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D Stoffner

Publications and source records attributed to D Stoffner.

7 recordsLinked to original sources
PubMed1984

Plasma exchange and concomitant therapy in TTP.

Since plasma exchange was introduced in the management of thrombotic thrombocytopenic purpura (TTP) in 1977, patient survival rate has increased from 10 to 80%. However, approximately 50 subsequent case reports in the literature provide no consensus as to the optimal therapy. We review here 4 episodes of TTP in 3 patients. In all cases, treatment was started with intensive FFP plasma exchange combined with administration of antiplatelet agents and corticosteroids. Remission was achieved in 3 out of 4 episodes although all required individualization of the medication regimen. In the remaining patient, cytotoxic therapy (vincristine) and ultimately splenectomy were required to achieve stable remission. The variable clinical response to these therapeutic protocols indicates that TTP may not represent a single homogeneous disease entity but rather may involve various underlying pathologies. We conclude that the most effective present therapy for the management of TTP is daily plasma exchange with fresh frozen plasma infusions combined with antiplatelet agents and steroids. Vincristine and splenectomy should only be employed if this protocol proves ineffective.

Adolescent↗
PubMedDate not supplied

Apheresis without substitution fluid: devices, directions and limitations.

Significant economic and medical drawbacks attend the requirement for infusion of large quantities of exogenous substitution fluid during therapeutic plasma exchange. A variety of physicochemical processes are available for the fractionation of plasma (ultrafiltration, fractional precipitation, adsorption, electrophoresis, selective enzymatic degradation) and we review here their application to 'closed loop' apheresis, a format in which the patient's own plasma is returned after the pathogenic species are removed. The different separation processes vary significantly in their method of action, their specificity, and their status of development. Disposables and hardware for two specific protocols, cascade filtration and cryofiltration, are already commercially available and appropriate for routine clinical use in limited subsets of diseases considered treatable by therapeutic apheresis.

Adsorption↗