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At least 19 recordsLinked to original sources

PubMed1978

Effect of intessive plasmapheresis on the plasma cholesterol concentration with familial hypercholesterolemia.

Plasmapheresis was studied as a means of reducing the serum cholesterol concentration in 3 hypercholesterolemic patients who each underwent courses of intensive plasmapheresis with removal of 250--500 ml of plasma each day for 5--9 days. In one homozygous Type II patient, the serum cholesterol concentration decreased from 609 +/- 45 mg/100 ml (mean +/- SEM) to 365 +/- 17 mg/100 ml (40% decrease, P less than 0.05) with two different courses of plasmapheresis. In the two other patients with non-homozygous hyperbetalipoproteinemia the serum cholesterol concentration decreased from 289 +/- 27 mg/100 ml to 205 +/- 19 mg/100 ml (29% decrease, p less than 0.05). After cessation of treatment, the cholesterol concentration returned to pre-treatment levels in 10--13 days in the homozygous patient and 7 days in one non-homozygous hyperbetalipoproteinemic patient; clofibrate (2 g/day) in this patient was associated with a smaller reduction of the cholesterol concentration with plasmapheresis and an increased rate of return of pre-treatment levels after plasmapheresis was stopped. Sustained plasmapheresis for 6 days in the other non-homozygous hyperbetalipoproteinemic patient resulted in a new approximate "steady state" with a serum cholesterol concentration of 176--199 mg/100 ml compared with a pre-plasmapheresis value of 227 mg/100 ml. The response of the plasma cholesterol levels to plasmapheresis was subjected to kinetic analysis based on a current model of the regulation of lipoprotein metabolism.

Adolescent↗

PubMed1979

Evidence for a therapeutic effect of plasmapheresis in patients with systemic lupus erythematosus.

Fourteen patients with active systemic lupus erythematosus (SLE) have been treated with plasmapheresis at a rate of two litres daily on three to four days per week, over a period of two to three weeks. Plasma was replaced isovolemically with either fresh frozen plasma or with human plasma protein fractions. Ten patients were receiving treatment with prednisone at the time of plasmapheresis, and four had received no prior treatment. Eight patients showed evidence of either clinical improvement or clinical and immunochemical improvement, at the time of plasmapheresis. In the three patients who showed high levels of circulating complexes before treatment, there was a sudden fall in the level of circulating immune complexes, which was quantitatively greater than could be explained by the amount removed. This suggests that in some patients with SLE, clearance of complexes by the mononuclear phagocytic system is initially blocked by high levels of circulating complexes and that one effect of plasmapheresis may be to relieve this blockade. Five patients showed a clinical response to plasmapheresis despite the fact that tests for immune complexes were negative. Three patients showed no response to plasmapheresis, and three were regarded as unevaluable. In a limited number of patients, who show a high level of circulating immune complexes, and whose condition is deteriorating despite treatment with corticosteroids, there may be an important therapeutic role for plasmapheresis.

Adolescent↗

PubMedDate not supplied

Short-term and long-term effects of plasmapheresis on serum proteins and immunoglobulins.

In order to evaluate the short-term and long-term effects of plasmaapheresis on serum proteins and immunoglobulins, the levels of alpha1, alpha2, beta, and gamma globulins, and IgG, IgA, and IgM were measured and statistically evaluated in 41 active plasmapheresis donors donating 500 to 1,000 ml of plasma weekly for up to three years. During the initial four months of plasmapheresis, the percentage of alpha1 and alpha2 globulins manifested a statistically significant rise and the IgG, IgA, and IgM concentrations declined. By the end of ten months, only the IgM continued to be depressed. Although the concentration of IgM continued to show a statistically significant decline for three years, it remained well within the normal range of values for our laboratory. Although no statistically significant difference existed between the baseline value of albumin and the level reached at the end of the third year, a gradual rise was followed by a decline in this interval. Most of the statistically significant alterations of serum protein and immunoglobulins occurring in plasmapheresis donors are seen in the initial six months of plasmapheresis. A falling serum protein in this time period is most likely an indication of declining immunoglobulins. It is feasible and appropriate to measure the donor's total serum protein at the time of each plasmapheresis. Any untoward reduction in this value necessitates quantification of the serum immunoglobulins. Routine measurement of the immunoglobulins in the face of normal total serum protein can be performed on a less frequent basis as is presently recommended by accrediting agencies, although this study should be performed more often during the first six months of a serial plasmapheresis program.

Alpha-Globulins↗

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↗

PubMed1977

Intensive plasmapheresis as a risk factor for arteriosclerotic cardiovascular disease?

Recent studies suggest that the analogy between intensive plasmapheresis and the nephrotic syndrome with respect to plasma protein loss includes events which are generally recognized as risk factors for the development of arteriosclerotic cardiovascular disease. Experimental nephrosis and plasmapheresis alike increase the synthesis of very low density and low density lipoproteins in response to the hypoproteinemic stimulation of plasma protein synthesis. During electrophoresis, these lipoproteins move with the alpha2- and beta-globulins, and the serum levels of these fractions are often elevated in humans subjected to intensive plasmapheresis. Hyperlipoproteinemias of the alpha2- and beta-types are recognized risk factors in the genesis of arteriosclerosis. Another such factor appears to be an increased synthesis of fibrinogen. This protein enhances plasma viscosity and red cell aggregation and may play a role in myocardial infarction. Intensive plasmapheresis thus not only creates an unphysiological and partly depletional state; it is also, like the nephrotic syndrome, capable of producing surplus abnormalities of plasma constituents with a potential for delayed, insidious injury.

Arteriosclerosis↗

PubMed1979

Plasmapheresis in Crohn's disease.

6 patients with Crohn's disease for 1-14 years have been treated with plasmapheresis for periods of up to 6 months. The symptoms of the one newly diagnosed patient were controlled by plasmapheresis alone, and 5 steroid-dependent patients were able to reduce their steroid requirements. During the study period, 13 clinical relapses were managed without increasing steroid dosage. There was evidence of circulating soluble immune complexes in all the patients and these levels were lowered by plasmapheresis. A possible role of plasmapheresis in the management of Crohn's disease is discussed.

Adult↗

PubMed1979

Goodpasture's syndrome--effects of plasmapheresis.

Two patients with Goodpasture's syndrome, who underwent plasmapheresis are presented. One patient received prednisone but the other patient received no concomitant cytotoxic therapy. Results indicate that plasmapheresis reduces morbidity in patients with Goodpasture's syndrome. The possible mode of action of plasmapheresis is discussed. The use of cytotoxic therapy as an adjunct to plasmapheresis may not be necessary since the anti-GBM production appears to be a self-limiting process.

Adult↗

PubMed1979

Treatment of Goodpasture's syndrome with plasmapheresis. A case report and review of the literature.

A case is reported of antiglomerular basement membrane antibody-induced Goodpasture's syndrome in which the patient required hemodialysis and was treated with immunosuppressive agents and plasmapheresis. A severe (80 per cent) cresentic lesion was reversed, and creatinine was stabilized at 2.5 mg/dl at one year follow-up. Earlier reports of therapy without plasmapheresis showed that 88 per cent of the patients would either die or require long-term hemodialysis. Fifteen other reported cases of Goodpasture's syndrome in which the patients were treated with plasmapheresis are reviewed. When reported, short-term follow-up showed that nine of these patients were alive without need of dialysis, five wee receiving dialysis, and only two had died. This suggests that plasmaheresis and immunosuppressive therapy may reverse the renal lesion in some patients with Goodpasture's syndrome.

Adult↗

PubMed1976

Antibody-dependent cell-mediated cytotoxicity against melanoma cells induced by plasmapheresis.

Patients with disseminated melanoma were treated by repeated plasmapheresis using a continuous-flow blood-cell separator, as part of a study to investigate methods of removing factors from tissue fluids which block cell-mediated immunity. Using 51Cr release cytotoxic assays, it was found that plasmapheresis resulted in removal of serum blocking activity. Post-plasmapheresis sera taken from several patients also increased cell-mediated cytotoxicity by induction of antibody-dependent cell-mediated killing. This effect may have resulted from removal or alteration of circulating immune complexes in the serum. It is not known whether cytotoxic activity induced in this way improves the patient's immune response against their tumours. However, the procedure is well tolerated and these preliminary in-vitro results indicate that this form of therapy could act as an adjunct to other forms of treatment of advanced melanoma.

Antigen-Antibody Complex↗

PubMed1976

Intensive antenatal plasmapheresis in severe rhesus isoimmunisation.

Intensive antenatal plasmapheresis can significantly lower Rh-antibody levels in the blood of mothers carrying babies severely affected with rhesus haemolytic disease. Twenty-seven out of forty-four mothers were successfully delivered of babies that survived, after being treated with a combination of plasmapheresis and intrauterine transfusions. A further 52 mothers were treated by plasmapheresis along. When severe disease developed as an early stage in pregnancy the results were rather poor, but excellent results were obtained when severe disease developed relatively late in pregnancy. No serious complications were encountered in the mothers or babies.

Blood Transfusion, Intrauterine↗

PubMed1976

Plasmapheresis in the management of acute systemic lupus erythematosus?

Eight patients with systemic lupus erythematosus (S.L.E.) have been treated with plasmapheresis. In four patients in whom immunochemical studies indicated high levels of circulating immune complexes, the removal of 5-8 litres of plasma weekly produced a striking clinical and immunochemical improvement. The four other patients, with only minor complement disturbances and no direct evidence of circulating immune complexes, could not be shown to benefit from plasmapheresis and one patient in this group died of cerebral lupus despite intensive treatment with cytotoxic drugs. It is concluded that plasmapheresis may be of value as an adjuvant to the treatment of acute S.L.E.

Acute Disease↗

PubMed1977

Volume limitations of plasmapheresis.

The published specifications of the acceptable limits of the maximum plasma volume to be "harvested" by plasmapheresis from one individual per year vary from 10-15 liters in Europe to 50-60 liters in the United States. To answer the question which of these widely diverging precepts is appropriate, the effects of plasmapheresis on serum protein levels and their relationship to albumin metabolism, the accepted safeguards for the donation of whole blood, and the disease known as the nephrotic syndrome are considered. A living person who cosents to his bodily integrity being violated for the benefit of others must be protected not only against the generation of manifest illness by such violation, but also against any prolonged deviation from the normal state of his body. It is concluded that plasmapheresis donors should not deliver more than 10 to 15 liters of plasma per year, as now recommended by European authorities. Not more than 500 ml of plasma should be withdrawn per session, and the interval between two such sessions should not be less than 2 weeks.

Blood Donors↗

PubMed1978

Experience with large volume plasmapheresis in malignant paraproteinaemia and immune disorders.

Clinical experience with large volume plasmapheresis in a wide range of malignant and immune disorders is described. An average of 4 litres of plasma was exchanged for various colloid and electrolyte solutions. Patient tolerance was good but close medical and nursing supervision in monitoring fluid balance and adverse reactions to replacement fluids is necessary. Plasmapheresis has been established to be of benefit in immunoproliferative diseases when complicated by hyperviscosity, and may also have a place in other cases with haemostatic or renal impairment. Autoantibodies, alloantibodies and immune complexes can be removed by plasmapheresis, but the effect is usually transient and the procedure should be combined with immunosuppressive therapy in most cases. The removal of blocking factors in disseminated malignant melanoma is an experimental procedure at present, but initial results have been encouraging.

Adult↗

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↗

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↗

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↗