Journal of Clinical Apheresis via MedWorm.com

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)

Prevention of Rh sensitization in the context of trauma: Two case reports

Journal of Clinical Apheresis — Tue, 22 Dec 2009 00:00:00 +0100

Transfusion of D+ red blood cells (RBCs) to D- recipients can be accidental or necessary due to D- RBC shortage. Alloimmunization can complicate future transfusions; implications for women of childbearing age are compounded by possible hemolytic disease of the fetus and newborn. Rh immunoprophylaxis is effective, and indicated, for preventing alloimmunization. Reports of massive D+ mismatch (e.g., in the case of fetal-maternal bleed) are limited, and standard recommendations for managing these rare events are lacking. The cases discussed herein of women of childbearing age who suffered severe trauma requiring emergency surgery illustrate the dilemma of determining the ideal strategy for Rh immunoprophylaxis.The first patient received two units of mismatched RBCs and was treated with intrav...

Long-term plasma exchange for severe refractory hypertriglyceridemia: A decade of experience demonstrates safety and efficacy

Journal of Clinical Apheresis — Fri, 20 Nov 2009 00:00:00 +0100

Hypertriglyceridemia (hyperTG) is a common form of dyslipidemia and is frequently associated with premature coronary disease, and when severe, recurrent events of pancreatitis may occur. The management of hyperTG is generally medical (life style modification, medications). Plasma exchange (PE) has been reported to be useful in emergency situations particularly when acute pancreatitis results from extreme hyperTG. To our knowledge, there is only one report on long-term use of PE for hyperTG. We here report our results of long-term treatment of hyperTG in 6 patients with Frederickson Type V hyperlipidemia who had recurrent attacks of pancreatitis due to hyperTG refractory to medical therapy. PE was performed from one to eight times a month, mostly using a Cobe Spectra apparatus. In total, ou...

Immunoadsorption apheresis and immunosuppressive drug therapy in the treatment of complicated HCV-related cryoglobulinemia

Journal of Clinical Apheresis — Thu, 19 Nov 2009 00:00:00 +0100

The immunosuppressive drug therapy (IDT) is not always effective to avoid the development of complications in hepatitis C virus-related cryoglobulinemia (HCV-Cr). Removal of cryoglobulins by therapeutic plasmapheresis is currently accepted. In this randomized, parallel group study, 17 male and female patients aged 43-79 years, with complicated HCV-Cr, were submitted for 12 weeks (initial immunosuppressive therapy) to IDT ([alpha]-interferon, pegylated-interferon [alpha]-2a, cyclophosphamide, methylprednisolone, prednisone, cyclosporine, ribavirin, and melphalan). Then, they were randomly assigned to two parallel groups: A # 9 patients treated by immunoadsorption apheresis (Selesorb®) (IA) plus IDT, and B # 8 patients submitted to IDT only, for further 12 weeks. # 187 IA aphereses were per...

Different inflammatory responses induced by three LDL-lowering apheresis columns

Journal of Clinical Apheresis — Thu, 19 Nov 2009 00:00:00 +0100

In conclusion, three LDL-apheresis devices with equal cholesterol-lowering effect differed significantly with respect to the inflammatory response. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Feasibility and safety of triple dose platelet collection by apheresis

Journal of Clinical Apheresis — Thu, 12 Nov 2009 00:00:00 +0100

Blood cell separators of the newest generation allow for the collection of high-dose platelet concentrates. The aim of this study was to evaluate triple dose platelet collection with respect to feasibility and safety.Four hundred eighty plateletphereses were performed targeting to collect a triple platelet dose. Platelet counts were performed before and after apheresis and in platelet concentrates. Furthermore, donors were monitored for adverse events.Triple dose platelet collection was achieved in 96% according to European and national guidelines. Mean donor platelet count before apheresis was 303 ± 64/nl and decreased to 195 ± 48/nl after plateletpheresis. The lowest platelet count after apheresis was 111/nl. Twenty-one donor adverse events were observed (4.4%).Triple dose platelet col...

Postthaw clotting of peripheral blood stem cell products due to insufficient anticoagulant

Journal of Clinical Apheresis — Wed, 11 Nov 2009 00:00:00 +0100

The amount of acid citrate dextrose formula A (ACD-A), which is a commonly used anticoagulant in leukopheresis, has to ensure both the safety of the donor and guarantee the integrity of the peripheral blood stem cell (PBSC) product until its transplant. Two recent consecutive cases of postthaw PBSC product clotting initiated a look-back investigation of the ACD-A percentage in leukopheresis products collected in our facility. The data indicated a significant difference between the average amount of ACD-A in prefreezing products collected during 2006 (11.4%) and in products collected during 2007 and 2008 (8.8% and 8.7%, respectively). These findings and the fact that the two clotted products had less than 7% ACD-A indicated that insufficient amount of anticoagulant might contribute to their...

Homozygous familial hypercholesterolemia: Long term clinical course and plasma exchange therapy for two individual patients and review of the literature

Journal of Clinical Apheresis — Tue, 10 Nov 2009 00:00:00 +0100

Familial hypercholesterolemia (FH) is an autosomal dominant disease. Homozygous FH (HFH) manifests with severe hypercholesterolemia since birth (cholesterol levels >5-6 the upper normal limit), which, if untreated, leads to early onset accelerated atherosclerosis and premature coronary death, usually before the 2nd or 3rd decades of life. Various invasive procedures (iliocecal bypass, porto-caval shunt, liver transplant, and gene therapy) have been introduced for lowering low density lipoprotein (LDL) aiming at reducing atherosclerosis and improving survival of HFH patients. Of all the various methods, LDL apheresis has become the most attractive. Although its impressive effect on LDL-C reduction is well established, its long-term (of more than 10 year) effect on the atherosclerotic proces...

Appropriate timing of G-CSF use after mobilization chemotherapy significantly increases the yield of CD34+ cells in autoPBSCT

Journal of Clinical Apheresis — Sat, 07 Nov 2009 00:00:00 +0100

The yield of CD34+ cells collected by apheresis for autologous peripheral blood stem cell (PBSC) transplantation was greatly increased when the appropriate timing was determined to begin using G-CSF after COAEP (Cytoxan, Vinblastine, Arabinosylcytosin, Etoposide and Prednisone) mobilization. Twenty-nine patients with lymphoma or multiple myeloma (MM) received the same mobilization chemotherapy, including cytoxan (CTX) 400 mg/m2 d1; vinblastine (VLB) 2 mg/m2 d1; Ara-C 60 mg/m2 × 5d; vp-16 60 mg/m2 × 5d; and prednisone 40 mg/m2 × 5d. The historical control group (12 cases) received subcutaneous G-CSF (filgrastim) at the first restoration after the initial nadir of the peripheral WBC count. The experimental group (17 cases) received G-CSF during the steady rise of the WBC count (end of flu...

Low CD34 collection from a healthy blood progenitor cell donor: A case report

Journal of Clinical Apheresis — Fri, 06 Nov 2009 00:00:00 +0100

Transplantation of hematopoietic progenitor cells is widely used to ameliorate the consequences of bone marrow failure. In allogeneic transplantation, peripheral blood progenitor cells (PBPCs) from an HLA-matched donor are collected by apheresis and then identified using flow cytometric methods as being CD34 marker positive cells.A 25-year-old healthy male was matched with an obese 106 kg 23-year-old female diagnosed with acute lymphoblastic lymphoma. After a routine course of G-CSF induction, a 2-day PBPC collection procedure with a collection volume of 12 L/day was planned. All samples for CD34 estimation were shipped, stored, and tested according to the laboratory standard regulations. Testing was performed per International Society for Hematotherapy and Graft protocol, and CD34+ cells ...

Predictors of complications in therapeutic plasma exchange

Journal of Clinical Apheresis — Wed, 04 Nov 2009 00:00:00 +0100

Plasma exchange (PE) is used for blood purification to modulate proteins involved in pathological processes. As the number of patients receiving PE treatment and the heterogeneity of the underlying diseases is steadily increasing, we evaluated the most frequent complications and analyzed causes leading to adverse reactions. 883 PE procedures in 113 patients between the years 2000 to 2006 were retrospectively analyzed with respect to complications. Additionally, underlying diseases and settings of PE procedure were analyzed to identify high-risk patients and respective PE settings. A total of 226 adverse reactions were recorded (25.6% of all PE procedures). Most complications were mild (n = 121, 13.7%) or moderate (n = 98, 11.0%). In seven cases (n = 7, 0.7%), severe, life-threatening adver...

Thrombotic microangiopathy during peripheral blood stem cell mobilization

Journal of Clinical Apheresis — Fri, 30 Oct 2009 00:00:00 +0100

We report a 58-year-old female with vasculitis and renal impairment. She was found to have an underlying monoclonal gammopathy of unknown significance (MGUS). The monoclonal protein was felt to play a role in her underlying renal disease and peripheral neuropathy. She was considered a candidate for peripheral blood stem cell transplantation to manage the monoclonal protein. During stem cell mobilization with GCSF, she developed worsening of anemia; thrombocytopenia and worsening of renal function. She was diagnosed with thrombotic microangiopathy (TMA) which was successfully treated with therapeutic plasma exchange and rituximab. It is possible that GCSF may have directly (activating endothelial cells) or indirectly (activation of underlying autoimmune disorder) contributed to TMA in this ...

Postdonation platelet counts are safe when collecting platelets with the Trima Accel using a postdonation platelet count target of [ge]50,000 platelets/[mu]L

Journal of Clinical Apheresis — Thu, 08 Oct 2009 23:00:00 +0100

In December 2007, the FDA issued a guidance document recommending that apheresis cell separators be configured with a postdonation platelet count target of [ge]100,000 platelets/[mu]L. Currently, our Trima Accel apheresis cell separators are configured with a postdonation platelet count target of [ge]50,000 platelets/[mu]L. To determine the safety of our current procedure, we analyzed the postdonation platelet counts of 115 donors collected using our current procedure. All of 115 donors had postdonation platelet counts [ge]100,000 platelets/[mu]L. On the basis of predonation platelet counts, we calculated that raising the postdonation target platelet count to [ge]100,000 platelets/[mu]L would have disqualified 19 out of 225 potential platelet products. We conclude that the current postdona...

The clinical significance of tumor cells in bone marrow or apheresis product and the efficacy of CD34+ selection and high-dose chemotherapy in patients with Stage III breast cancer

Journal of Clinical Apheresis — Wed, 07 Oct 2009 23:00:00 +0100

In conclusion, the presence of tumor cells in bone marrow or apheresis product decreases DFS in patients with Stage III breast cancer who underwent high-dose chemotherapy. CD34+ selection does not change survivals, but it may decrease the distant metastases. J. Clin. Apheresis 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Alteration of adipokines during peripheral blood stem cell mobilization induced by granulocyte colony-stimulating factor

Journal of Clinical Apheresis — Wed, 07 Oct 2009 23:00:00 +0100

Adipokines, soluble mediators produced by adipocytes, have been shown to play a role in various physiological and pathological conditions. We investigated the involvement of adipokines in granulocyte colony-stimulating factor (G-CSF)-induced mobilization of hematopoietic stem cells in 21 healthy donors. We found that serum visfatin and resistin levels, but not leptin and adiponectin levels, were significantly elevated by G-CSF treatment. G-CSF treatment activated signaling proteins like extracellular signal-regulated kinase and stimulated secretion of visfatin from 3T3-L1 adipocytes. These findings suggest that some adipokines may play a role in G-CSF-induced mobilization of stem cells from the bone marrow into systemic circulation. J. Clin. Apheresis 2009. © 2009 Wiley-Liss, Inc. (Source...

Is therapeutic plasma exchange indicated for patients with gemcitabine-induced hemolytic uremic syndrome?

Journal of Clinical Apheresis — Wed, 07 Oct 2009 23:00:00 +0100

Atypical hemolytic uremic syndrome (aHUS) has been described as an uncommon complication of gemcitabine. In this review, we discuss the diagnosis of gemcitabine-induced aHUS (GiHUS) and the published experience with therapeutic plasma exchange (TPE). To illustrate GiHUS, we present a patient who developed hypertension and peripheral edema while receiving gemcitabine and subsequently was found to have thrombocytopenia, hemolytic anemia, renal failure, and normal ADAMTS-13 activity. Although laboratory parameters improved on suspending gemcitabine, they worsened after reinstitution of the drug. Thrombocytopenia and hemolysis ceased once the drug was permanently discontinued without therapeutic plasma exchange (TPE). The pathological characteristics of GiHUS suggest damage of the glomeruli en...

Iron depletion before HCV antiviral therapy: A pilot, randomized, controlled trial

Journal of Clinical Apheresis — Wed, 16 Sep 2009 23:00:00 +0100

It is not known whether iron depletion before pegylated IFN or combination treatment improves sustained virological response (SVR) rate in patients with chronic hepatitis C, despite its use in clinical practice in this setting. We aimed to investigate whether blood letting improves the efficacy (SVR) and tolerability of PEG-IFN[alpha]2b + Ribavirin in chronic hepatitis C patients. Patients with chronic hepatitis C and ferritin >100 ng/mL were randomized to: (1) repeated phlebotomies to obtain a ferritin level (Source: Journal of Clinical Apheresis)

Granulocyte transfusion therapy in abdominal organ transplant recipients

Journal of Clinical Apheresis — Mon, 14 Sep 2009 23:00:00 +0100

Conclusions: We observed temporal increases in ANC to levels above 1,000/[mu]l in 15/18 (83.3%) courses of GT. We observed a clinical response to infection in 5/12 (42%) patients, the remaining infected patients had no clinical response. Our results suggest that GT therapy in neutropenic solid organ transplant recipients can boost peripheral blood neutrophil counts. Additional studies areneeded to document an independent clinical benefit for GT in this patient population. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Mobilization effects of G-CSF, GM-CSF, and darbepoetin-[alpha] for allogeneic peripheral blood stem cell transplantation

Journal of Clinical Apheresis — Sun, 13 Sep 2009 23:00:00 +0100

In conclusion, the triple regimen did not seem to be superior to G-CSF alone in terms of the CD34+ cell dose, hemoglobin recovery, and GVHD. However, the CD8+ cell count was significantly lower in the triple regimen group. The role of a lower CD8+ cell count in the graft may need to be elucidated in the future. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

LDL lipid apheresis rapidly increases peripheral endothelial progenitor cell competence

Journal of Clinical Apheresis — Sun, 13 Sep 2009 23:00:00 +0100

Endothelial progenitor cells (EPCs) have been shown to promote neovascularization under physiologic and pathologic conditions. Statins have been documented to increase the total number of circulating EPCs in long-term treated patients. Lipid apheresis is used to treat patient with refractory hyperlipidemia. The aim of our study was to evaluate whether lipid apheresis is associated with EPC mobilization.Thirteen patients with refractory hyperlipidemia (analysis at the beginning and at the end of a single lipid apheresis treatment) and 10 healthy controls were included into the study. For quantifying total peripheral EPCs, CD133+/Flk-1+ myelo-monocytic blood cells were enumerated by flow cytometry. The proliferative potential of EPCs was evaluated by a "colony-forming unit" assay. In some pa...

Therapeutic plasma exchange for desensitization prior to transplantation in ABO-incompatible renal allografts

Journal of Clinical Apheresis — Wed, 05 Aug 2009 23:00:00 +0100

Conclusions: The desensitization protocol used by our institution allowed for successful ABOi renal transplantation. Although there were incidents of AMR and DGF, the majority of the transplants resulted in viable grafts. A larger patient study group may be needed to fully evaluate the efficacy and safety of this protocol. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Effects of protein A immunoadsorption in patients with advanced chronic dilated cardiomyopathy

Journal of Clinical Apheresis — Thu, 09 Jul 2009 23:00:00 +0100

In this study, on severely limited heart failure patients with nonfamilial DCM, IA therapy moderately improved markers of heart failure severity in a limited subgroup of patients. This may be due to the selected study population with end-stage heart failure patients and the lower reduction of IgG3 compared to previous studies. Future blinded multicenter studies are necessary to identify those patients that benefit most. J. Clin. Apheresis 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Peripheral blood stem cell collection in multiple myeloma: A retrospective analysis of 6 years leukapheresis activity in 109 patients treated at the Istituto Nazionale dei Tumori of Milan

Journal of Clinical Apheresis — Wed, 08 Jul 2009 23:00:00 +0100

Double autologous stem cell transplantation is the standard treatment in newly diagnosed multiple myeloma (MM) patients younger than 65 years; therefore, optimization of leukapheresis is crucial. We performed a retrospective analysis of 297 leukaphereses comparing semiautomated (V4.7 in 20% of collections) versus automated (V6.0 in 80%) Caridian (COBE) Spectra versions and analyzing the influence of M-protein on the outcome. Both methods gave comparable collection efficiencies (CE%) (53.4% vs. 55.7% in V6.0 and V4.7, respectively) with similar leukapheresis time and processed volume. Harvest volume was higher in V4.7 (P < 0.0001) with similar contamination of red blood cells (RBCs) (P = 0.77) and platelets (P = 0.09) when compared with V6.0. In patients with higher peripheral white blood c...

Elevated procalcitonin and C-reactive protein as potential biomarkers of sepsis in a subpopulation of thrombotic microangiopathy patients

Journal of Clinical Apheresis — Wed, 08 Jul 2009 23:00:00 +0100

Thrombotic microangiopathy (TMA) comprises a group of microvascular thrombosis syndromes associated with multiple pathogenic factors. Deficient activity of ADAMTS13 is a pathogenic factor in a subset of TMA patients that provides a strong rationale for plasma exchange treatment. However, the subset of TMA patients with normal ADAMTS13 activity remains a heterogeneous group of patients in which the appropriate treatment is not well understood. In addition to the common forms of TMA thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome, the differential diagnosis of TMA may include sepsis, autoimmune disorders, and disseminated intravascular coagulation. Optimal treatment of TMA depends on timely recognition of treatable pathogenic factors. We hypothesized that sepsis is a ra...

Effect of blood group on idiopathic thrombotic thrombocytopenic purpura

Journal of Clinical Apheresis — Wed, 08 Jul 2009 23:00:00 +0100

We report a retrospective analysis of 74 patients presenting from 1993 to 2008 with idiopathic TTP. We studied the incidence across various blood groups and also estimated the recurrence and mortality in each group. The incidence of various blood groups were as follows: O 36%, A 36%, B 25%, and AB 2%, compared with expected frequencies in the Detroit area: O 44%, A 33% B 20%, and AB 3%. There was a trend of lower than expected frequency of blood group O. There were 24 recurrences and 14 deaths, uniform across blood groups. We hypothesized that there may be an association between blood groups and the risk of TTP; however the differences in our study were not statistically significant. Recurrence and disease specific mortality did not appear to be impacted by blood group. J. Clin. Apheresis ...

Successful weaning after plasma exchange for polyneuropathy related to POEMS syndrome

Journal of Clinical Apheresis — Wed, 24 Jun 2009 23:00:00 +0100

In this report, we describe a 47-year-old male patient with polyneuropathy related to POEMS syndrome who suffered from hypercapnic respiratory failure due to progressive weakness of the respiratory muscles. His respiratory muscle strength significantly improved after plasma exchange and was extubated successfully. To our knowledge, this is the first case of POEMS syndrome with aggressive polyneuropathy that was successful treated by plasma exchange and our experience provides insight regarding the optimal management of such patients. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Photopheresis therapy for problematic renal allograft rejection

Journal of Clinical Apheresis — Tue, 16 Jun 2009 23:00:00 +0100

Conclusion: Photopheresis may have a role as an adjuvant or salvage antirejection therapy in solid organ transplantation. Furthermore, evaluation in randomized controlled clinical trials is required to evaluate its potential. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Preoperative therapeutic plasma exchange in patients with thyrotoxicosis

Journal of Clinical Apheresis — Sat, 30 May 2009 04:00:00 +0100

The purpose of this report was to determine the effectiveness of therapeutic plasma exchange (TPE) in preoperative preparation of patients with thyrotoxicosis scheduled for either thyroid or nonthyroid surgery. We retrospectively reviewed 11 patients with thyrotoxicosis and those who prepared surgery with plasmapheresis between 1999 and 2008 at our institution. Ten patients underwent thyroid surgery and one patient was operated for femur fracture during antithyroid drug treatment. The indications for plasmapheresis in all patients with severe thyrotoxicosis were poor response to medical treatment (seven patients), agronulocytosis due to antithyroid drugs (three patients), iodine-induced thyrotoxicosis (Jodd Basedow effect in one patient), and rapid preparation for urgent orthopedic operati...

TRALI risk reduction: Donor and component management strategies

Journal of Clinical Apheresis — Sat, 18 Apr 2009 04:00:00 +0100

Transfusion-related lung injury (TRALI) occurs in [sim]1 in 5,000 transfusions and may cause considerably more morbidity and mortality that is not recognized in clinical practice. Based on the current understanding of the etiology of TRALI, blood centers have implemented or are evaluating various donor and component management strategies in an effort to mitigate the risk of TRALI. Many cases of TRALI are likely caused by antibodies to leukocyte antigens (HLA or HNA) in blood components. Approximately 10 to 20% of female blood donors with a history of pregnancy and 1 to 5% of male blood donors harbor these antibodies. Alternatively, TRALI may be mediated by other bioactive lipids or substances that accumulate during storage and cause a reaction when transfused to susceptible patients. The c...

Red cell exchange transfusion for babesiosis in Rhode Island

Journal of Clinical Apheresis — Tue, 17 Mar 2009 04:00:00 +0100

We report four cases of clinically severe tick borne babesiosis treated with chemotherapy and adjunctive red cell exchange (RCE) at two Rhode Island hospitals from 2004 to 2007. All RCE procedures were performed using a Cobe Spectra device and were well tolerated without complications. The volume of allogeneic red cells used in the exchange was determined using the algorithm in the apheresis device with the input variables of preprocedure hematocrit, weight, height, an assumed allogeneic red cell hematocrit of 55 and a desired post procedure hematocrit of 27. The preprocedure level of parasitemia varied between 2.4% and 24% and the postprocedure level of parasitemia between 0.4 and 5.5% with an average overall percent reduction in parasitemia of 74%. Retrospectively, application of a new f...

Abstracts from the American Society for Apheresis 30th Annual Meeting, May 20-23, 2009, San Diego, California

Journal of Clinical Apheresis — Fri, 06 Mar 2009 05:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Is it quinine TTP/HUS or quinine TMA? ADAMTS13 levels and implications for therapy

Journal of Clinical Apheresis — Wed, 04 Mar 2009 05:00:00 +0100

Thrombocytopenia with or without microangiopathy following quinine is often referred to as quinine "hypersensitivity." When schistocytes are present it is frequently termed "quinine-associated TTP/HUS." A severe deficiency of the vWF-cleaving protease, ADAMTS13, is associated with idiopathic TTP. A previous study of patients with "quinine-associated TTP/HUS" found that ADAMTS13 activities were not abnormal in 12/12 patients. A retrospective review of TTP patients with quinine-associated thrombotic microangiopathy (TMA) for whom ADAMTS13 was measured before plasma exchange was performed. Six patients were identified. All were females (age range: 43 to 73, mean = 61.7 years) and had taken quinine for leg cramps. Four of the six experienced renal failure requiring dialysis. Five of the patien...

Value of ADAMTS13 activity and inhibitor in the postmortem diagnosis of thrombotic thrombocytopenic purpura

Journal of Clinical Apheresis — Sat, 28 Feb 2009 05:00:00 +0100

We report a case of fulminant TTP in a woman who died before receiving plasma exchange. An autopsy plasma sample was analyzed for ADAMTS13 activity and inhibitor for correlation with the diagnosis of TTP. Recognizing that hemolysis in postmortem blood samples could interfere with ADAMTS13 activity, plasma samples from four additional decedents not suspected of having TTP were analyzed and correlated with their autopsy results. The purpose of this study was to assess whether testing postmortem samples for ADAMTS13 is useful in the postmortem diagnosis of TTP.Plasma samples from the index case and four non-TTP decedents were analyzed for ADAMTS13 activity, ADAMTS13 inhibitor levels, and plasma free hemoglobin (PFH). Autopsy tissues were evaluated for evidence of platelet microthrombi in all ...

Peripheral blood stem cell recovery following early termination of apheresis due to hypotension in a 4.8-kg infant

Journal of Clinical Apheresis — Fri, 27 Feb 2009 05:00:00 +0100

We report a case in which peripheral blood stem cells (PBSC) were successfully recovered following early termination of a collection procedure due to hypotension in a 7-month-old patient. The patient was diagnosed at 4 months of age with neuroblastoma stage IV-S with favorable Shimada histology. She had completed two cycles of chemotherapy before the PBSC collection (PSCC). The procedure was performed on the Cobe Spectra in manual mode, and terminated after 35 min due to severe hypotension. Etiologies considered for the hypotensive episode included a transfusion reaction to the unit of red blood cells (RBC) used for priming the Spectra, citrate reaction, and hypovolemia due to blood drawn for laboratory testing and fluid shifts at the beginning of the procedure. Hypovolemia was ultimately ...

Large-volume-apheresis facilitates autologous transplantation of hematopoietic progenitors in poor mobilizer patients

Journal of Clinical Apheresis — Sat, 24 Jan 2009 05:00:00 +0100

Given that pre-apheresis CD34+ cell count (PA-CD34) predicts the apheresis' yield, a minimum of 5 to 20 PA-CD34/ml is required in many institutions to initiate cell collection. The aim of this study was to clarify whether large-volume-apheresis (LVA) could facilitate progenitor cell transplantation in patients with low PA-CD34. Apheresis was initiated in 226 patients, disregarding PA-CD34, at days: +5 in G-CSF, +10 in cyclophosphamide+G-CSF, and +15 to +20 in other chemotherapy+G-CSF mobilization, when leucocytes >2.5 × 109/l. Four times the blood volume was processed. Patients were grouped according to their PA-CD34: [ge]10/ml (group-A, n = 143); (Source: Journal of Clinical Apheresis)

Management of familial hypertriglyceridemia during pregnancy with plasma exchange

Journal of Clinical Apheresis — Fri, 23 Jan 2009 05:00:00 +0100

We report the successful use of therapeutic plasma exchange (TPE) in the management of hypertriglyceridemia during pregnancy resulting in avoidance of pancreatitis and delivery of a healthy term infant. Thirteen TPEs were performed from 19 to 36 weeks gestation to maintain tight control of triglyceride levels. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Immunoadsorption with tryptophan columns: A therapeutic option for the treatment of rheumatoid arthritis with septic complications

Journal of Clinical Apheresis — Wed, 21 Jan 2009 05:00:00 +0100

In conclusion, immunoadsorption is a safe and effective therapeutic alternative, which should be considered to bridge infectious complications in patients with severe RA. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Plasmapheresis therapy for rare but potentially fatal reaction to rituximab

Journal of Clinical Apheresis — Tue, 20 Jan 2009 05:00:00 +0100

We report a near-fatal reaction to rituximab, which started 30 min after infusion and worsened over 24 to 48 h, resulting in hemodynamic and respiratory compromise that necessitated both intubation and high-dose vasopressors. Subsequent treatment with plasmapheresis helped stabilize and improve the patient's clinical condition, and the patient was discharged home on hospital day 5. There is no specific treatment for these severe and sometimes fatal reactions except supportive care with plasmapheresis. With the increased use of rituximab therapy in the medical management of numerous diseases, those in the medical community need to be cognizant of the rare fatal or near-fatal infusion reaction and the benefit that may accrue from plasmapheresis therapy. J. Clin. Apheresis, 2009. © 2009 Wile...

ADAMTS13 activity levels in patients with human immunodeficiency virus-associated thrombotic microangiopathy and profound CD4 deficiency

Journal of Clinical Apheresis — Tue, 20 Jan 2009 05:00:00 +0100

Thrombotic microangiopathy (TMA) encompasses a number of disorders with hemolytic anemia and thrombocytopenia, including thrombotic thrombocytopenic purpura (TTP). A deficiency in ADAMTS13 enzyme levels, along with an inhibitory antibody, is found in most patients with idiopathic TTP. Patients with human immunodeficiency virus (HIV) infection can have a TTP-like illness; however, it appears to have a different etiology.A retrospective review of patients who had an ADAMTS13 activity level performed from 2005 through 2007 was completed. Patients with a diagnosis of HIV infection with TMA were investigated.Two patients were identified. Case 1: a 47-year-old man with HIV infection and a CD4 count (Source: Journal of Clinical Apheresis)

Multiple myeloma patients receiving large volume leukapheresis efficiently yield enough CD34+ cells to allow double transplants

Journal of Clinical Apheresis — Tue, 20 Jan 2009 05:00:00 +0100

Current protocols for myeloma patients require more than one autologous transplant. We performed a retrospective study to determine the cost-effectiveness of large volume leukapheresis (LVL) compared with standard volume leukapheresis (SVL) collection when two transplants are required. We evaluated 87 patients who underwent a cumulative total of 260 LVL and SVL collections. The median product volume per collection was 356 ml for LVL, and this was significantly higher than the median product volume per collection for SVL (median 149.5 ml, P < 0.001). The median total CD34+ cell yield/kg was 6.4 × 106 for LVL and 5.2 × 106 for SVL. This difference was statistically significant (P = 0.005). Because the target CD34+ cell dose for a single transplant was 3 × 106/kg at our institution, overal...

Clinical improvement of a patient with severe Wilson's disease after a single session of therapeutic plasma exchange

Journal of Clinical Apheresis — Tue, 20 Jan 2009 05:00:00 +0100

Here, we report a case of a 17-year old female with Wilson's disease presenting with progressive Coombs' negative hemolytic anemia and hepatic cirrhosis who was treated with one session of therapeutic plasma exchange (TPE) and clinically improved. In clinical situations where multiple sessions of TPE may not be possible, the use of a single session of TPE in conjunction with conventional therapy may be of benefit in preventing further clinical deterioration. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Treatment of severe amitriptyline intoxication with plasmapheresis

Journal of Clinical Apheresis — Wed, 14 Jan 2009 05:00:00 +0100

Tricyclic antidepressant poisoning is one of the most common causes of serious intoxication. Here, we report a 2-year-old girl with severe amitriptyline (70 mg/kg) intoxication. She was in comatose, had generalized tonic clonic seizure, ventricular tachycardia, and wide QRS complexes. Although she did not respond to classical therapies, very good clinical response to plasmapheresis was obtained and she developed no complications. Thus, plasmapheresis may be an effective treatment modality in poisoning with drugs, which bind to plasma proteins with high affinity. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

The Italian registry of pediatric therapeutic apheresis: A report on activity during 2005

Journal of Clinical Apheresis — Tue, 16 Dec 2008 05:00:00 +0100

The results of the 2005 Survey of the Italian Society for Apheresis and Cell Manipulation (SIdEM) reporting on the pediatric procedures carried out in 18 Italian Apheresis Units are presented here. Utilizing a standardized questionnaire, the survey collected data on techniques, types of blood separators, clinical indications, and adverse events. A total of 1,693 apheresis procedures were carried out in 355 pediatric patients: 219 plasma-exchange, 291 peripheral blood stem cell collections, 791 extracorporeal photochemotherapy (ECP), 265 LDL-apheresis, 71 erythro-exchange, 9 cytoreductive apheresis, 47 immunoadsorption sessions. Adverse events were registered in 94 procedures (5.6%), most of which of mild entity, e.g., insufficient flow rate (50.0%) and symptomatic hypocalcemia (24.4%). Our...

Atypical presentations of thrombotic thrombocytopenic purpura: A review

Journal of Clinical Apheresis — Mon, 15 Dec 2008 05:00:00 +0100

Thrombotic thrombocytopenic purpura (TTP) is diagnosed by the presence of microangiopathic hemolytic anemia and thrombocytopenia in a patient who frequently presents with central nervous system involvement and, to a lesser extent, renal dysfunction. Recent understanding of the pathophysiology of TTP due to severe deficiency of von Willebrand factor cleaving protease, known as ADAMTS13, has improved diagnosis of TTP. Once the diagnosis is suspected, life-saving therapeutic plasma exchange therapy is initiated. Occasionally, an unusual clinical presentation makes TTP diagnosis difficult, thus resulting in a delay in the management of TTP. This review highlights a variety of atypical TTP presentations described in the literature. It is intended to bring unusual scenarios to the clinician's aw...

Hypersensitivity to plasma exchange in a patient with thrombotic thrombocytopenic purpura

Journal of Clinical Apheresis — Mon, 15 Dec 2008 05:00:00 +0100

We present a case report of a patient with TTP and idiopathic thrombocytopenic purpura (ITP) who had an elevated inhibitor level after plasma exchange. After instituting plasma exchange, patient improved clinically with a platelet count in the normal range. Subsequently, she developed an elevated ADAMTS antibody titer accompanied by a decline in platelet count despite continued exchange. She was successfully treated with a combination of steroids, rituximab and increased dose plasmapheresis. Based on this experience, we conclude that a drop in platelet count while patient is undergoing plasma exchange especially in an initial episode of TTP needs prompt institution of additional therapy to improve outcomes. This case also brings to attention the possibility of an underlying ITP in a patien...

A retrospective review of the outcome of plasma exchange and aggressive medical therapy in antibody mediated rejection of renal allografts: A single center experience

Journal of Clinical Apheresis — Sat, 15 Nov 2008 05:00:00 +0100

Antibody-mediated rejection (AMR) has been recognized as a major cause of renal allograft loss. Protocols using plasma exchange (PE) to reverse rejection have mixed results. Methods: A retrospective chart review was performed to determine the clinical response to PE inpatients with AMR of renal allograft. A good response to treatment was defined as a decline in serum creatinine (SCr) to within 25% above the prerejection value or discontinuation of dialysis with a SCr (Source: Journal of Clinical Apheresis)

Plasmapheresis and intravenous immune globulin for the treatment of D alloimmunization in pregnancy

Journal of Clinical Apheresis — Wed, 12 Nov 2008 05:00:00 +0100

We present a case report of an Rh(D) alloimmunized pregnancy, in which successful management consisted of initial therapeutic plasmapheresis (TPE) followed by intravenous immunoglobulin (IVIG) administration until delivery at 37 weeks gestation without the need for intrauterine transfusion. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Predictive parameters for granulocyte colony-stimulating factor-induced peripheral blood stem cell mobilization

Journal of Clinical Apheresis — Fri, 07 Nov 2008 05:00:00 +0100

In conclusion, the CD34+ cell numbers in the PB steady state may be a useful parameter selecting allogeneic PBSC donors. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Is it HIV TTP or HIV-associated thrombotic microangiopathy?

Journal of Clinical Apheresis — Thu, 30 Oct 2008 04:00:00 +0100

This article reviews emerging concepts of HIV associated microangiopathies. It concludes that the pathophysiology, in many cases seems to be distinct from idiopathic TTP (particularly with advanced HIV disease - (Source: Journal of Clinical Apheresis)

Preparing for inspection: Managing regulations and practices surrounding donors with positive infectious disease testing

Journal of Clinical Apheresis — Wed, 29 Oct 2008 04:00:00 +0100

Federal and local regulatory agencies mandate that all blood collection facilities test each allogeneic blood donation for evidence of infectious diseases. When a donation tests positive or reactive for any of the required screening tests, facilities are required to take appropriate action by deferring donors and removing potentially infectious products from inventory. Each required action must be performed in accordance with posted regulations and documented for record retention. Donor deferral records related to positive or reactive infectious disease testing are particularly vulnerable targets of inspection. There are currently numerous regulations and requirements for handling donors who test positive or reactive in infectious disease screening tests. Each of these regulations must be ...

Therapeutic apheresis in neurological disorders: A survey of the evidence in support of current category I and II indications for therapeutic plasma exchange

Journal of Clinical Apheresis — Wed, 29 Oct 2008 04:00:00 +0100

This article provides a critical look at the evidence in support of the assignment by ASFA of Category I or II indications to neurologic disorders in its most recent (2007) evaluation of therapeutic apheresis. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Starch and albumin mixture as replacement fluid in therapeutic plasma exchange is safe and effective

Journal of Clinical Apheresis — Fri, 26 Sep 2008 04:00:00 +0100

Conclusions: TPE with a mixture of 3% HES and 5% human albumin is as effective and safe as 5% human albumin alone for patients with these diseases. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Support groups for patients who have recovered from thrombotic thrombocytopenic purpura

Journal of Clinical Apheresis — Fri, 12 Sep 2008 04:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Combination of Cobe AutoPBSC and Gambro Elutra as a platform for monocyte enrichment in dendritic cell (DC) therapy: Clinical study

Journal of Clinical Apheresis — Wed, 20 Aug 2008 04:00:00 +0100

Monocytes are a common source for generating dendritic cells (DCs). The aim of the present study was to evaluate the efficiency of a platform for monocyte collection and enrichment in a clinical setting. The platform was based on the combination of two semiautomated devices; the Cobe Spectra Auto PBSC for mononuclear cells (MNC) collection followed by counterflow elutriation for monocyte enrichment (Gambro BCT Elutra). Twenty-four patients with various types of epithelial cancer participated in the study. MNC collections were first performed as large volume leukapheresis (LVL). Subsequently, MNC products were processed with an elutriation system for monocyte isolation. LVL resulted in the collection of MNC at a median of 8.1 × 109 cells, containing of 31.4% monocytes. A similar efficacy w...

Rituximab as an adjunct to plasma exchange in TTP: A report of 12 cases and review of literature

Journal of Clinical Apheresis — Tue, 19 Aug 2008 04:00:00 +0100

We report a retrospective review of 12 patients treated with rituximab for TTP refractory to plasma exchange. Eleven patients were treated during initial presentation, and one patient was treated for recurrent relapse. Ten patients responded to treatment. Median time to response after first dose of rituximab was 10 days (5-32). Of the 11 patients treated during initial presentation, nine remain free of relapse after a median follow-up of 57+ months (1+-79+). Two patients died during initial treatment. One patient was lost to follow-up 1 month after achieving complete response. The patient treated for recurrent disease during second relapse remained disease free for 2years, relapsed and was treated again with rituximab, and was in remission for 22 months. She relapsed again, was retreated, ...

Extracorporeal photopheresis improves nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis: Three case reports and review of literature

Journal of Clinical Apheresis — Thu, 17 Jul 2008 04:00:00 +0100

We report a clinical response to treatment with extracorporeal photopheresis (ECP) using the Therakos UVAR XTS system in three cases of NFD/NSF associated with flexion contractures affecting all four limbs. All three patients were receiving renal replacement therapy for longstanding end-stage renal failure. All three showed clinical response with softening of skin plaques at the end of four cycles, and improved range of movement in all four limbs on completion of treatment. The first patient, with NFD/NSF of 4.5 year's duration, was able to resume most activities of daily living although still chairbound, while a second patient with more recent onset of NSF was able to walk short distances with the help of Zimmer frames by the end of 16-18 cycles of treatment, having been chairbound pretre...

Postpartum plasma exchange as adjunctive therapy for severe acute fatty liver of pregnancy

Journal of Clinical Apheresis — Wed, 16 Jul 2008 04:00:00 +0100

Acute fatty liver of pregnancy (AFLP) is a rare disease of progressive hepatic insufficiency and secondary systemic compromise that poses significant fetal-maternal risk. Plasma exchange (PEX) is an effective bridge therapy to sustain liver function and enable hepatocellular regeneration to occur in nonpregnant patients following acute decompensation of a chronic liver disease or while awaiting liver transplantation. The application of PEX for patients with AFLP is a novel concept; since 1988 we have utilized postpartum PEX (PPEX) as adjunctive medical therapy for six patients with severe AFLP. Before PPEX initiation, four patients had signs and symptoms of encephalopathy, three required ventilatory support, five had advanced liver insufficiency, and all six were developing renal failure. ...

Lessons learned from the Oklahoma Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome Registry

Journal of Clinical Apheresis — Thu, 10 Jul 2008 04:00:00 +0100

The Oklahoma TTP-HUS Registry provides a complete community perspective of thrombotic thrombocytopenic purpura (TTP). This is possible because plasma exchange is the essential treatment for TTP and the Oklahoma Blood Institute provides all plasma exchange procedures for a region encompassing most of the State, including 58 of Oklahoma's 77 counties. The Registry is an inception cohort of consecutive patients for whom plasma exchange treatment was requested for a diagnosis of either TTP or hemolytic uremic syndrome (HUS). All 382 patients identified from January 1, 1989 to December 31, 2007 have consented to be enrolled. Complete follow-up is available for 380 of 382 patients. Patients are described both by clinical categories, related to their associated conditions and clinically apparent ...

A 3-year analysis of plateletpheresis donor deferral pattern in a tertiary health care institute: Assessing the current donor selection criteria in Indian scenario

Journal of Clinical Apheresis — Wed, 09 Jul 2008 04:00:00 +0100

This study reports the frequency and nature of plateletpheresis deferrals and evaluates donors with low platelet count and hemoglobin levels so as to assess the possibility of reentry without hampering donor safety. Materials and methods: Three-year retrospective data of plateletpheresis deferral was collected. Data from actual procedures was also reviewed to analyze the safety of performing plateletpheresis in donors with low hemoglobin and platelet values. Results: Four hundred sixteen donors were deferred for various reasons among 1,515 screened (27.5%), of which 69.7% deferrals were because of low platelet count (55.8%) and less hemoglobin levels. Among the low platelet count donor group, 20.3% had a count between 141 and 149 × 109/L and 41.8% below 120 × 109/L. Of the 14% donors def...

Standardized protocol to identify high-risk patients undergoing therapeutic apheresis procedures

Journal of Clinical Apheresis — Tue, 03 Jun 2008 04:00:00 +0100

As the scope of therapeutic apheresis (TA) expands and more procedures are requested for critically ill patients, adverse reactions (AR) associated with TA become a major concern for physicians, nurses, patients and their families. To assess the risks for ARs associated with patients' underlying diseases, we developed a preprocedure assessment tool with a set of high-risk criteria which included: (1) unstable vital signs, (2) active nonphysiological bleeding, (3) evidence of severe bronchoconstriction, (4) severe anemia, (5) projected extracorporeal volume (ECV) >15% of total blood volume (TBV) in adults or >10% of TBV in pediatric patients, (6) pregnancy, and (7) conditions requiring continuous nursing support. A standard operating procedure with a "Request for Apheresis Procedure on High...

Double-filtration plasmapheresis in the treatment of leg ulcers in cryoglobulinemia

Journal of Clinical Apheresis — Sat, 17 May 2008 04:00:00 +0100

We describe a case of HCV-positive type I cryoglobulinemia with severe leg ulcers, not responsive to antiviral and immunosuppressive treatment. Thirty sessions of double filtration plasmapheresis were performed, over a period of 6 months, with no other associated treatment. Before and after each session an assessment of immunoglobulins, complement, cryocrit, and fibrinogen was made. HCV RNA levels were determined in serum cryoprecipitate, supernatant before and after each session, and in the collection bag. No differences in pre and postapheresis values were observed in the serum concentrations and the supernatant, whereas the postapheresis cryoprecipitate showed a significantly reduced viral load (P < 0.02) as compared with the preapheresis values. There was improvement in the condition o...

Unilateral serous retinal detachment in a patient with thrombotic thrombocytopenic purpura

Journal of Clinical Apheresis — Tue, 06 May 2008 04:00:00 +0100

We report a case of a 46 year old woman who presented with TTP, received therapeutic plasma exchange, and developed unilateral serous retinal detachment with retinal pigment epithelial tear in the absence of reported hypertension. The increased perfusion pressure due to hypertension, combined with the choroidal vasculature damage from TTP are thought to lead to retinal epithelial tear. This suggests that although hypertension may play a role in retinal detachment in these patients, other mechanisms may be responsible. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

A multi center study of granulocyte and monocyte adsorption apheresis therapy for ulcerative colitis - Clinical efficacy and production of interleukin-1 receptor antagonist

Journal of Clinical Apheresis — Thu, 01 May 2008 04:00:00 +0100

Granulocyte and monocyte adsorption apheresis (GCAP) is a useful strategy for intractable ulcerative colitis, but its mechanisms of therapy is not fully explained. Previously, depleting activated granulocytes and monocytes (GMs) and modifying product of proinflammatory cytokines had been proposed. In addition, activated GMs are releasing anti-inflammatory cytokines, interleukin-1 receptor antagonist (IL-1ra) that may contribute to the clinical efficacy of GCAP therapy. Hence, to investigate contribution of IL-1ra as well as to confirm clinical efficacy of this therapy based on clinical activity index (CAI), we performed a multicenter study. Twenty-five of 38 (65.8%) patients achieved remission state (CAI [le] 4) and two of 38 (5.3%) revealed clinical improvement. Almost effective cases sig...

Pro-tolerogenic effects of photodynamic therapy with TH9402 on dendritic cells

Journal of Clinical Apheresis — Thu, 27 Mar 2008 04:00:00 +0100

A major goal in transplantation immunology is to develop strategies that can specifically promote tolerance to foreign cells and tissues without compromising other immune functions. Experimental induction of transplantation tolerance by dendritic cells (DCs) and/or T regulatory (Treg) cells can efficiently prevent graft-versus-host disease and organ graft rejection in animal models, and there is much hope that similar strategies in transplanted patients will provide an alternative to immunosuppression. Photodynamic therapy (PDT) is a therapeutic treatment for graft versus host disease and organ rejection that may operate via induction of tolerance. We investigated whether a new PDT therapy, based on exposure of cells to 4,5-dibromorhodamine methyl ester (TH9402), may operate via induction ...

Concentration changes to counteract the effects of bacteriological sampling on PLT yields

Journal of Clinical Apheresis — Wed, 26 Mar 2008 04:00:00 +0100

Introduction: Bacterial culturing of apheresis platelet (PLT) units appeared to increase the incidence of low yield products of (Source: Journal of Clinical Apheresis)

Transfusion-related acute lung injury: A thrombotic thrombocytopenic purpura treatment-associated case report and concise review

Journal of Clinical Apheresis — Thu, 28 Feb 2008 05:00:00 +0100

We report a thrombotic thrombocytopenic purpura (TTP) treatment-associated case of TRALI and review the history, pathogenesis, diagnosis and management of this syndrome. Current risk reduction strategies are also discussed. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Refractory thyrotoxicosis induced by iodinated contrast agents treated with therapeutic plasma exchange. A case report

Journal of Clinical Apheresis — Thu, 21 Feb 2008 05:00:00 +0100

Excess free iodide in the blood (ingested or injected) may cause thyrotoxicosis in patients at risk. Iodinated contrast solutions contain small amounts of free iodide and may be of significance for patients affected by Graves' disease, multinodular goiter or living in areas of iodine deficiency. Herein, we report a 57 elderly woman with a clinical history of multinodular goiter presented with a thyrotoxicosis induced by an iodinate contrast agent used during computed tomography scan. Because of the patient's resistance to conventional antithyroid drugs, she was treated with therapeutic plasma exchange (TPE). TPE is used in the treatment of several immunologic and nonimmunologic disorders. Temporary improvement after TPE in cases with thyrotoxicosis has been reported. In our patient's case,...

Abstracts from the American Society for Apheresis 29th Annual Meeting, April 9-12, 2008, Galveston, Texas

Journal of Clinical Apheresis — Wed, 20 Feb 2008 05:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Exclusive use of acid citrate dextrose for anticoagulation during extracorporeal photopheresis in patients with contraindications to heparin: An effective protocol

Journal of Clinical Apheresis — Tue, 19 Feb 2008 05:00:00 +0100

In conclusion, an effective protocol for ECP using ACD-A anticoagulation exclusively in patients with contraindications to heparin employs continuous monitoring of flow rates and prophylactic administration of calcium gluconate to minimize citrate toxicity. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

The role of immunomodulation in ABO-incompatible adult liver transplant recipients

Journal of Clinical Apheresis — Fri, 11 Jan 2008 05:00:00 +0100

ABO-incompatible (ABO-i) liver transplantation (LT) is a high-risk procedure due to the potential for antibody-mediated rejection (AMR) and cell-mediated rejection. The aim of the current report is to illustrate the results of a retrospective comparison study on the use of immunomodulation with therapeutic plasma exchange (TPE) associated to high-dose immunoglobulins (IVIg) and extracorporeal photopheresis (ECP) in ABO-i adult LT patients.Between January 1996 and December 2005, 19 patients underwent ABO-i LT. The study was designed for a comparison between two groups of ABO-i LT. Group 1 (control group) consisted of 11 patients treated with TPE only. Group 2 (study group) included eight patients treated with TPE and IVIg. Moreover, all Group 2 patients received acute rejection prophylaxis ...

CMV antibody prevalence and seroincidence in plateletpheresis donors

Journal of Clinical Apheresis — Tue, 08 Jan 2008 05:00:00 +0100

Conclusion: CMV seroprevalence and seroincidence in this plateletpheresis donor population are relatively low so that a large percentage of donors are likely to be able to provide CMV seronegative platelet components for many years. Our data suggest that targeting groups with lower CMV seroprevalence and seroincidence rates such as young people and possibly men will likely yield the highest percentage of CMV seronegative donors. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Recruitment of immature neutrophils in peripheral blood following leukocytapheresis therapy for rheumatoid arthritis

Journal of Clinical Apheresis — Thu, 20 Dec 2007 05:00:00 +0100

The objective of this study is to evaluate the cellular mechanism underlying filtration leukocytapheresis (LCAP) therapy for the treatment of rheumatoid arthritis (RA). Thirteen patients with refractory RA each underwent three sessions of LCAP. Before (pre-) and after (post-) the completion of the first LCAP session, peripheral blood was sampled and analyzed for neutrophil surface markers using flow cytometry. The surface antigens of peripheral blood mononuclear cells (PBMCs) and neutrophils obtained at pre- and post-LCAP were then analyzed using a fluorescence-activated cell sorter. The American College of Rheumatology's criterion of a 20% improvement was achieved in six patients, but not in the other seven patients, after LCAP therapy. The post-LCAP number of blood band form neutrophils ...

ABO-incompatible kidney transplantation - Proposal of an intensified apheresis strategy for patients with high initial isoagglutinine titers

Journal of Clinical Apheresis — Wed, 19 Dec 2007 05:00:00 +0100

We report on 11 "high-titer patients" who entered our ABOi kidney transplant program with initial titers of 1:256 or above. Seven of 11 patients (64%) could successfully be transplanted with our modified ABO-apheresis protocol. Four of 11 high-titer patients did not reach target isoagglutinine titers of 1:4 or less and therefore did not undergo transplantation. We conclude that intensified preoperative IA renders a majority of high-titer patients suitable candidates for ABOi kidney transplantation. J. Clin. Apheresis, 2007. © 2007 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Improved peripheral blood stem cell collection following plasma exchange in a patient with elevated viscosity and coagulopathy

Journal of Clinical Apheresis — Wed, 19 Dec 2007 05:00:00 +0100

We report a case of improved CD34+ cell yields from peripheral blood stem cell (PBSC) collection following therapeutic plasma exchange (TPE) in a patient with elevated viscosity and coagulopathy. The patient was a 46-year-old male diagnosed with IgM lambda multiple myeloma that was largely unresponsive to standard chemotherapy. He had coagulopathy due to lymphoproliferative disease-associated acquired von Willebrand Factor (vWF) deficiency. The patient underwent two rounds of PBSC collections over 3 consecutive weeks (five total collections) prior to planned tandem transplant for multiple myeloma. Both rounds resulted in poor collections due to processing difficulties. It was decided to perform three TPEs daily immediately prior to attempting additional PBSC collections, to treat the patie...

Performance of a new separator system for routine autologous hematopoietic progenitor cell collection in small children

Journal of Clinical Apheresis — Fri, 14 Dec 2007 05:00:00 +0100

The AMICUSTM system was recently introduced for peripheral blood stem cell (PBSC) aphereses in adults. We conducted a single center field evaluation to obtain data about the performance of this system in children with a body weight (bw) < 25 kg. Results of blood priming procedures were compared to historical data obtained with the Fenwal CS3000+ (CS 3000). From August, 2001 to February, 2007, 47/178 (26%) PBSC aphereses procedures were performed in our institution with the AMICUSTM system in 35 small patients (median bw 13.9 kg; range 6.7-24; age 2.78 years; range 0.97-7.06). The patients suffered from various malignant primary diseases or recurrences. We primed the system with packed RBC in case of >30% dilution of the RBC volume (n = 31) or with saline (n = 16). Compared to the CS3000, t...

Successful management of a Jehovah's Witness with thrombotic thrombocytopenic purpura unwilling to be treated with therapeutic plasma exchange

Journal of Clinical Apheresis — Thu, 13 Dec 2007 05:00:00 +0100

We report a case of one such patient who presented with TTP, whom we successfully managed with vincristine and responded favorably without the need for plasma exchange. J. Clin. Apheresis, 2007. © 2007 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Therapeutic plasma exchange performed in parallel with extra corporeal membrane oxygenation for antibody mediated rejection after heart transplantation

Journal of Clinical Apheresis — Thu, 13 Dec 2007 05:00:00 +0100

We report on the feasibility, safety, and efficacy of performing therapeutic plasmapheresis (TPE) in parallel with extracorporeal membrane oxygenation (ECMO) to alleviate antibody mediated rejection (AMR) after heart transplantation. Two pediatric and one adult patient presented with severe congestive heart failure and respiratory distress after heart transplantation and required ECMO support. TPE was initiated to treat AMR while patients remained on ECMO. Each patient received three to five procedures either every day or every other day. One equivalent total plasma volume (TPV) was processed for each procedure (patient TPV + ECMO extracorporeal TPV). A total of 13 TPE procedures were performed with 12 procedures completed without complications or adverse events; one procedure was terminat...

Effects of two whole blood systems (DALI and Liposorber D) for LDL apheresis on lipids and cardiovascular risk markers in severe hypercholesterolemia

Journal of Clinical Apheresis — Sat, 13 Oct 2007 04:00:00 +0100

In conclusion, both devices were highly effective in eliminating atherogenic lipoproteins. CRP and fibrinogen were better eliminated with Liposorber D. However, following Liposorber D, interleukin-6 levels were higher than after DALI possibly indicating an increased inflammatory activation. J. Clin. Apheresis, 2007. © 2007 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Plasmapheresis for hemolytic crisis and impending acute liver failure in Wilson disease

Journal of Clinical Apheresis — Wed, 19 Sep 2007 04:00:00 +0100

We report a patient presenting with severe hemolysis and impending acute liver failure that made a rapid recovery with prompt initiation of plasmapheresis and chelation therapy. Rapid copper removal by plasmapheresis alleviated hemolysis and liver injury. A review of the literature was performed examining the use of plasmapheresis and albumin dialysis with continuous veno-venous hemodialysis or molecular adsorbents and recirculating system. J. Clin. Apheresis, 2007. © 2007 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

The introduction of 7-day platelets: A university hospital experience

Journal of Clinical Apheresis — Wed, 19 Sep 2007 04:00:00 +0100

Discussion: Over the 6-month period, we noted a decrease in outdates from 2.9% to 1.3%. There was a shift toward older platelets (from a mean of day 3.4 to day 4). During the study period, 139 platelets were transfused on days 6 or 7 of storage. Overall, the implementation of 7-day platelets in a university hospital setting was easily accomplished and has resulted in benefits to our institution by decreasing our outdate rate and to our patients by providing an additional 139 days 6 and 7 apheresis platelets with a potential cost savings of $78,952 (over the 6-month study). J. Clin. Apheresis, 2007. © 2007 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

A randomized comparison of peripheral blood hematopoietic progenitor cell level of 5/mm3 versus 50/mm3 as a surrogate marker to initiate efficient autologous blood stem cell collection

Journal of Clinical Apheresis — Wed, 19 Sep 2007 04:00:00 +0100

We previously showed that at least 5/mm3 hematopoietic progenitor cells (HPCs) could be used as a marker for initiating autologous blood stem cell collection (ABSCC). However, the timing of efficient ABSCC following mobilization is still to be determined. We conducted a prospective, randomized comparison of 5/mm3 versus50/mm3 peripheral blood (PB) HPCs as a surrogate marker to initiate efficient ABSCC. Forty-five consecutive patients, 26 with multiple myeloma (MM) and 19 with non-Hodgkin's lymphoma (NHL), were enrolled between October 2004 and October 2006. Chemotherapy was cyclophosphamide 4 g/m2 for MM and ESHAP (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin), with or without Rituximab, for NHL. Circulating HPCs were monitored daily with the Sysmex SE9000 automated h...

ISBT 128 implementation plan for cellular therapy products

Journal of Clinical Apheresis — Fri, 07 Sep 2007 04:00:00 +0100

The publication of new standards for terminology and labeling marks an important step in ensuring consistency and traceability of cellular therapies at the global level. However, it is only with the widespread implementation of the standard that the benefits can be truly realized. This paper provides guidance on the practical aspects of adopting these new standards for organizations with differing current levels of computerization. It discusses project management, equipment, licensing, and validation topics. J. Clin. Apheresis, 2007. © 2007 Internal Cellular Therapy Coding and Labeling Advisory Group. (Source: Journal of Clinical Apheresis)

Standards for the terminology and labeling of cellular therapy products

Journal of Clinical Apheresis — Thu, 06 Sep 2007 04:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Abstract from the American Society for Apheresis 28th Annual Meeting, April 18-21, 2007 Nashville, Tennessee

Journal of Clinical Apheresis — Sat, 25 Aug 2007 04:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Continuous infusion of calcium gluconate in 5% albumin is safe and prevents most hypocalcemic reactions during therapeutic plasma exchange

Journal of Clinical Apheresis — Fri, 24 Aug 2007 04:00:00 +0100

While therapeutic plasma exchanges (TPEs) performed with 5% albumin are considered safe, concerns regarding venous access and hypocalcemic toxicity remain. We reviewed the frequency of complications during TPEs performed with 5% albumin supplemented with calcium gluconate and potassium chloride for a 5 year period in our institution. Eighty-four adult patients (46 males and 38 females) underwent 581 plasma exchanges during the study period. The most common indications were myasthenia gravis (37%), acute inflammatory demyelinating polyradiculoneuropathy (31%), and chronic inflammatory demyelinating polyneuropathy (13%). All procedures used 2.2% ACD-A delivered at a calculated average rate of 0.26 mg/kg/min, which led to a mean dose of citrate per TPE of 2.18 ± 0.48 g or 27.8 ± 5.24 mg/kg ...

Complications of therapeutic plasma exchange: A prospective study of 1,727 procedures

Journal of Clinical Apheresis — Fri, 24 Aug 2007 04:00:00 +0100

The type and number of complications was prospectively examined in 1,727 successive TPE treatments in 174 patients over 66 months at a single center. Most treatments were prescribed for thrombotic thrombocytopenic purpura (TTP; 42%), recurrent focal segmental glomerulosclerosis (FSGS; 22%), or myasthenia gravis (MG; 13%). About 57% of treatments used albumin-saline as the replacement solution and 43% used fresh-frozen plasma (FFP), almost all for TTP. There were 889 complications; 614 treatments (36% of the total) involved a complication. Most complications were minor; there were no deaths. Three treatments (0.2%) were discontinued due to a complication, and 2 (0.1%) required transfer to a higher acuity hospital bed. The most common complications were fever (7.7% of treatments), urticaria ...

Collection of mobilized peripheral blood stem cells from a donor with severe iron deficient anemia

Journal of Clinical Apheresis — Wed, 15 Aug 2007 04:00:00 +0100

We report a 45-year-old woman with iron deficient anemia (IDA) who underwent a collection of allogeneic peripheral blood stem cells (PBSCs) induced by granulocyte-colony stimulating factor (G-CSF) after a rapid improvement of IDA by iron replacement. Her peripheral red blood cells (RBCs) after iron therapy were composed of two different-sized subpopulations; one consisted of microcytes, which were iron deficient RBCs, and another of normocytes, which were produced after iron replacement. On the first day of PBSC collection, the interface setting was maintained aiming at 2% hematocrit as usual; however, PBSCs could not be collected adequately. Sedimentation of iron deficient, lighter RBCs under centrifugation within a blood cell separator could be similar to that of mononuclear cells, and t...

American Society for Apheresis, Society of Hemapheresis Specialists and Francis S. Morrison, MD, revisited

Journal of Clinical Apheresis — Thu, 12 Jul 2007 04:00:00 +0100

The histories of the American Society for Apheresis (ASFA) and the Society for Hemapheresis Specialists (SHS) are intimately intertwined with Francis S Morrison, MD. Because many of the relevant historical events are not recorded as written documents, it is useful to revisit them via the memory of those who lived-through the growth and development of ASFA. ASFA began in 1982 as an organization of physicians interested in automated hemapheresis - actually, meetings of ASFA perse were preceded in the late 1970s by apheresis symposia sponsored by the American Red Cross Blood Services in Chicago. Concurrently, SHS formed as an organization of nurses and "operators" performing hemapheresis procedures and held meetings separate from ASFA. Following a number of turbulent years, ASFA and SHS merge...

Immunoadsorption with single-use columns for the management of bleeding in acquired hemophilia A: A series of nine cases

Journal of Clinical Apheresis — Wed, 04 Jul 2007 04:00:00 +0100

We report on a retrospective analysis of nine cases of acquired hemophilia A treated with IA using disposable adsorber columns. Data collection was performed by retrospectively reviewing the patients' files regarding clinical course, mode of therapy, inhibitor titers, and coagulation status.Inhibitor titers were effectively reduced in all but one patient following the treatment with IA. In two out of seven patients surviving the acute bleeding an inhibitor relapse occurred. The overall remission rate was determined as 77.8% within a median follow-up of 613 days. In two of our nine patients fatal outcome resulted due to major bleeding complications. IA treatment showed good tolerability and no fatal complications were caused.The presented cases support our assumption that patients with acqu...

Treatment of chronic dilated cardiomyopathy with immunoadsorption using the staphylococcal A-Agarose column: A comparison of immunoglobulin reduction using two different techniques

Journal of Clinical Apheresis — Tue, 03 Jul 2007 04:00:00 +0100

Auto-antibodies to myocardial antigens have been implicated in the pathogenesis of chronic dilated cardiomyopathy (DCM). A protein A immunoadsorption affinity column system was used to remove IgG antibodies, particularly IgG3. Two techniques, the standard technique (T-1) used for removal of IgG Factor VIII inhibitors and a technique (T-2) designed to enhance IgG3 removal and address issues in venous access, minimize positive fluid balance, and adverse reactions were compared. A total of four patients were treated, two patients were treated for 5 consecutive days with each technique. T-2 resulted in larger, but not significantly so, IgG3 reduction (70% and 63%) than T-1 (53% and 59%). Both techniques lowered total IgG levels by [ge]93%. Because of venous access problems, 60% of T-1 procedur...

Efficacy of low-density lipoprotein apheresis in arteriosclerosis obliterans of the lower extremities: Two cases with marked alleviation of clinical symptoms

Journal of Clinical Apheresis — Tue, 03 Jul 2007 04:00:00 +0100

We have recognized marked effectiveness for intermittent claudication with low-density lipoprotein (LDL) apheresis in two cases of arteriosclerosis obliterans (ASO). The Case 1 was a 73-year-old man with intermittent claudication of both lower extremities (Fontaine class II), digital subtraction angiography (DSA) revealed complete obstruction of the left common iliac artery, formation of a collateral to the peripheral portion of the left common iliac artery, and diffuse stenosis of the peripheral portion of the right common iliac artery. Ten sessions of LDL apheresis (LDL-A) improved the walking distance from 100 m before to 600 m after LDL-A treatment. The Case 2 was a 61-year-old man with intermittent claudication of the left lower extremity (walking distance: 200 m) began at 59 years. D...

Dextran-sulfate-adsorption of atherosclerotic lipoproteins from whole blood or separated plasma for lipid-apheresis - Comparison of performance characteristics with DALI and lipidfiltration

Journal of Clinical Apheresis — Mon, 23 Apr 2007 04:00:00 +0100

For many years dextran sulfate adsorption (DSA) treatment of separated plasma has been an established technology for low-density lipoprotein (LDL)-elimination. Recently a system for the treatment of whole blood based on DSA was introduced into clinical practice. To further characterize DSA treatment of whole blood, the performance characteristics of both DSA modalities were compared at two investigational sites with two alternative LDL apheresis systems being already in routine clinical use. In prospective cross-over design, DSA whole blood treatment was compared with a whole blood polyacrylate LDL adsorption system (DALI) in one study group. DSA for plasma treatment was compared with Lipidfiltration in cross-over design in a second study group. In total, 12 patients on chronic LDL apheres...

The new approach to assignment of ASFA categories - Introduction to the fourth special issue: Clinical applications of therapeutic apheresis

Journal of Clinical Apheresis — Fri, 30 Mar 2007 04:00:00 +0100

This article describes the novel methodology, based on structured systematic review of the published literature, used to assign categories for indications for therapeutic apheresis. This is the first time each entity is presented as a fact sheet, which summarizes the evidence for the use of therapeutic apheresis. A detailed description of the fact sheet format and the individual fact sheets for categories I through III and category P are presented in the main article of this Special Issue. The diseases assigned to category IV are discussed in a separate article in this issue. Information on how the Apheresis Applications Committee proposes to include new diseases for category assignment is also provided. J. Clin. Apheresis., 2007 © 2007 Wiley-Liss, Inc. (Source: Journal of Clinical Aphere...

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, 29 Mar 2007 04:00:00 +0100

This article is the integral part of the Fourth ASFA Special Issue. The Fourth ASFA Special Issue is significantly modified in comparison to the previous editions. A new concept of a fact sheet has been introduced. The fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis. A detailed description of the fact sheet is provided. The article consists of 53 fact sheets devoted to each disease entity currently categorized by the ASFA. Categories I, II, and III are defined as previously in the Third Special Issue. However, a few new therapeutic apheresis modalities, not yet approved in the United States or are currently in clinical trials, have been assigned category P (pending) by the ASFA Clinical Categories Subcommittee. The diseases assigned to category IV are dis...

Plasma exchange treatment to reduce anti-beta1-adrenergic receptor antibody in a patient with dilated cardiomyopathy

Journal of Clinical Apheresis — Mon, 26 Mar 2007 04:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Plasma exchange as treatment for Lawsone (henna) intoxication

Journal of Clinical Apheresis — Mon, 26 Mar 2007 04:00:00 +0100

Lawsone (2-hydroxy-1,4-naphthoquinone) is the active ingredient of Lawsonia alba, whose crushed leaves are known as henna, used as a hair and skin dye in many parts of the world. Accidental or deliberate ingestion of Lawsone has a high mortality rate (up to 31%) owing to rhabdomyolysis and renal failure. The authors report the first successful use of plasmapheresis as an adjunct to the treatment of these symptoms in a 69-year-old man who suffered severe symptoms of Lawsone poisoning due to inadvertent ingestion. Although most cases reported in the literature have been treated using supportive techniques, including hemodialysis, the high mortality despite these measures suggests that prompt plasma exchange may be a lifesaving technique for this syndrome. J. Clin. Apheresis., 2007. © 2007 W...

A pilot study to assess the use of protein a immunoadsorption for chronic dilated cardiomyopathy

Journal of Clinical Apheresis — Mon, 26 Mar 2007 04:00:00 +0100

Dilated cardiomyopathy (DCM) is a leading cause of end-stage heart failure and cardiac transplantation. Anticardiac antibodies are common and removal of these through immunoadsorption (IA) is associated with improvement in global cardiac function. The effect of IA on regional function and quality of life (QOL) without intravenous immunoglobulin (IVIG) substitution has not been described. We performed a pilot trial using Immunosorba® columns in four patients with chronic DCM and NYHA Class II-III congestive heart failure. Subjects were followed for 6 months with serial echocardiograms and validated QOL assessments. Regional and global left ventricular (LV) end-systolic deformations were assessed by two-dimensional strain echocardiography. Total IgG decreased 95% (from 1,210 ± 274 mg/dl to...

Evidence of seriousness in apheresis medicine

Journal of Clinical Apheresis — Sat, 24 Mar 2007 04:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Guidelines for therapeutic apheresis clinical privileges

Journal of Clinical Apheresis — Wed, 21 Mar 2007 04:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Guidelines for documentation of therapeutic apheresis procedures in the medical record by apheresis physicians

Journal of Clinical Apheresis — Wed, 21 Mar 2007 04:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Category IV indications for therapeutic apheresis - ASFA fourth special issue

Journal of Clinical Apheresis — Wed, 21 Mar 2007 04:00:00 +0100

The American Society for Apheresis (ASFA) Committee on Clinical Applications systematically and critically reviews published information on the use of therapeutic apheresis in clinical practice. On the basis of this review, selected diseases are assigned one of five categories (category I, II, III, IV, and P). The diseases, which were classified as category IV indications, and the rationale for such assignment are reviewed in this article. The diseases assigned to category I, II, III, and newly created category P are discussed in a separate article in this issue. J. Clin. Apheresis, 2007 © 2007 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

American society for apheresis Bylaws

Journal of Clinical Apheresis — Sun, 18 Mar 2007 04:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Abstracts from the American society for apheresis 28th annual meeting, april 18-21, 2007 Nashville, Tennessee

Journal of Clinical Apheresis — Mon, 12 Mar 2007 04:00:00 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Infection as a cause of early relapse in patients recovering from thrombotic thrombocytopenic purpura

Journal of Clinical Apheresis — Mon, 05 Mar 2007 05:00:00 +0100

This report emphasizes the need to be vigilant for new infections especially urinary tract infections in TTP patients undergoing plasma exchange. Instituting appropriate antibiotic therapy once an infection is suspected may reduce the need for prolonged plasma exchange procedures and extended hospital stay. J. Clin. Apheresis. © 2007 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

A new model for predicting the timing of leukapheresis on the basis of CD34+ cell and hematopoietic progenitor cell levels

Journal of Clinical Apheresis — Mon, 12 Feb 2007 07:00:00 +0100

We developed a model (depending on peripheral CD34+ cell count and hematopoietic progenitor cell count) to determine the optimal timing of 3-day leukapheresis in patients pretreated with chemotherapy and G-CSF. Marrow potentials were identified on the basis of three patterns of leukapheretic yield. Pattern 1 predicted good marrow potential. The positive predictive value of a first-day leukapheretic yield of >1 × 106 CD34+ cells/kg (mean 3-day yield = 8.18 × 106 CD34+ cells/kg, n = 11) was 100%. Pattern 2 predicted poor marrow potential. The negative predictive value of a 3-day leukapheretic yield of >1 × 106 CD34+ cells/kg (3-day yield = 0.26 × 106 CD34+ cells/kg, n = 1) was 100%. Pattern 3 met neither of the above criteria (mean 3-day yield = 1.37 × 106 CD34+ cells/kg, n = 19). The m...

Avoiding calcineurin inhibitors in the early post-operative course in high-risk liver transplant recipients: The role of extracorporeal photopheresis

Journal of Clinical Apheresis — Fri, 09 Feb 2007 07:00:00 +0100

The aim of this work is to report on the results of a single-center, prospective study on the feasibility of calcineurin-inhibitor (CNI)-staggered immunosuppression by use of extracorporeal photopheresis (ECP) in liver transplant (LT) recipients at risk of renal and neurological complications.Patients were matched on a 1:1 basis with historical controls on standard CNI immunosuppression. ECP patients were treated with ECP plus antimetabolites and/or steroids, while CNIs were withheld until clinically indicated. Thirty-six patients were evaluated: 18 ECP patients and 18 controls. ECP was tolerated in 100% of cases. CNI were introduced at a median of 8 days (4-55) in 17 ECP patients, while one patient was on a fully CNI-sparing regimen 22 months after LT. Acute rejection occurred in 27.7% pa...

Factors affecting platelet yield and their impact on the platelet increment of patients receiving single donor PLT transfusion

Journal of Clinical Apheresis — Mon, 05 Feb 2007 07:00:00 +0100

The aim of this study was to analyze the impact of various donor and machine parameters on PLT yield in 127 PLT apheresis procedures, to optimize PLT yield achieving clinical and economic advantages. One hundred and twenty-seven apheresis procedures were analyzed. Age, gender, volume processed, Hb, and PLT precounts were included as donor predicting variables. AC infusion rate, processing time, and plasma volume collected with PLTs were assessed as machine parameters. We evaluated the post-transfusion effectiveness in 23 patients with thrombocytopenia, studying the effect of PLT dose, ABO group, and PLT storage time. Females gave higher yields, compared to males, P < 0.01. PLT yield correlated positively with PLT precount (r = 0.512), and TBV (r = 0.404), and negatively with donor preapher...

Journey in reverse: TTP from bedside to blood bank to bench

Journal of Clinical Apheresis — Fri, 24 Nov 2006 05:00:00 +0100

Thrombotic thrombocytopenic purpura (TTP) is the most extensive and dangerous intravascular platelet clumping disorder. For more than a half-century after its initial recognition, mortality was near 100% and the etiology totally obscure. Then, in the late 1970s to early 1980s, empiric, but successful, therapy by a few clinician/blood bank partnerships was followed by sudden laboratory insight into pathophysiology. The discussion that follows was prepared in conjunction with the 2006 Francis Morrison, M.D., Memorial Lecture at the 27th Annual Meeting of the American Society for Apheresis. J. Clin. Apheresis. © 2006 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Effect of immunoadsorption on refractory idiopathic focal and segmental glomerulosclerosis

Journal of Clinical Apheresis — Wed, 22 Nov 2006 11:46:01 +0100

A case of a young adult with refractory nephrotic syndrome due to focal segmental glomerulosclerosis is reported. Several treatments had been used without success including steroids, cyclophosphamide, cyclosporine A, tacrolimus, and mycophenolate mofetil. Immunoadsorption was performed as a last resort to manage the nephrotic syndrome, which led to a drastic urinary protein reduction. We review the literature supporting immunoadsorption in primary focal segmental glomerulosclerosis. J. Clin. Apheresis. © 2006 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Optimization of the concentration of autologous serum for generation of leukemic dendritic cells from acute myeloid leukemic cells for clinical immunotherapy

Journal of Clinical Apheresis — Wed, 22 Nov 2006 11:46:01 +0100

We examined the effect of autologous serum on the properties of leukemic DCs derived from leukemic cells of AML patients by culture in AIM-V medium with GM-CSF, IL-4, TNF-[alpha], and 0, 2, 5, or 10% human autologous serum. The expressions of CD80, CD83, CD86, and HLA-DR were upregulated under all culture conditions; however, 10% autologous serum induced the highest expression levels of several molecules. The capacity of leukemic DCs to stimulate allogeneic T cells increased with increasing serum concentration. Stimulation of autologous CD3+ T cells with leukemic DCs grown in the presence of various concentrations of autologous serum resulted in induction of more IFN-[gamma]-secreting cells than was the case for unprimed CD3+ T cells. Leukemic DCs cultured with 10% autologous serum induced...

Comparison of plateletpheresis on the Fresenius AS.TEC 204 and Haemonetics MCS 3p

Journal of Clinical Apheresis — Sun, 19 Nov 2006 05:00:00 +0100

This is an attempt at comparing two cell separators for plateletpheresis, namely the Fresenius AS.TEC 204 and Haemonetics MCS 3p, at a tertiary care center in India. Donors who weighed between 55-75 kg, who had a hematocrit of 41-43%, and platelet counts of 250 × 103-400 × 103/[mu]l were selected for the study. The comparability of the donors who donated on the two cell separators were analysed by t-test independent samples and no significant differences were found (P > 0.05). The features compared were time taken for the procedure, volume processed on the separators, adverse reactions of the donors, quality control of the product, separation efficiency of the separators, platelet loss in the donors after the procedure, and the predictor versus the actual yield of platelets given by the ...

Successful peripheral blood stem cell harvest on a 5.5-kg infant

Journal of Clinical Apheresis — Sun, 19 Nov 2006 01:02:05 +0100

No abstract. (Source: Journal of Clinical Apheresis)

Severe citrate toxicity complicating volunteer apheresis platelet donation

Journal of Clinical Apheresis — Sun, 19 Nov 2006 01:02:05 +0100

We report a case of severe citrate toxicity during volunteer donor apheresis platelet collection. The donor was a 40-year-old female, first-time apheresis platelet donor. Past medical history was remarkable for hypertension, hyperlipidemia, and depression. Reported medications included bumetanide, pravastatin, and paroxetine. Thirty minutes from the start of the procedure, the donor noted tingling around the mouth, hands, and feet. She then very rapidly developed acute onset of severe facial and extremity tetany. Empirical treatment with intravenous calcium gluconate was initiated, and muscle contractions slowly subsided over approximately 10 to 15 minutes. The events are consistent with a severe reaction to calcium chelation by sodium citrate anticoagulant resulting in symptomatic systemi...

Combination regimen of methylprednisolone, IV immunoglobulin, and plasmapheresis early in the treatment of acute disseminated encephalomyelitis

Journal of Clinical Apheresis — Sun, 24 Sep 2006 04:00:00 +0100

We report a case of a 42 year-old previously healthy man, whom we treated successfully with a combination regimen of methyprednisolone, IV immunoglobulin, and plasmapheresis early in the course of the disease. J. Clin. Apheresis 21: 2006. © 2006 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Isolation of monocytes from whole blood-derived buffy coats by continuous counter-flow elutriation