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Results for “PLASMAPHERESIS”

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PubMed1992

Early plasmapheresis in patients with thrombotic thrombocytopenic purpura.

OBJECTIVES: To investigate the relationship of thrombotic thrombocytopenic purpura to adult respiratory distress syndrome (ARDS) and study the responses of thrombotic thrombocytopenic purpura patients to early plasmapheresis. DESIGN: Case series. SETTING: ICU of a university hospital. PATIENTS: Twenty-four consecutive patients with thrombotic thrombocytopenic purpura, with various periods of time (1 to 18 days) having elapsed since the onset of this condition. Patients ranged in age from 17 to 66 yrs. INTERVENTIONS: Plasmapheresis, using intermittent flow separators, was instituted soon after the patients' ICU admission. The retinoscopic findings on admission and the relationship of Pao2 to platelet counts before and after plasmapheresis therapy were recorded. Antiplatelet agents were given to the survivors to prevent relapses. MEASUREMENTS AND MAIN RESULTS: Eighteen patients survived and six died. Plasmapheresis was administered for a range of 1 to 5 days (mean 3) and 3 to 18 days (mean 9.8) in survivors and nonsurvivors, respectively (p less than .001). Four patients with confluent fundus hemorrhages died and seven without these fundoscopic findings had easily controlled disease. Increases in Pao2 paralleled increases in platelet counts after plasmapheresis (p less than .001) in this small series of patients. Three of 18 discharged survivors relapsed over a period of 3 to 56 months of follow-up. CONCLUSIONS: Early introduction of plasmapheresis in thrombotic thrombocytopenic purpura seems to increase the survival rate and to halt the development of ARDS. Fundus findings may be a prognostic factor in thrombotic thrombocytopenic purpura. The antiplatelet agents seem to be efficacious in the prevention of relapses.

Adolescent↗

PubMed1996

Cerebral blood flow, oxygen metabolism and transcranial Doppler sonography during high-volume plasmapheresis in fulminant hepatic failure.

OBJECTIVE: The effect of high-volume plasmapheresis on hepatic encephalopathy, cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2) was investigated in patients with fulminant hepatic failure (FHF). METHODS: Twelve consecutive patients (8 women, 4 men, median age 34 years (range 19-51), were studied before and after high-volume plasmapheresis with 10-16 litres fresh frozen plasma, while PaCO2 and body temperature were maintained at 30 (23-34) mmHg and 37.6 degrees C (36.6-38.4), respectively. Blood samples from the internal jugular vein and a radial artery allowed calculation of the cerebral arteriovenous oxygen difference (AVDO2) and oxygen extraction (AVDO2 divided by arterial oxygen content). CBF was determined by a xenon-133 clearance method in eight patients and CMRO2 calculated as AVDO2 times CBF. Cerebral perfusion pressure (CPP) was determined as the difference between mean arterial and subdural pressures in eight patients. RESULTS: High-volume plasmapheresis was initiated 22 (6-168) h after the development of hepatic encephalopathy and 11 patients had grade 4 encephalopathy. Following high-volume plasmapheresis the grade of encephalopathy improved in four patients. The CBF increased from a median of 31 (16-86) to 45 (18-97) ml/100 g/min and as oxygen extraction remained unchanged (32 (9-41) vs. 29 (7-39)%), CMRO2 increased from 1.24 (0.96-1.82) to 1.86 (1.00-2.07) ml/100 g/min (P < 0.05). The CPP increased from 62 (19-76) to 92 (50-105) mmHg (P < 0.01), whereas the intracranial pressure remained unchanged (19 (3-45) vs. 11 (5-33) mmHg). No statistical difference was found between the relative changes in the above parameters in survivors compared to non-survivors. CONCLUSION: Although the clinical status did not improve in all patients, both CBF and CMRO2 increased after high-volume plasmapheresis. The alleviation of brain oxygen metabolism by high-volume plasmapheresis may reflect partial removal of neuroinhibitory plasma factors.

Adult↗

PubMed2006

Plasmapheresis in nephrology: an update.

PURPOSE OF REVIEW: In the past, recommendations for the use of plasmapheresis were based on findings reported from pilot studies or anecdotes. New results from several randomized controlled trials have changed the indications for the use of plasma exchange. RECENT FINDINGS: A large randomized controlled study of patients with antineutrophil cytoplasmic antibody associated vasculitis showed benefit of plasmapheresis in those with severe renal disease. Patients receiving plasmapheresis compared with methylprednisolone as adjuvant therapy were more likely to be alive and dialysis independent. Plasmapheresis, following publication of a recent randomized controlled trial, should no longer be used for patients with myeloma and acute renal failure. Standard therapy with five to seven plasma exchanges was compared with standard therapy alone. There was no difference in those patients reaching the composite endpoints between the two treatments. New indications include desensitization protocols, using plasmapheresis and intravenous immunoglobulin, which have allowed transplantation across immunological barriers. Highly sensitized patents and ABO incompatible patients compared with their potential donors are now being transplanted with excellent results. Studies still need to be done to assess the best desensitization protocol. SUMMARY: The use of plasmapheresis requires further validation by randomized clinical trials. Recent published trials should alter practice but further studies are required.

Humans↗

PubMed2004

The impact of different intensities of regular donor plasmapheresis on humoral and cellular immunity, red cell and iron metabolism, and cardiovascular risk markers.

BACKGROUND AND OBJECTIVES: Major studies are still lacking on the impact of differing intensities of long-term donor plasmapheresis, not only on total serum protein, albumin and immunoglobulin G (IgG), but also on humoral and cellular immunity, red cell and iron metabolism, and biochemical cardiovascular risk markers. MATERIALS AND METHODS: Three groups of donors, comprising 483 individuals undergoing differing intensities of long-term serial plasmapheresis, were entered into a cross-sectional study. A fourth control group consisted of 100 non-donors. In addition to measuring total protein, albumin and IgG levels, we determined parameters of humoral and cellular immunity, red cell and iron metabolism and recognized biochemical cardiovascular risk factors. RESULTS: The median annual net amount of plasma donated by the three donor groups was 37, 16 and 10 l, respectively (P < 0.0001). Donors had significantly lower total serum protein, albumin and IgG levels than non-donors (P < 0.0001), but the intensity of plasmapheresis had no influence on those parameters. Like non-donors, all plasma donors had normal humoral and cellular immunity. No increased rates of iron store depletion were observed in the three groups of plasma donors. Plasma donors were not at increased cardiovascular risk. CONCLUSIONS: Regular donor plasmapheresis of up to 45 l of plasma per year appears to be as safe as more moderate plasmapheresis programmes, with respect to the parameters analysed in this study. Individuals donating under these conditions did not develop impaired humoral and cellular immunity, iron store depletion, or increased cardiovascular risk with regard to established biochemical risk markers. Prospective studies are required to determine more exactly than in retrospective analyses the reasons why donors withdraw from plasmapheresis programmes.

Adult↗

PubMed1998

A study of the efficacy of plasmapheresis for the treatment of drug induced toxic epidermal necrolysis.

The efficacy of plasmapheresis for the treatment of toxic epidermal necrolysis (TEN) in our patient and related reports in the literature were examined. The patient, a 41-year-old female, was diagnosed as having drug (Sedes-G [isopropylantipyrin, arylisopropylacetoureid, and phenacetinum]) induced TEN. Upon admission to our hospital, extensive corticostroid therapy was initiated. After 6 days, because more than 90% of the patient's body surface was affected by TEN, it was concluded that the patient was unresponsive to corticosteroid therapy. Double filtration plasmapheresis (DFPP) was therefore begun. After 2 sessions of DFPP, extensive reepithelialization rapidly occurred, and after 3 sessions of DFPP, the improvement was dramatic. The patient's condition had almost healed during 1 month's hospitalization. It has been reported in the literature that 22 patients with drug induced TEN have been treated with plasmapheresis. The mortality rate of 23 patients, including our patient, was 17.4%. The rate of effectiveness of plasmapheresis on drug induced TEN is 82.6%. It appears that some kind of necrolytic factors were removed by the plasmapheresis. This suggests that plasmapheresis may be an effective treatment for drug induced TEN.

Adult↗

PubMed1977

Continuous-flow plasmapheresis in management of severe rhesus disease.

Eight patients with severe rhesus disease and expected fetal loss were treated by intensive plasmapheresis using a continuous-flow cell separator. Plasmapheresis was started at 16-27 weeks' gestation, and continued until planned intrauterine transfusion or until the infant was delivered or the rhesus disease became uncontrolled again. Altogether 24 to 2371 of plasma was exchanged over periods ranging from seven to 16 weeks. In seven of the eight patients the anti-D concentration fell during the period of plasmapheresis. Amniotic fluid spectrophotometry values remained below those recorded in the preceding pregnancy in six out of seven women. In five patients an attempt was made to control the rhesus disease by plasmapheresis alone, and two of these women delivered infants who survived. In the other three cases the infants died, one from the idiopathic respiratory distress syndrome and the other two in utero. These preliminary findings suggest that intensive plasmapheresis with a cell separator may reduce fetal haemolysis is delivered. Nevertheless, plasmapheresis may best be used to reduce haemolysis until intrauterine transfusions may be given more safely after 30 weeks' gestation.

Amniocentesis↗

PubMedDate not supplied

Evaluation of plasmapheresis in the treatment of an acute overdose of carbamazepine.

OBJECTIVE: To report the use of plasmapheresis in the treatment of an acute overdose of carbamazepine. CASE SUMMARY: A 21-year-old black man was admitted unresponsive and combative following a carbamazepine overdose. The total body load of carbamazepine was approximated at 5.91 g using an assumed volume of distribution of 1.4 L/kg. The patient underwent three plasmapheresis treatments. A total of only 335.82 mg of carbamazepine was removed by this process. DISCUSSION: Case reports in the literature were reviewed and compared. Carbamazepine concentrations lack correlation with the clinical outcome. Our patient's symptoms were consistent with the Weaver classification system. Carbamazepine clearance increased by almost 70 percent above its natural clearance during plasmapheresis. However, a significant rebound effect was observed after plasmapheresis: 40.1 percent after the first and 18.3 percent after the second treatment. CONCLUSIONS: Plasmapheresis did not seem to have a great impact on the patient's clinical status. Under the circumstances we find it extremely difficult to recommend plasmapheresis in the treatment of an acute overdose of carbamazepine.

Adult↗

PubMed2004

The effect of plasmapheresis on plasma cholinesterase levels in a patient with organophosphate poisoning.

OBJECTIVE: To describe the role of plasmapheresis in management of organophosphate poisonings. DESIGN: Case report. SETTING: A medical intensive care unit of a medical faculty. PATIENT: A patient with organophosphate poisoning whose cholinesterase levels continuously decline and then increase up to a normal level after plasmapheresis is performed for his sepsis. INTERVENTIONS: Plasmapheresis with fresh frozen plasma. MEASUREMENTS AND MAIN RESULTS: Baseline plasma cholinesterase (ChE) level was 4001 IU/L (normal values: 4000-10000 IU/L). Aspiration pneumonia was developed on day 3, and sepsis occurred on day 5. During this period, ChE levels gradually decreased. On day 5, plasmapheresis was performed for sepsis. Interestingly, plasma ChE levels increased from 2101 IU/L to 6144 IU/L after plasmapheresis. Atropine and pralidoxime were stopped, and a high level of ChE continued during hospitalization. The patient was successfully weaned from mechanical ventilation 3 days after plasmapheresis. CONCLUSION: Plasma exchange therapy may be considered for patients with organophosphate poisoning unresponsive to atropine and pralidoxime.

Antidotes↗

PubMed2000

Plasmapheresis: an effective therapy for primary allograft nonfunction after liver transplantation.

BACKGROUND: The role of plasmapheresis in liver failure and hepatic coma remains controversial. Also, its use as a salvage strategy for patients with severe allograft dysfunction after liver transplantation has not been defined. This report reviews the use of plasmapheresis in primary hepatic allograft nonfunction (PNF). METHODS: From May of 1997 to October of 1998, five patients underwent plasmapheresis for PNF after other causes of immediate allograft dysfunction were excluded. These patients underwent two to five plasmapheresis procedures during which one plasma volume was removed and replaced with fresh frozen plasma (FFP) or with 50% FFP and 50% albumin. RESULTS: All recipients who underwent plasmapheresis had restoration of liver function. There was one death from pulmonary embolism, for an overall survival rate of 80%. The four surviving patients all had functioning allografts 1 year after liver transplantation. In contrast, during the same period, there were two patients in whom PNF was treated by retransplantation, and both died within 3 months after surgery with functioning allografts. CONCLUSIONS: Plasmapheresis provides an effective treatment option for PNF immediately after liver transplantation and may obviate the need for retransplantation.

Adolescent↗

PubMedDate not supplied

[A comparative study of intravenous immunoglobulin and plasmapheresis preoperatively in myasthenia].

INTRODUCTION: Thymectomy is a well established procedure in myasthenia gravis (MG). To reduce its morbidity, treatments which are effective in the short term, such as plasmapheresis and intravenous immunoglobulin (IGI) have been used. OBJECTIVE: To evaluate the efficacy and tolerability of the IGI, compared with plasmapheresis, in the preparation of myasthenic patients before thymectomy. PATIENTS AND METHODS: We compared a group of 33 prospective myasthenic patients treated with IGI with 38 clinical histories taken as controls treated by plasmapheresis during the peri operative period of thymectomy. RESULTS: The patients treated with IGI were in the intensive care unit and neurology ward for less time. The endotracheal tube was also removed sooner. However, these differences were not significant. The commonest complications of IGI were fever, shivering and phlebitis. The most frequent adverse reaction to plasmapheresis were cutaneous eruptions. One patient developed Hepatitis C after plasmapheresis. CONCLUSION: IGI is comparable in efficacy to plasmapheresis in the peri operative period of MG, but has a better profile of adverse reactions.

Adult↗

PubMed2006

[Therapeutic plasmapheresis in patients with destructive pulmonary tuberculosis].

Therapeutic plasmapheresis was performed in 159 patients with pulmonary tuberculosis treated in the clinic in 2000 to 2005. Four hundred and seventy-seven manipulations were made. Among its clinical forms, there was prevalent fibrocavernous tuberculosis (in 136 patients); 9 had infiltrative tuberculosis; caseous pneumonia was present in 5 patients; 4 had tuberculoma; 3 and 2 patients had focal and disseminated tuberculosis, respectively. Out of the 159 patients, 42 (26.4%) underwent therapeutic plasmapheresis at the stages of surgical treatment. Plasmapheresis was made in 61.9% (26/42) before surgery and in 38.1% (n = 16). The study defined indications for and contraindications to therapeutic plasmapheresis in patients with destructive pulmonary tuberculosis, including adolescents and patients at the stages of surgical treatment. A procedure has been developed for discrete and membranous plasmapheresis for this category of patients. In patients with destructive patients, therapeutic plasmapheresis was shown: 1) to level the symptoms of antituberculous chemotherapy intolerance; 2) to correct homeostatic disorders; 3) to enhance the efficiency of basic drug therapy and to promote timely preparation of patients for surgery; 4) to improve the quality of life.

Adolescent↗

PubMed2006

[The role of the plasmapheresis in the treatment of patients with acute intestinal ileus].

Efficiency of the extracorporal detoxication method such as plasmapheresis in the complex treatment of acute intestinal ileus has been studied. 52 patients with acute intestinal ileus of various etiology were investigated. Clinical data such as nausea, vomiting, mouth dryness, body temperature, lessening of sounding of peristaltic or its absence, heart rate, short breath, presence of encephalopathy, lowering of diuresis, quantity of excretion at Miller-Ebbot sounding were used as the criteria of detoxication efficiency of plasmapheresis. For the estimation of efficiency of plasmapheresis by laboratory investigations the following data were determined: toxicity of blood plasma up to plasmapheresis and after carrying it according to the parametion test, leucocyte index, molecular composition of average blood mass. After plasmapheresis all indices of plasma toxicity had positive changes. Likewise positive changes were observed in clinical indices of intoxication. All the above stated enables us to evaluate plasmapheresis as a highly efficient method of extra-corporal detoxication, which may be successfully used during complex treatment of acute intestinal ileus.

Combined Modality Therapy↗

PubMed1991

[Efficiency of mechanical plasmapheresis].

In a clinical study the automated donor plasmapheresis devices Autopheresis-C A 100, Plasmapur-Monitor, and Ultralite-PCS were tested. Including also manual plasmapheresis, we analyzed the efficiency of donor plasmapheresis, the reliability and breakdown susceptibility of the methods, the quality of the collected fresh plasma, and the suitability of the different machine plasmapheresis devices for routine application, using a total of 2,372 donor plasmaphereses. We also studied the behavior of some individual laboratory parameters due to plasmapheresis with Plasmapur-Monitor. The data allow us to recommend machine plasmapheresis for routine operation (Ultralite-PCS greater than Autopheresis-C A 100 greater than Plasmapur-Monitor).

Adult↗

PubMed1991

[Plasmapheresis in the treatment of patients with hypertension].

The authors discuss the results of the use of plasmapheresis in multimodality treatment of patients with stage II essential hypertension. At present the prevalence, ever increasing accessibility and relative simplicity of plasmapheresis make it possible to use it for the treatment of essential hypertension. Analysis of the data obtained shows the high efficacy of plasmapheresis in essential hypertension. Since plasmapheresis turned out effective in combination with drug therapy and alone as well, it is concluded that plasmapheresis is not only an approach to overcoming resistance to hypotensive therapy but also an independent treatment modality that exerts a considerable effect on the immunologic and hemorheologic blood properties. The above-indicated allows recommending plasmapheresis for the treatment of patients suffering from essential hypertension, since it may lead to a long-term decrease of arterial pressure, to the enhancement of the sensitivity to hypotensive drugs, to the diminution of drug requirements, thereby ameliorating the course and prognosis of the disease in patients suffering from essential hypertension.

Antihypertensive Agents↗

PubMed1990

[Immediate and long-term results of the use of plasmapheresis in obliterating atherosclerosis of the vessels of the lower limbs].

Plasmapheresis was applied to treat 67 patients with lower extremity vessel atherosclerosis obliterans. A total of 92 therapy courses were performed, which involved 250 sessions of plasmapheresis (205 with a PF-0.5 apparatus and 45 with plastic bags and centrifuge). During the course, an average of 160% volume of circulating plasma were removed to be replaced with crystalloids and dextrans. A positive effect shown by a 6.9-fold increase in the distance covered by patients who experienced no pains and by resting pain relief was achieved in 93.8% with Stage II circulatory failure and 75% with Stage III, regardless of the severity of vascular lesions. It was shown that it was necessary to make a "programmed" plasmapheresis when the patient received 2 plasmapheresis courses a year. The mechanism of a positive effect of plasmapheresis remains unclear. A significant plasmapheresis-induced decrease was observed in the concentration of "acute phase proteins" (plasma fibrinogen and globulins), which plays the leading role in improving blood rheology, which seems to affect clinical outcomes.

Adult↗

PubMedDate not supplied

[The blood rheological properties in suppurative-septic urologic diseases and their correction by plasmapheresis].

A total of 18 patients with pyoseptic urological diseases (the main group) treated with plasmapheresis and 18 patients who were not (the control group) were studied for certain rheological parameters: platelet and red cell aggregation, number of platelets, hematocrit, ESR, viscosity values of the blood with a shift rate of 9 and 105 s-1 and osmotic resistance of red cells. 18 patients were exposed to 26 plasmapheresis sessions with a plasma removal of 3-3.2% of the body weight. Significant disorders of blood rheology: higher platelet ad red cell aggregation, lower erythrocyte osmotic resistance and increased blood viscosity were revealed in patients with pyoseptic urological diseases. In case plasmapheresis was included into the complex treatment, in line with the clinical efficacy of the latter a rapid normalization of the aforementioned parameters was documented by the 3-7th day of the treatment. Uroseptic patients who were exposed to plasmapheresis demonstrated improved microcirculation confirmed by isotope renography and Bengal rose which identified the improved performance of the kidneys and the liver. With account for the beneficial effect of plasmapheresis on hemorheological values in uroseptic patients, the authors suggested that for septic patients plasmapheresis substitution type should be changed.

Blood Viscosity↗

PubMedDate not supplied

[Plasmapheresis in the treatment of the acute reaction of transplanted kidney rejection].

A total of 14 patients with acute rejection of transplanted kidney were treated with plasmapheresis (in combination with prednisolone supporting therapy in a dose of 15 mg/kg). For the arrest of the rejection it was necessary to use 4 sessions of plasmapheresis on average for each person (from 3 to 8 sessions). The average volume of discharged plasma, 2,000 ml approximately, was compensated with frozen plasma. Plasmapheresis was exercised by plasma separation with an "Asahi" plasma filter with the surface of 0.5 m2. Plasmapheresis successfully arrested the rejection in 50 per cent of the patients. Pathogenetic reasonability of plasmapheresis for the treatment of the aforementioned patients (elimination of toxins, circulating immune complexes, elevation of C3 and C4 components of the complement) was substantiated. In patients who had undergone plasmapheresis for the arrest of acute rejection, lowered levels of proteinuria were considered as a favourable prognostic sign.

Acute Disease↗

PubMedDate not supplied

[Plasmapheresis in the combined therapy of the acute rejection reaction and of suppurative-septic complications in the pretransplantation period].

To define the efficacy of plasmapheresis performed as part of combined treatment for steroid-resistant patterns of acute rejection of a renal transplant, the results of the treatment were analysed in 11 patients. The analysis also involved the results of plasmapheresis treatment of 3 patients with terminal renal failure complicated with septic conditions and 1 patient with stenosed artery of the transplanted kidney and irreversible arterial hypertension. Plasmapheresis was used in various terms of rejection after a 3-4-day prednisolone pulsatile therapy. The effect of the procedure was recorded in 7 out of 13 patients, i. e. in 50 per cent of those treated. The necessity of applying early plasmapheresis (immediately after methylprednisolone pulsatile therapy in case of its failure) was demonstrated as were the methods of intensive plasmapheresis performance (daily within 4-5 days). The technique permitted to eliminate septic conditions before and after the period of transplantation, to decrease blood pressure in the patients with stenosed arteries of transplanted kidney. The authors considered the mechanism of the curative effect of plasmapheresis in the patients with acute rejection and the criteria for its efficiency.

Acute Disease↗