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PubMed1979

Plasmapheresis in the treatment of renal allograft rejection.

Thirty-four patients with renal allograft rejection unresponsive to conventional therapy underwent plasmapheresis. Twenty-four patients evidenced prompt and marked improvement and were discharged. Seventeen of these are presently stable off dialysis. Ten patients were not improved and required return to dialysis and/or transplant nephrectomy. Four hour warm, complement-dependent crossmatches which had become positive following transplant became negative following plasmapheresis in 3 patients who now have stable long-term function. Plasmapheresis appears promising in the treatment of refractory acute renal allograft rejection.

Cadaver↗

PubMed1979

Use of combined plasmapheresis and immunosuppression in the treatment of Goodpasture's syndrome.

Five consecutive patients with well-documented Goodpasture's syndrome were treated with plasmapheresis and immunosuppression. In all patients, the antiglomerular basement-membrane antibody titers decreased with treatment. In three patients, hemoptysis responded promptly to plasmapheresis. Two patients presenting with severe renal failure required chronic dialysis, and three patients who had serum creatinine levels less than 2.1 mg/dl before treatment improved or had stabilization of their renal function. We confirm that the use of plasmapheresis and immunosuppression is a promising method of treatment in some patients with Goodpasture's syndrome.

Adult↗

PubMed1975

[Treatment of thyroid storm with plasmapheresis (author's transl)].

The conventional treatment of thyrotoxicosis is based on central and periphery therapeutic measures which respectively block the thyroid hormone production and subdue the hormone effect in the tissue. On account of long biological hal-life of thyroxine conventional methods of treatment fail to achieve a rapid reduction of the excessively high serumhormone level. As the overwhelming proportion of thyroid hormone is boud to serum proteins, plasmapheresis presents itself as a possibility of achieving this therapeutic aim. In the following a report is given on the successful practice of plasmapheresis in two cases of thyrotoxiicosis. In each of these, 1.4 and 1.2 litres of plasma respectively were re moved in all. Immediate combined use of plasmapheresis and conventional therapy appears to constitute a definite improvement in the treatment of thyrotoxicosis.

Adult↗

PubMed1975

Follow-up of certain immunologic indicators in the treatment of plasmacytoma with cyclophosphamide in combination with plasmapheresis.

Changes in the immunoglobulin and complement levels in untreated plasmacytoma were compared with those resulting from massive doses of Cyclophosphamide (15--25 mg per kg b. w. at intervals of 10--14 days) applied in combination with double plasmapheresis (involving removal of about 500 ml of plasma). A follow-up of the levels of normal immunoglobulins, paraprotein, total complement and the C3 component revealed a significant decline in the total complement following each single application of this treatment, but the decrease in C3 was nonsignificant. A decline of about 20% in immunoglobulins and of about 15% in paraprotein was observed in relation to the pretreatment values, but only that in the IgM class proved to be of statistical significance. The decrease in proteins was also established with the methods of total protein determination (refractometric or biuret methods) and was found to amount to 1000--3000 mg% after each dose of Cyclophosphamide with plasmapheresis. In the author's view, a combined Cyclophosphamide-plasmapheresis treatment is effective for achieving clinical remission. It should, however, be kept in mind that the effect of protein and paraprotein depression persists for only a few days, hence, to achieve long-term results, this treatment should be repeated in 2--3 week's cycles. The lowered values of humoral immunity indicators do not increase the danger of complications from a clinical aspect, when suitable preventive measures are taken.

Antibody Formation↗

PubMed1976

[Therapeutic plasmapheresis--a new form of adjuvant treatment (author's transl)].

We have been separating cells and plasma from the peripheral blood since 1967 for the isolation of lymphocytes and hence the preparation of ALG. Expanding the method following a therapeutic need the therapeutic plasmapheresis took its place in our clinical trials. We have carried out 210 plasmapheresis without complications. According to the clinical experience therapeutic plasmapheresis may be indicated in the following conditions: 1. some cases of intensive care patients (intoxications, metabolic disorders such as liver coma, thyreotoxicosis), 2.hyperviscosity-syndromes (plasmocytoma, macroglobulinemia), 3. immune complex diseases (e.g. systemic lupus erythematodes), 4.toxic antibody syndromes (Goodpasture-syndrome, graft rejection on the basis of HL-A-antibodies), 5.hyper-hydration and electrolyte imbalances in renal insufficiencies until hemodialysis can take place, 6. leukemias before intensive chemotherapy.

Adult↗

PubMed1976

[Plasmapheresis as an experimental model for studies on the extracellular distribution of enzymes. Distribution and transport of cell enzymes within the extracellular space. IV (author's transl)].

The rate of distribution of cell enzymes between the intravascular and extravascular space was studied, following a sudden decrease of enzyme activities in plasma. This rapid decrease of enzyme activities was achieved in rats by a rapid exchange of the blood with a twofold volume of a suspension of homologous erythrocytes in isoosmolar bovine serum albumin solution. After this plasmapheresis, the activities of seven cell enzymes in the plasma were decreased to 14 to 22% of their original values. The subsequent increase in activities showed different kinetics, depending on the enzyme. After 120 min, creatine kinase had reached the starting activity; malate dehydrogenase and aldolase reached their original activities after 180 min. Aspartate aminotransferase, glutamate dehydrogenase, alanine aminotransferase and pyruvate kinase increased more slowly and they had still not reached their starting values after 240 min. Repetition of the plasmapheresis after 90 min had no obvious effect on the kinetics of the subsequent activity increase. During the first minutes after plasmapheresis the adjustment of the activity equilibrium between the interstitial and the intravascular compartments depends mainly on the capillary permeability. It is therefore possible to determine half-life constants for the distribution of enzymes within the extracellular space. The constants for malate dehydrogenase and aldolase are almost identical with those determined by intravenous injection, whereas there are discrepancies in the constants for the remaining enzymes. The constants for pyruvate kinase and glutamate dehydrogenase are significantly lower, while those for aspartate aminotransferase, alanine aminotransferase and creatine kinase are significantly higher, than those determined after intravenous injection. Possible reasons for these differences are disucssed.

Animals↗

PubMed1979

Plasmapheresis and immunosuppressive therapy. Effect on levels of intercellular antibodies in pemphigus vulgaris.

A patient with pemphigus vulgaris and serious side effects of steroid therapy was treated by exchange plasmapheresis. Eight plasmaphereses were performed over six weeks. Each procedure reduced the serum level of intercellular antibodies by 50% to 87%. A rebound in levels of intercellular antibodies usually followed their depletion but could be minimized or completely suppressed by administration of cyclophosphamide. After six weeks of therapy, clinical symptoms had greatly improved and intercellular antibody levels had decreased from a titer of 5,120 to 160. It is not possible to ascribe these improvements specifically to plasmapheresis since the patient was concurrently receiving low doses of prednisone and intermittent treatment with cyclophosphamide.

Autoantibodies↗

PubMed1976

[Successful treatment of thyroid storm by continuous plasmapheresis with a blood-cell separator (author's transl)].

Continuous plasmapheresis with the IBM blood cell separator showed to be a successful therapy in a 26 year old patient with thyroid storm. The patient regained consciousness already during plasmapheresis whereby 5 liters of plasma were exchanged within 3.5 h. Although 633 mug thyroxine (T4) and 13.6 mug triiodothyronine (T3) were removed with the 51 plasma, no fall occurred in total serum T4 and T3 levels, probably due to the rapid reflux of thyroid hormones from the tissue into the intravascular space. Though total T4 and T3 did not change, there was a significant fall in free thyroid hormone levels documented by reduction of T3-uptake test and particularily of urine T4 and T3 excretion. These findings show that the elevation of thyroid hormone binding sites with donor plasma is even more important than the removal of thyroid hormones.

Adult↗

PubMed1979

Plasmapheresis in the treatment of acute renal failure in multiple myeloma.

Three patients with multiple myeloma and severe acute renal failure were treated by repeated plasmapheresis. Recovery of renal function was observed in all. The pathogenetic role of light chains and the possible mechanisms responsible for renal damage are discussed. It is suggested that the removal of light chains by plasmapheresis may be of therapeutic value in this condition.

Acute Kidney Injury↗

PubMed1978

Plasmapheresis in Raynaud's disease.

Understanding of the pathogenesis, clinical course, and treatment of Raynaud's disease is confused and unsatisfactory, and no success in treatment can be promised. Five patients with severe Raynaud's disease, who had not responded to other forms of treatment, were treated by plasmapheresis, which produced a striking improvement. Ultrasonic velocimetry showed that segments of digital arteries which had been thought to be permanently occluded became patent and remained patent after plasmapheresis.

Adult↗

PubMedDate not supplied

Motivation of voluntary plasmapheresis donors.

A totally voluntary plasmapheresis program recruits 900 individual donors per year at a cancer institute, where 500 to 900 units of platelets are transfused each month. Staff and donors use a film and brochures to recruit donors from the local community. Television and radio spots, with donor recognition pins, certificates, receptions, and picnics are utilized. Donor motivation was studied by use of: 1) California Psychological Inventory--measures a variety of "normal" personality traits; 2) Study of values--measures theoretical, economic, aesthetic, social, political, religious values; 3) Internal-External Control Scale--measures degree to which a person blames self vs. external events for what happens to him; 4) Faith in People Scale--measures individual's confidence in his fellow man; 5) Anomia Scale--measure of feelings of self-to-others alienation; 6) Mach IV Scale--measure of persons tendency to manipulate others; and 7) Biographical Data Form. Results are presented for 25 male donor subjects studied, as they compare with normative data for the scales used. Donors appeared to have the same traits as do the general population, but appeared lower in Machiavellianism than non-plasmapheresis donors. Prospective study plans include additional subjects to provide appropriate control groups.

Adult↗

PubMedDate not supplied

The Ito "Flow-Through" Centrifuge. A new device for long-term (24 hours) plasmapheresis without platelet deterioration.

An efficacious procedure for continuous plasmapheresis in long-term extracorporeal circulation has not yet been devleoped. This technique could be important in plasma exchange or cross-exchange and in artificial organ support if it could be accomplished safely using heparin as the anticoagulant. When sheep were connected to the Celltrifuge for 23 hours and administered 150 units/kg per hour heparin anticoagulant, we found gross platelet clumping in separated plasma and a 60 per cent fall in platelet count. When 120,000 units of heparin were directly injected into the centrifuge bowl at the onset of the centrifugation followed by hourly heparin administration at 500 units/kg, there was no platelet clumping but the platelet count fell to 52 per cent. Under identical conditions the Ito Flow-Through Centrifuge, a new continuous flow centrifuge with no rotating seals, was used. We found no platelet aggregates and no drop in platelet count, and there was a 100 per cent recovery of platelets in the separated plasma. Platelets sampled from arterial blood and separated plasma were found to have normal function in vitro, and responded 100 per cent to both collagen and ADP. These results indicate that the Ito Flow-Through Centrifuge can be used in plasmapheresis with heparin anticoagulation with no donor platelet loss and normal function in separated plasma.

Animals↗

PubMedDate not supplied

Plasmapheresis for thrombotic thrombocytopenic purpura (TTP).

A 70-year-old woman with thrombotic thrombocytopenic purpura (TTP) was treated with plasmapheresis using fresh frozen plasma as a fluid replacement. Complete recovery and lasting remission were observed. It appears that plasmapheresis combined with massive fresh frozen plasma can be an effective mode of treatment for patients who were, otherwise, refractory to conventional therapy.

Aged↗

PubMed1979

[Treatment of myasthenia gravis with plasmapheresis (author's transl)].

Nine out of eleven severely ill patients with myasthenia gravis could be markedly improved by a combination of immunosuppressive drug therapy and plasmapheresis, two patients however suffered grave complications. The effectiveness of plasma exchange underlines the importance of plasma factors in the pathomechanism of myasthenic functional disturbance. Treatment with plasmapheresis may be regarded as a supportive measure of immunosuppressive drug therapy. However, the considerable risk and high technical requirements limit the indication to severe forms of the disease.

Adolescent↗

PubMed1977

Plasmapheresis and immunosuppressive drug therapy in myasthenia gravis.

Plasmapheresis combined with prednisone and azathioprine therapy produced striking clinical improvement in five patients with myasthenia gravis who still had moderate to severe disability despite thymectomy, high-dose prednisone therapy and optimal doses of cholinesterase inhibitors. Serial determinations of titers of serum antibody toward the acetylcholine receptor demonstrated a fall to 21 +/- 5 per cent (mean +/- S.D.) of the original levels concurrently with the patients' increasing strength. Clinically improved patients maintained lowered titers, whereas clinical relapses were associated with a rebound in titer. Our results suggest that plasmapheresis will find a place in the management of patients with myasthenia gravis, and they implicate antibodies to acetylcholine receptor as a pathogenic factor in this disease.

Acetylcholine↗

PubMed1977

Treatment of glomerulonephritis with drainage of the thoracic duct and plasmapheresis.

Nine patients with various types of severe glomerulonephritis were treated with drainage of the thoracic duct (n=8) and/or plasmapheresis (n=6) without the use of pharmacological immunosuppression. In most of the patients treatment produced a prompt temporary regression of albuminuria and creatininemia. In one patient renal function was substantially improved 8 months after the last period of treatment, in 2 patients the progress of the uremia was probably retarded. In the remaining 6 patients treatment had no obvious effect on the course of the illness. Drainage of the thoracic duct and plasmapheresis may be of benefit in the treatment of glomerulonephritis, but their proper utilization requires further studies.

Adolescent↗

PubMed1979

The incidence of antibodies to low frequency antigens (LFA) in plasmapheresis donors with hyperimmune Rh antisera.

Over 50% of plasmas from plasmapheresis donors hyperimmunized for Rh antibodies were found to contain antibodies to low frequency red cell antigens (LFA). The majority of these plasmas contained antibodies to more than one LFA. On the other hand, the incidence of these antibodies in immune plasma from control plasmapheresis donors was markedly lower. The significance of the high incidence of these antibodies in grouping reagents is discussed.

Antibodies↗

PubMed1977

Development of Rh-specific maternal autoantibodies following intensive plasmapheresis for Rh immunisation during pregnancy.

Two cases of autoantibody formation following large volume plasmapheresis for rhesus immunisation during pregnancy are described. In each case the autoantibody was directed against the Rh complex but showed a preference for G-positive cells. It is postulated that repeated plasmapheresis in the presence of persistent antigenic stimulation has removed a feedback inhibition of the immune response. The specificity of the alloantibody has broadened resulting in cross-reactivity against self-antigens. The possible implications of these cases in relation to autoimmunity are discussed.

Adult↗