney disease, as well as the most cost‐effective renal replacement therapy for the health care system that serves them. Immunologic sensitization, defined by the presence of antibodies directed against foreign HLA (or so called, donor specific antibodies, or DSA), is a significant barrier to kidney transplantation. Further, the presence of DSA is associated with an increase in the incidence of antibody‐mediated rejection and decreased graft survival following transplantation. Therapeutic plasma exchange, an extracorporeal therapy directed at removing plasma proteins, including DSA, has proven to be an important part of a comprehensive strategy to minimize the effect of sensitiza...

Therapeutic apheresis instrumentation

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

This article provides a concise overview of therapeutic apheresis medicine instrumentation. Three instrument modalities are discussed: (1) centrifugation‐based instruments, (2) extracorporeal photopheresis instruments (a subset of centrifugation‐based instruments), and (3) column‐based instruments. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Lipid apheresis, indications, and principles

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

AbstractLow‐density lipoprotein apheresis (LDL apheresis) is a term that describes a group of apheresis techniques and devices that selectively remove apolipoprotein B containing lipoproteins. A number of different devices are available worldwide, which all effectively remove low‐density lipoprotein cholesterol while sparing other important plasma components. LDL apheresis is used to treat familial hypercholesterolemia (FH), an inherited condition of accelerated atherosclerosis and severe coronary artery disease resulting in premature death. It has also been used to treat other disorders, although the evidence for its use is limited. This review describes the underlying pathophysiology of FH, the mechanism of action of the various LDL apheresis devices available, and how LDL apheresis ...

Mucosal healing of esophageal involvement of Crohn's disease with granulocyte/monocyte adsorption

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

We report a case of a 16‐year‐old male who suffered from Crohn's disease (CD) with esophageal involvement, showing remarkable improvement with granulocyte/monocyte adsorption (GMA). The patient had been diagnosed as ileocolic CD and was treated with 5‐aminosalicylate. He was admitted to our hospital with symptoms of fever, diarrhea, and odynophagia. Endoscopic examinations revealed that the exacerbation of ileocolic ulcers, and advent of ulcers in esophagus. Because of the patient's refusal to receive corticosteroids, immunomodulators, or biologics, he underwent GMA twice a week. After 10 sessions of GMA, he entered remission with significant decrease in clinical activity. In addition, endoscopic examinations showed remarkable improvement of ileocolic ulcers and disappearance of esop...

Bone marrow processing with the AMICUS™ separator system

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

Conclusions: We conclude that, in principle, the Amicus device can be used for MNC collection from BM to deplete erythrocytes from BM grafts in allogeneic stem cell transplantations. J. Clin. Apheresis 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Successful preoperative treatment of a Graves' disease patient with agranulocytosis and hemophagocytosis using double filtration plasmapheresis

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

Recurring extracorporeal circuit clotting during continuous renal replacement therapy resolved after single‐session therapeutic plasma exchange

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

We report a case of a 17‐year‐old white male with multiple fractures and multiorgan failure who developed oliguric acute renal failure requiring continuous renal replacement therapy. Repeated clotting of the extracorporeal circuit (ECC) prevented delivery of a minimally acceptable dose of renal replacement therapy despite adequate anticoagulation and dialysis catheter exchanges. Evaluation for a primary hypercoagulable state was negative, but his fibrinogen was elevated (1,320 mg/dL, normal range: 150–400 mg/dL), which is likely induced by his severe inflammatory state. A single session of therapeutic plasma exchange (TPE) with albumin and normal saline replacement was performed with subsequent drop in fibrinogen to 615 mg/dL. No further episodes of premature ECC clotting occurred, s...

Therapeutic leukapheresis in patients with leukostasis secondary to acute myelogenous leukemia

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

We report a single center experience in managing leukostasis with leukapheresis. Fifteen patients with leukostasis of 187 patients with AML (8.02%) followed at our institution were treated with leukapheresis associated with chemotherapy. The procedures were scheduled to be performed on a daily basis until clinical improvement was achieved and WBC counts were significantly reduced. Overall and early mortalities, defined as that occurred in the first 7 days from diagnosis, were reported. A high proportion of our patients with leukostasis (46.66%) had a monocytic subtype AML (M4/M5, according to French‐American‐British classification). The median overall survival was 10 days, despite a significant WBC reduction after the first apheresis procedure (from 200.7 × 109/L to 150.3 × 109/L). A...

Early plasmapheresis followed by high‐dose γ‐globulin treatment saved a severely Rho‐incompatible pregnancy

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

AbstractAn alloimmunized pregnancy induces anemia in the fetus and can ultimately lead to fetal hydrops and intrauterine fetal death. A woman with a severe Rho‐incompatible pregnancy had experienced frequent pregnancies with fetomaternal transfusion without receiving RhIg and had high anti‐D antibody titers present from early pregnancy. We succeeded in long‐term inhibition of antibody production using plasmapheresis followed by high‐dose γ‐globulin treatment in early pregnancy. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Lipid‐apheresis improves microcirculation of the upper limbs

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

AbstractLipid‐apheresis (LA) is thought to improve microcirculation. However, limited data are available on the effects on peripheral microcirculation. We investigated upper limb microcirculation of 22 patients undergoing regular LA on a weekly basis before and after LA. Using standardized semiquantitative scales, we analyzed blood flow, vasomotor function, and erythrocyte aggregation by capillary microscopy. In addition, capillary blood flow in quiescence and under heat and cryo‐stress was evaluated by photoplethysmographic and laser Doppler anemometry. Moreover, levels of vasoactive mediators adrenalin, noradrenalin, endothelin‐1 (ET‐1), atrial natriuretic peptide (ANP), asymmetrical dimethyl‐arginine (ADMA), as well as total protein and fibrinogen were measured. We found a sig...

Abstracts from the American Society for Apheresis 32nd Annual Meeting, June 1–4, 2011 Scottsdale, Arizona

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

(Source: Journal of Clinical Apheresis)

Hematocrit and C‐reactive protein predict treatment response times in ADAMTS13‐deficient thrombotic microangiopathy

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

AbstractThrombotic microangiopathy (TMA) syndromes are a heterogeneous group of microvascular syndromes that are typically treated with plasma exchange and other adjunctive therapies. Important pathogenic factors, such as ADAMTS13 deficiency, define distinct subsets of TMA. New treatments for TMA are being explored that are hypothesized to bring about remission more quickly. However, the existing factors that influence response to treatment time are poorly understood. We hypothesized that common laboratory parameters available at the time of treatment initiation might correlate with the number of days of plasma exchange required to induce remission. We therefore retrospectively compared pretreatment platelet counts, hematocrit levels, and C‐reactive protein (CRP) levels to the number of ...

Successful therapeutic plasma exchange in a 3.2‐kg body weight neonate with atypical hemolytic uremic syndrome

Journal of Clinical Apheresis — Sat, 01 Jan 2011 00:00:00 +0100

AbstractAtypical hemolytic uremic syndrome (aHUS) is a rare form of complement dysregulation disease, and recently various reports have shown that it is associated with one or more mutations in the complement regulatory genes including complement factor H (CFH). Plasma exchange is a therapeutic option for adult patients, but not for a very young infant because of a potential side effect of therapeutic plasma exchange (TPE) itself. Herein, we describe a case of successful treatment of early onset aHUS associated with a novel CFH mutation with total 21 sessions of TPE over a period of 46 days in 3.2 kg 23‐day‐old neonate. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Management of cyclosporine overdose in a hematopoietic stem cell transplant patient with sequential plasma exchange and red blood cell exchange

Journal of Clinical Apheresis — Mon, 13 Dec 2010 00:00:00 +0100

We present a case of successful rapid clearance of cyclosporine utilizing a combined approach of red cell exchange and plasma exchange. J. Clin. Apheresis, 2010. © 2010 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Stroke in a young patient treated by alteplase heralding an acquired thrombotic thrombocytopenic purpura

Journal of Clinical Apheresis — Mon, 13 Dec 2010 00:00:00 +0100

Conclusion: This observation highlights the fact that even if platelet count and hemoglobin rate are normal in the beginning, an acute ischemic stroke in a young patient can be related to TTP. Faced with subsequent thrombopenia, practitioners should be aware of acquired TTP, and, thus, schistocytes, haptoglobin, and LDH assays should be performed. Early diagnosis is paramount to start the life‐saving plasma exchanges. J. Clin. Apheresis, 2010. © 2010 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Flow cytometric platelet cross‐matching to predict platelet transfusion in acute leukemia

Journal of Clinical Apheresis — Mon, 13 Dec 2010 00:00:00 +0100

AbstractA great variety of patient‐ and product‐related factors influence the outcome of platelet transfusions. Our study assessed the predictive value of a flow cytometric platelet cross match test for the outcome of HLA matched and unmatched platelet transfusions in patients with acute leukemia. Thirty nine patients (26 adults and 13 children) received 60 ABO compatible apheresis platelet unites ranging from 1 to 4 per patient (mean = 1.54; median = 2). We performed flowcytometric platelet cross‐matching, HLA Class I typing by sequence‐specific primer (SSP) for patients and complement‐dependent cytotoxicity (CDC) for donors and screening of HLA Class I antibodies by ELISA. Effectiveness of platelet transfusion was evaluated using the corrected count increment which was calculat...

Hematopoietic progenitor cell count, but not immature platelet fraction value, predicts successful harvest of autologous peripheral blood stem cells

Journal of Clinical Apheresis — Mon, 06 Dec 2010 00:00:00 +0100

AbstractMobilized stem cells in the peripheral blood (PB) must be efficiently harvested at the appropriate time before autologous PB stem cell (PBSC) transplantation. Enumeration of CD34+ cells in the PB before apheresis predicts the number of PBSCs that can be collected, but the cytometric techniques used are complex and expensive. Therefore, it is necessary to identify an alternative to the CD34+ cell count in PBSC harvest‐time monitoring. Fully automated flow cytometry using blood cell counters now allows reliable quantification of immature myeloid cells in the PB, referred to as hematopoietic progenitor cells (HPC), and reticulated platelets, expressed as the immature platelet fraction (IPF). Immature or reticulated platelets are thought to correlate with thrombopoietic activity of t...

Effect of heparin‐induced extracorporeal lipoprotein apheresis on renal function

Journal of Clinical Apheresis — Thu, 11 Nov 2010 00:00:00 +0100

AbstractDuring the course of heparin‐induced extracorporeal lipoprotein apheresis, a patient with no prior known renal impairment or proteinuria demonstrated sustained improvement in estimated glomerular filtration rate, commensurate with reduction in serum lipids and creatine phosphokinase levels. Causes and implications of this observation, which was not a priori, are discussed. J. Clin. Apheresis, 2010. © 2010 Wiley‐Liss, Inc. (Source: Journal of Clinical Apheresis)

Erratum: Special issue: Clinical applications of therapeutic apheresis: An evidence based approach. 5th edition

Journal of Clinical Apheresis — Tue, 20 Jul 2010 23:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Rinseback during red blood cell exchange with COBE Spectra does not affect fraction of cells remaining or post-exchange hematocrit

Journal of Clinical Apheresis — Fri, 09 Jul 2010 23:00:00 +0100

CaridianBCT currently does not recommend rinseback with its COBE Spectra cell separator during red blood cell (RBC) exchange procedure, as the machine's software does not take into account the "rinseback" when calculating the fraction of cells remaining (FCR, and therefore target hemoglobin S (HbS) value) and postexchange hematocrit (Hct). To our knowledge, no study has investigated the effect of rinseback on these laboratory values. Therefore, we performed pre- and postrinseback evaluations of FCR and Hct in 22 consecutive combined Isovolemic Hemodilution/Red blood cell (IHD-RBCx) exchange procedures in sickle cell anemia patients with stroke currently enrolled in our institution's chronic RBC exchange program. The pre- and-post rinseback values for HbS were 9.9 ± 4.66 and 10.7 ± 4.83 (...

Factors affecting stem cell mobilization for autologous hematopoietic stem cell transplantation

Journal of Clinical Apheresis — Thu, 08 Jul 2010 23:00:00 +0100

High-dose chemotherapy with autologous stem cell transplantation (ASCT) is curative treatment in various hematologic malignancies. Mobilization and collection of peripheral blood stem cell is the essential part of ASCT. The aim of this study was to evaluate the effectiveness of various mobilization regimens, determine the risk factors associated with mobilization failure (MF). We also investigated whether iron overload, which has an adverse impact on various aspects of HSCT including overall survival had any impact on mobilization kinetics. A total of 118 consecutive patients were included in this study. The rate of MF was 11.8 % with the first mobilization regimen. Frequency of MF was higher in lymphoma (P < 0.001) patients and in those receiving G-CSF alone (P= 0.01). Peripheral CD34+ ce...

A case of severe ARDS caused by novel swine-origin influenza (A/H1N1pdm) virus: A successful treatment with direct hemoperfusion with polymyxin B-immobilized fiber

Journal of Clinical Apheresis — Thu, 08 Jul 2010 23:00:00 +0100

In 2009, a 35-year-old female with Down syndrome was admitted to our hospital because of severe pneumonia caused by an infection with the novel swine-origin influenza (A/H1N1pdm) virus (S-OIV). A chest X-ray on admission revealed bilateral infiltration shadows. Although mechanical ventilation was administered because of the development of ARDS, the hypoxemia continued to progressed. We observed evidence of alveolar hemorrhage on evaluation of the patient using bronchofiberscopy. The bacterial examination was negative. Despite intensive care, including respiratory management with high-frequency oscillatory ventilation (HFOV), the patient's hypoxemia and hypotension progressed. We concluded that a cytokine storm due to the influenza infection with SIRS caused shock status, resulting in septi...

Induction of Foxp3 expression in T cells by cellulose acetate beads in vitro

Journal of Clinical Apheresis — Fri, 11 Jun 2010 23:00:00 +0100

Gene expression of transforming growth factor-[beta] (TGF-[beta]) is needed to induce expression of transcription factor forkhead box P3 (Foxp3), which is required for the development and function of regulatory T (Treg) cells. The number of circulating Treg cells and the level of Foxp3 expression increase during granulocyte and monocyte apheresis (GMA), a useful therapy for ulcerative colitis. However, the mechanism underlying GMA-induced Foxp3 expression is unknown. We found that the level of TGF-[beta] mRNA in peripheral blood mononuclear cells (PBMCs) was augmented just after treatment of peripheral blood with a GMA carrier, cellulose acetate beads, in vitro and that Foxp3 expression in PBMCs increased after culturing these cells for 5 days after the treatment. The augmentation of TGF-[...

Selective depletion of peripheral granulocyte/monocyte enhances the efficacy of scheduled maintenance infliximab in Crohn's disease

Journal of Clinical Apheresis — Thu, 10 Jun 2010 23:00:00 +0100

Conclusions: IFX appears to induce and maintain remission of CD, but it may lose its efficacy after repeated administration. GMA is safe and by selectively depleting elevated/activated leukocytes may be a useful adjunct for IFX efficacy. J. Clin. Apheresis, 2010. © 2010 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Guidelines on the use of therapeutic apheresis in clinical practice - Evidence-based approach from the apheresis applications committee of the American Society for Apheresis

Journal of Clinical Apheresis — Thu, 03 Jun 2010 23:00:00 +0100

The American Society for Apheresis (ASFA) Apheresis Applications Committee is charged with a review and categorization of indications for therapeutic apheresis. Beginning with the 2007 ASFA Special Issue (fourth edition), the subcommittee has incorporated systematic review and evidence-based approach in the grading and categorization of indications. This Fifth ASFA Special Issue has further improved the process of using evidence-based medicine in the recommendations by refining the category definitions and by adding a grade of recommendation based on widely accepted GRADE system. The concept of a fact sheet was introduced in the Fourth edition and is only slightly modified in this current edition. The fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis. The a...

Plasma filtration in the treatment of Graves' ophthalmopathy: A randomized study

Journal of Clinical Apheresis — Tue, 01 Jun 2010 23:00:00 +0100

The aim of this study was to perform a randomized study to evaluate the role of plasma filtration in the treatment of severe thyroid-associated ophthalmopathy (TAO). 20 patients were enrolled, and all patients were treated with methylprednisolone IV pulses. 10 randomly chosen patients were also subjected to plasma filtration (twice weekly in Weeks 1, 2, 4, 7, and 10). The procedure proved to be safe. All immunoglobulin classes as well as autoantibodies directed against thyroglobulin, thyroid peroxidase, and TSH receptor exhibited statistically significantly decreases. Some markers of cell-mediated immunity such as soluble antigen CD30 and monocyte chemotactic protein 1 decreased, but serum levels of other markers such as CD40 ligand and soluble protein Fas/Apo-1 did not change significantl...

Evidence-based apheresis makes the GRADE

Journal of Clinical Apheresis — Thu, 13 May 2010 23:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Plerixafor mobilization leads to a lower ratio of CD34+ cells to total nucleated cells which results in greater storage costs

Journal of Clinical Apheresis — Wed, 12 May 2010 23:00:00 +0100

Conclusion: Mobilization with plerixafor plus G-CSF resulted in a smaller proportion of CD34+ cells collected and a greater number of storage bags. An increase in the number of bags required for stem cell storage may be logistically problematic and will also lead to increased costs for storage of stem cells. J. Clin. Apheresis, 2010. © 2010 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

The diagnosis of autoimmune hepatitis in patients with adult-onset Still's disease

Journal of Clinical Apheresis — Wed, 12 May 2010 23:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

The significance of clinical diagnosis of autoimmune hepatitis in patients with adult-onset Still's disease

Journal of Clinical Apheresis — Tue, 11 May 2010 23:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

The treatment of acute liver failure with fractionated plasma separation and adsorption system: Experience in 85 applications

Journal of Clinical Apheresis — Tue, 11 May 2010 23:00:00 +0100

Artificial liver support systems represent a potential useful option for the treatment of liver failure. The outcomes of patients treated with the fractionated plasma separation and adsorption (FPSA) system are presented.FPSA was performed 85 times for 27 patients (median 3 treatments/patient) with liver failure [85.2% acute liver failure (ALF) and 14.8% acute-on-chronic liver failure] using the Prometheus 4008H (Fresenius Medical Care) unit. Citrate was used for anticoagulation. A variety of clinical and biochemical parameters were assessed. Comparisons between pretreatment and post-treatment data were performed using paired t-test.The 85 sessions had a mean duration of 6 h. There were significant decreases in total bilirubin (13.18 ± 9.46 mg/dL vs. 9.76 ± 7.05 mg/dL; P < 0.0001), ammon...

Increased risk of citrate reactions in patients with multiple myeloma during peripheral blood stem cell leukapheresis

Journal of Clinical Apheresis — Wed, 05 May 2010 23:00:00 +0100

The citrate based anticoagulant ACD is commonly used in apheresis procedures. Due to its ability to decrease ionized calcium, citrate may cause unpleasant symptoms, such as paresthesias and muscle cramps, in patients undergoing therapeutic and donor apheresis. We noticed that patients with multiple myeloma (MM) undergoing autologous stem cell leukapheresis appeared to have more citrate reactions when compared to other patients undergoing the same procedure. A retrospective chart review was performed to evaluate 139 (of 151) consecutive patients with MM, amyloidosis, hematological and solid malignancies who had autologous peripheral blood stem cell collection between January 2007 and February 2008. Citrate reactions, ranging from mild (e.g., perioral tingling and parasthesias) to severe (e....

Plasmapheresis in the treatment of hypertriglyceridemia-induced pancreatitis: A community hospital's experience

Journal of Clinical Apheresis — Tue, 04 May 2010 23:00:00 +0100

Hyperlipidemic pancreatitis is a potentially fatal complication of hypertriglyceridemia (HTG). The current mainstay of treatment for the hypertriglyceridemia associated with pancreatitis includes heparin, insulin and lipid lowering agents. Experiences with plasmapheresis are limited. Here, we report our experience using plasmapheresis in the treatment of four patients with acute severe HTG-induced pancreatitis.Four patients with acute severe HTG-induced pancreatitis due to severe primary hyperlipidemia exacerbated by secondary factors were studied. In addition to the standard treatment (insulin or heparin infusion), antibiotics and lipid lowering agents, two were treated within the first 48 hours, and two with early ( (Source: Journal of Clinical Apheresis)

Granulocyte colony-stimulating factor produces a decrease in IFN[gamma] and increase in IL-4 when administrated to healthy donors

Journal of Clinical Apheresis — Tue, 04 May 2010 23:00:00 +0100

In conclusion, Th1 and Th2 cytokines are relevant in predicting the clinical outcome after allogeneic peripheral blood HSCT. J. Clin. Apheresis, 2010. © 2010 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Splenic rupture in a plasma cell leukemia, mobilized with G-CSF for autologous stem cell transplant

Journal of Clinical Apheresis — Wed, 21 Apr 2010 23:00:00 +0100

We report a case of a woman with PCL, who presented a SR after PHSC mobilization with Cyclophosphamide+G-CSF. The spleen removed showed hematopoietic foci and amiloid material. In the course of a second mobilization, 2 months after, the patient died from sepsis. We considered it important to report this case, in order to keep in mind the possibility of SR in patients with malignant gammopathy. gammopathy. J. Clin. Apheresis, 2010. © 2010 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

The use of fluid boluses to safely perform extracorporeal photopheresis (ECP) in low-weight children: A novel procedure

Journal of Clinical Apheresis — Fri, 19 Mar 2010 00:00:00 +0100

We present a safe and feasible alternative to the procedure for children who weigh less than 40 Kg, while maintaining a closed loop, sterile system utilizing the UVAR XTS device. A retrospective chart review was performed analyzing the use of fluid boluses (normal saline in those between 20 and 40 Kg, 5% albumin in those under 20 Kg) before ECP. Eleven patients underwent 334 ECP procedures for acute and chronic graft-versus-host disease (n = 9), and for prevention of graft-versus-host disease (n = 2). Volumes of fluid boluses were calculated based on the expected extracorporeal volume during the first draw cycle. Treatments consisted of at least three draw cycles using the 125 mL bowl. The median weight was 28.5 Kg (range 19 to 39); nine of 11 required red cell transfusions to maintain ade...

Controlled application and removal of liposomal therapeutics: Effective elimination of pegylated liposomal doxorubicin by double-filtration plasmapheresis in vitro

Journal of Clinical Apheresis — Wed, 10 Mar 2010 00:00:00 +0100

Conclusions: Convenient apheresis techniques are capable of a safe and efficient elimination of therapeutic used liposomal doxorubicin in an experimental model system. J. Clin. Apheresis, 2010. © 2010 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Abstracts from the American Society for Apheresis 31St Annual Meeting, May 26-29, 2010 New Orleans, Louisiana

Journal of Clinical Apheresis — Tue, 02 Mar 2010 00:00:00 +0100

(Source: Journal of Clinical Apheresis)

Pancytopenia with severe thrombocytopenia in a patient treated with twice-weekly LDL-apheresis by polyacrylate adsorption from whole blood

Journal of Clinical Apheresis — Tue, 26 Jan 2010 00:00:00 +0100

Pancytopenia with severe thrombocytopenia occurred in a patient treated with low-density lipoprotein (LDL)-apheresis by polyacrylate adsorption from whole blood, after treatment frequency had been increased from once to twice a week. Cell counts recovered with discontinuation of LDL-apheresis, but thrombocytopenia recurred after resumption of twice-weekly treatments. Thrombocyte counts remained stable following the replacement of polyacrylate adsorption from whole blood by double-filtration plasmapheresis. The complications' close coincidence with twice-weekly polyacrylate adsorption from whole blood suggests a causal relationship, although by a still unknown mechanism. Monitoring of thrombocytes should be advised in patients treated with LDL-apheresis by polyacrylate adsorption from whole...

Infection frequently triggers thrombotic microangiopathy in patients with preexisting risk factors: A single-institution experience

Journal of Clinical Apheresis — Mon, 25 Jan 2010 00:00:00 +0100

We report a retrospective analysis of 65 patients presenting to our institution from 1997 to 2008 with all forms of thrombotic microangiopathy. Therapeutic plasma exchange was a requirement for analysis and 65 patients were referred to our institution; 66% of patients were female and median age at presentation was 52 years. Bacterial infection was the most commonly identified etiologic factor and in the multivariate model was the only significant variable associated with survival outcome (odds ratio 5.1, 95% confidence interval, 1.2-21.7). As infection can be considered a common trigger event for thrombotic microangiopathy, patients with hepatobiliary sepsis may benefit from elective cholecystectomy. We conclude that bacterial infection frequently triggers TTP and other thrombotic microang...

A case report of successful treatment with plasma exchange for adult-onset Still's disease with autoimmune hepatitis

Journal of Clinical Apheresis — Mon, 25 Jan 2010 00:00:00 +0100

Adult onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology and pathogenesis. The disease is characterized by typical spiking fever with evanescent rash, sore throat, polyarthralgias or polyarthritis, and involvement of various organs. Most of the reported cases with liver involvement occurred during the period of treatment with hepatotoxic drugs, whereas AOSD associated autoimmune hepatitis (AIH) is extremely rare. AIH may be an indicator of the poor prognosis of AOSD. Herein we describe a case of successful treatment with plasma exchange for AOSD-associated AIH. J. Clin. Apheresis 2010. © 2010 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

CD34+ collection efficiency as a function of blood volumes processed in pediatric autologous peripheral blood stem cell collection