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Maia SR, de Moraes RS, Geraldes SS, de Azevedo MGP, Stefaniszen AG, Moreira MAB, Afonso A, García HDM, Okamoto AS, Melchert A, Lourenço MLG, Takahira RK, de Souza FF, Giuffrida R, Okamoto PTCG. Evaluation of the safety and feasibility of extracorporeal therapy: therapeutic plasma exchange in dogs - report of five cases. BMC Vet Res 2025; 21:348. [PMID: 40380160 PMCID: PMC12082980 DOI: 10.1186/s12917-025-04758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/15/2025] [Indexed: 05/19/2025] Open
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) has been used in immunological diseases, conditions of hyperviscosity, and the removal of protein-bound drugs and toxins. Although complications may be encountered, its use has been reported to offer some degree of safety and clinical improvement for dogs. This case report aimed to describe the feasibility and safety of TPE in dogs. CASE PRESENTATION Five dogs with immune-mediated hemolytic anemia (IMHA) and/or canine visceral leishmaniasis (CVL) not responsive to immunosuppressive treatment underwent TPE by centrifugation. Physical, laboratory, and cardiovascular parameters were assessed pre- and post-TPE. Although one dog presented with angioedema and another dog presented with neurological signs (nystagmus) during the procedure, no other significant hemodynamic or hemostatic complications were observed, and both the physical and cardiovascular parameters remained stable post-TPE. Both angioedema and nystagmus were controlled at post-TPE. A tendency for a decrease in serum protein and ionic calcium was the main laboratory finding. CONCLUSIONS Centrifugation-based TPE is a safe and feasible therapy in dogs with IMHA and CVL. Attention should be given to hypocalcemia, the tendency toward hypoproteinemia, and secondary complications such as the occurrence of neurological signs.
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Affiliation(s)
- Suellen Rodrigues Maia
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
| | - Reiner Silveira de Moraes
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Silvano Salgueiro Geraldes
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Maria Gabriela Picelli de Azevedo
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Amanda Garcia Stefaniszen
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | | | - Angélica Afonso
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | | | - Adriano Sakai Okamoto
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Alessandra Melchert
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Maria Lúcia Gomes Lourenço
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Regina Kiomi Takahira
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Fabiana Ferreira de Souza
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Rogério Giuffrida
- Department: Postgraduate Program in Animal Science, Universidade do Oeste Paulista (Unoeste), Presidente Prudente, São Paulo, Brazil
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Miranda DM, Coelho MVP, Delamain MT, Fabreti-Oliveira RA. Therapeutic Plasma Exchange: Analysis of Practices and Compliance With International Guidelines. J Clin Apher 2025; 40:e70023. [PMID: 40247606 DOI: 10.1002/jca.70023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 03/20/2025] [Accepted: 03/30/2025] [Indexed: 04/19/2025]
Abstract
Therapeutic plasma exchange (TPE) is widely used in the treatment of autoimmune diseases and hematological emergencies. It is also applied in transplant patients for the desensitization of anti-HLA (human leukocyte antigen) antibodies and the management of antibody-mediated rejection. This study aims to assess the epidemiology of therapeutic plasmapheresis and evaluate whether indications for plasmapheresis align with the guidelines of the American Society for Apheresis (ASFA) and investigate the associated adverse effects. This retrospective observational study was conducted in hospitals in Belo Horizonte, Minas Gerais, and included 85 patients who underwent 493 TPE sessions between April 2021 and December 2023. The median age was 43 years, and 60% of the patients were women. The most common indications for TPE were neuromyelitis optica (24%) and acute rejection following kidney transplantation (21%). The replacement fluids used were primarily albumin (84%) and plasma frozen 24 h after phlebotomy (16%). Adverse events were reported in 5.88% of patients, including hypotension, vasovagal reflex, and one case of facial edema and urticaria. No procedure-related deaths were observed. TPE sessions were conducted in accordance with the guidelines of the ASFA, with 50% of procedures classified as Category I. There was no significant association between adverse events and patient diagnoses. The study demonstrated that TPE is effective and safe, with predominant indications for neuromyelitis optica and kidney transplant rejection, following ASFA guidelines. Adverse events were rare and manageable.
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Affiliation(s)
| | | | - Márcia Torresan Delamain
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
- Vita Hemoterapia, Belo Horizonte, Brazil
| | - Raquel A Fabreti-Oliveira
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
- IMUNOLAB-Laboratório de Histocompatibilidade, Belo Horizonte, Brazil
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Ergun C, Eskizengin H. Recent Updates on Blood Purification: Use of Smart Polymer Materials. J Biomed Mater Res A 2025; 113:e37883. [PMID: 39995147 DOI: 10.1002/jbm.a.37883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 01/08/2025] [Accepted: 01/29/2025] [Indexed: 02/26/2025]
Abstract
Blood purification is indispensable in addressing various conditions such as liver dysfunction, autoimmune diseases, and renal failure whereby toxins have to be cleared from the bloodstream effectively. Conventional methods that involve hemoperfusion, hemodialysis, and hemofiltration possess several weaknesses, including loss of plasma components and inefficient clearance of high molecular weight solutes. This review explores current developments in blood purification techniques particularly stimuli-responsive polymers for use in extracorporeal therapy among other applications. Many aspects of engineering stimuli-responsive polymers are described in terms of their role in the removal of small soluble molecules and toxins in blood purification techniques. The development of stimuli-responsive systems has introduced a new paradigm in blood purification by enabling selective, on-demand control of polymer parameters in response to external stimuli such as temperature, pH, electrolytes, and light. Such advanced materials have been demonstrated potential for toxin clearance, minimizing thrombosis, and improving blood compatibility and antifouling, which are far much better than traditional approaches. Furthermore, the review presents a perspective on stimuli-responsive polymers that could be used in developing novel extracorporeal systems for future medical purposes.
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Affiliation(s)
- Can Ergun
- Department of Biology, Faculty of Science, Ankara University, Ankara, Türkiye
| | - Hakan Eskizengin
- Department of Biology, Faculty of Science, Ankara University, Ankara, Türkiye
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España-Cueto S, Loste C, Lladós G, López C, Santos JR, Dulsat G, García A, Carmezim J, Carabia J, Ancochea Á, Fernández-Prendres C, Morales-Indiano C, Quirant B, Martínez-Cáceres E, Sanchez A, Parraga IG, Chamorro A, San José A, Abad E, Muñoz-Moreno JA, Prats A, Fumaz CR, Coll-Fernández R, Estany C, Torrano P, Puig J, Clotet B, Tebé C, Massanella M, Paredes R, Mateu L. Plasma exchange therapy for the post COVID-19 condition: a phase II, double-blind, placebo-controlled, randomized trial. Nat Commun 2025; 16:1929. [PMID: 39994269 PMCID: PMC11850642 DOI: 10.1038/s41467-025-57198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 02/13/2025] [Indexed: 02/26/2025] Open
Abstract
The post-COVID-19 condition (PCC) is a highly debilitating and persistent postinfectious syndrome that affects millions of people worldwide and has no effective treatment. Therapeutic plasma exchange (TPE) has the potential to improve the PCC by clearing the peripheral soluble pro-inflammatory immune milieu derived from acute or persistent SARS-CoV-2 infection. In a phase II, double-blind, placebo-controlled, randomized trial, fifty subjects with PCC were randomly assigned (1:1) to receive six sessions of either TPE or a sham plasma exchange and were followed for 90 days (ClinicalTrials.gov registration: NCT05445674). The primary endpoint was safety; secondary endpoints included functional status, symptomology, quality of life, neurocognitive symptoms, and peripheral biochemistry, hematology, coagulation and inflammation parameters. Both study arms had a similarly favorable safety profile. There were no diferences between groups in any of the efficacy parameters evaluated. Whereas TPE is safe, it did not lead to any discernible improvement of the PCC in this clinical trial.
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Affiliation(s)
- Sergio España-Cueto
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Cora Loste
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Red Española de Investigación en Covid Persistente (REICOP), Madrid, Spain
| | - Gemma Lladós
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- Red Española de Investigación en Covid Persistente (REICOP), Madrid, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Cristina López
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
| | - José Ramón Santos
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Gemma Dulsat
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
| | - Anna García
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
| | - João Carmezim
- Biostatistics Support and Research Unit, Germans Trias i Pujol Research Institute and Hospital (IGTP), Barcelona, Spain
| | - Julia Carabia
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
| | - Águeda Ancochea
- Banc de sang i teixits, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carla Fernández-Prendres
- Laboratory Medicine Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cristian Morales-Indiano
- Laboratory Medicine Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Bibiana Quirant
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Immunology Deptartment, LCMN, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Eva Martínez-Cáceres
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Immunology Deptartment, LCMN, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Anna Sanchez
- Banc de sang i teixits, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Anna Chamorro
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
| | - Alba San José
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
| | - Elena Abad
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
| | - Jose A Muñoz-Moreno
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- Red Española de Investigación en Covid Persistente (REICOP), Madrid, Spain
- Facultat de Psicologia i Ciències de l'Educació, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Anna Prats
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- Red Española de Investigación en Covid Persistente (REICOP), Madrid, Spain
| | - Carmina R Fumaz
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- Red Española de Investigación en Covid Persistente (REICOP), Madrid, Spain
| | - Roser Coll-Fernández
- Red Española de Investigación en Covid Persistente (REICOP), Madrid, Spain
- Rehabilitation Department. Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carla Estany
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
| | - Pamela Torrano
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Puig
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Bonaventura Clotet
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- IrsiCaixa, Badalona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristian Tebé
- Biostatistics Support and Research Unit, Germans Trias i Pujol Research Institute and Hospital (IGTP), Barcelona, Spain
| | - Marta Massanella
- Red Española de Investigación en Covid Persistente (REICOP), Madrid, Spain
- IrsiCaixa, Badalona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Roger Paredes
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain
- University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- IrsiCaixa, Badalona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lourdes Mateu
- Department of infectious diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Fundació Lluita contra les infeccions, Badalona, Spain.
- University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.
- Red Española de Investigación en Covid Persistente (REICOP), Madrid, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, Spain.
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Aplenc LM, Wood N, Iqbal NT, George C, Burroughsscanlon C. Therapeutic Plasma Exchange in Tandem With Other Types of Extracorporeal Circuits: The Experience of a Pediatric Center and a Review of Other Pediatric Center Reports. J Clin Apher 2025; 40:e70007. [PMID: 39963067 DOI: 10.1002/jca.70007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 12/17/2024] [Accepted: 01/27/2025] [Indexed: 05/10/2025]
Abstract
Therapeutic plasma exchange (TPE) concurrently performed in critically ill pediatric patients with other extracorporeal circuits is a complex process. We sought to characterize tandem procedures, including patient demographics, primary diagnosis, American Society for Apheresis (ASFA) category indications, survival at 24 h and 30 days after completion, blood product utilization, and complications. A retrospective analysis of medical records was performed. Data were collected from July 2014 to January 2021 with institutional review board approval. Patients' demographics, blood product utilization, and adverse events data were collected. In addition, we performed a literature review to identify studies in the pediatric population that were similar in design to our study. Fifty patients underwent 262 procedures. The median age was 9 years, and median weight was 21 kg (42% of patients weighed less than 10 kg). The most frequent indications for plasma exchange included sepsis with multiorgan failure (11 patients) and multiorgan failure (9 patients). ASFA indication category III was the most common (42 patients), followed by uncategorized indications (6 patients). The most common adverse events were hypocalcemia, occurring in 120 (45%) procedures, hypotension in 25 (9.5%) procedures, and circuit clotting in 12 (4.5%) procedures. Citrate, heparin, and bivalirudin were used as anticoagulants. Thirty-nine (78%) patients survived 24 h, and 26 (52%) patients were alive 30 days after completion of tandem procedures. Despite the high level of complexity, tandem procedures can be performed efficiently and safely in critically ill children.
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Affiliation(s)
- Lejla Music Aplenc
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, USA
| | - Nicole Wood
- Department of Pediatric Hematology Oncology, Children's Mercy Hospital, Kansas City, USA
| | - Nazia Tabassum Iqbal
- Department of Pediatric Hematology Oncology, Children's Mercy Hospital, Kansas City, USA
| | - Cindy George
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, USA
| | - Cherie Burroughsscanlon
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, USA
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Bava D, Panda S, Jain R, Mittal S, Gupta A, Khan A, Mandal S, Bajpayee A. Therapeutic plasma exchange in autoimmune neurological disorders: A comprehensive evaluation of clinical outcomes, safety, and long-term disability using the modified Rankin scale. Ther Apher Dial 2025; 29:114-122. [PMID: 39053908 DOI: 10.1111/1744-9987.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/21/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Autoimmune neurological diseases (ANDs) involve the immune system attacking the nervous system, leading to various symptoms. Therapeutic plasma exchange (TPE) is used to remove pathogenic autoantibodies, aiming to improve clinical outcomes. METHODS This ambispective observational study included 99 patients with ANDs who underwent TPE from January 2018 to June 2022 at a tertiary care center in India. Clinical outcomes were measured using the modified Rankin Scale (mRS) scores at admission, post-TPE, at 3-months, 6-months, and 1-year follow-up post-discharge. Data were analyzed using Epi Info version 7.0. RESULTS The median mRS score improved significantly from 5 (IQR 4-5) before TPE to 3 (IQR 2-4) post-TPE (p < 0.001). Complications occurred in 5.95% of procedures, with allergic reactions being the most common. The in-hospital mortality rate was 9%. CONCLUSION TPE is a safe and effective treatment modality for autoimmune neurological diseases, especially in resource-constrained settings. It aids in both symptomatic relief and reducing long-term functional disability.
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Affiliation(s)
- Davood Bava
- Department of IHBT, NIMS Jaipur, Jaipur, India
| | - Samhita Panda
- Department of Neurology, AIIMS Jodhpur, Jodhpur, India
| | - Romesh Jain
- Department of Transfusion Medicine & Blood Bank, AIIMS Bhopal, Bhopal, India
| | - Siddharth Mittal
- Department of Transfusion Medicine, AIIMS Jodhpur, Jodhpur, India
| | - Anubhav Gupta
- Department of Transfusion Medicine, AIIMS Jodhpur, Jodhpur, India
| | - Atik Khan
- Department of Transfusion Medicine, Jupiter Hospital, Indore, India
| | - Saptarshi Mandal
- Department of Transfusion Medicine, AIIMS Jodhpur, Jodhpur, India
| | - Archana Bajpayee
- Department of Transfusion Medicine, AIIMS Jodhpur, Jodhpur, India
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Balaban U, Kara E, Mahmoud SH, Ozcebe OI, Demirkan K. Examination of drug removal profiles in patients undergoing therapeutic plasma exchange: A retrospective study. Ther Apher Dial 2024; 28:954-963. [PMID: 39009957 DOI: 10.1111/1744-9987.14185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/24/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) eliminates disease-contributing substances but may also affect drug concentrations. This study aimed to assess the prevalence of prescription drugs removable via TPE by reviewing patient medication histories. METHODS A retrospective, single-center study was conducted from January 1, 2021 to December 31, 2022. The study included 244 patients undergoing 1087 TPE sessions. Drugs prescribed to patients on TPE days were categorized as "yes" (probably removable), "maybe" (possibly removable), and "no" (unlikely removable) regarding their removability via TPE. RESULTS Among 3966 prescriptions, 556 (14.0%) were analyzed, with 21.8%, 36.5%, and 41.7% falling into the "yes," "maybe," and "no" categories for removability. Although only 14.0% were categorized, 83.6% of patients received at least one analyzable drug. Among them, 83.8% had at least one potentially removable drug. CONCLUSION Real-world data highlights the need for caution in drug treatments during TPE to ensure optimal therapeutic outcomes, particularly for specific drugs.
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Affiliation(s)
- Ugur Balaban
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Emre Kara
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sherif Hanafy Mahmoud
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Osman Ilhami Ozcebe
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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Dima D, Khouri J. The role of therapeutic plasma exchange in plasma cell disorders. Ann Hematol 2024; 103:3941-3946. [PMID: 38558184 PMCID: PMC11512890 DOI: 10.1007/s00277-024-05712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Therapeutic plasma exchange (TPE) is an extracorporeal technique where patient's plasma containing pathogenic substances is separated and removed from the whole blood, while the cellular component is returned to the patient mixed with replacement solution via an apheresis machine. Due to its ability to remove pathogenic substances from plasma including immunoglobulins, TPE has proven efficacious in the management of various disorders across different medical disciplines, including plasma cell dyscrasias, which are characterized by the abundant secretion of non-functional immunoglobulins produced by an abnormally proliferating plasma cell clone. This review summarizes the current indications of TPE in plasma cell-related disorders and discusses its application, safety, and therapeutic effects.
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Affiliation(s)
- Danai Dima
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Liu Q, Liu F, Sun P, Du X, Zhu L, Xu J, Cheng L, Huang Y, Huang C, Chen J, Wang Z, Lu A, Zhu Y, Huang H, Huang J, Pan J, Ma L, Wang Z, Li C. Effect of apheresis plasma donation on plasma uric acid levels, the lipid profile, and major plasma proteins in plasma donors in China: A multicenter, prospective cohort study. Transfus Apher Sci 2024; 63:103940. [PMID: 38781881 DOI: 10.1016/j.transci.2024.103940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
Abnormal plasma uric acid (UA) levels, the lipid profile, and plasma proteins in blood are associated with a range of adverse health outcomes. This multicenter, prospective cohort study aimed to determine the possible effects of multiple apheresis plasma donations on plasma UA levels, the lipid profile, and major proteins in plasma donors. Participants were enrolled from 1 April 2021 to 31 August 2022. When their plasma UA (men: >420 µmol/L, women: >360 µmol/L) and/or lipid levels (total cholesterol [TC]: ≥6.2 mmol/L, triglycerides [TGs]: ≥2.3 mmol/L, low-density lipoprotein cholesterol: ≥4.1 mmol/L, or high-density lipoprotein cholesterol [HDL-C]: <1.0 mmol/L) were abnormal at their first plasma donation, the enrolled participants were followed up until they had completed 10 plasma donations. A total of 11485 participants were enrolled, of whom 1861 met the inclusion criteria. During the study period, 320 donors completed 10 plasma donations. None of the participants took any corrective medicine for their abnormal index. The measured parameters were significantly different from the first to the tenth plasma donations (donors with asymptomatic hyperuricemia: UA, P < 0.001; donors with asymptomatic hyperlipidemia: HDL-C, P < 0.001; TC, P = 0.025; TGs, P < 0.001; apolipoprotein B, P = 0.025; all of the plasma donors, immunoglobulin G, P < 0.001). The levels of HDL-C, TC, and apolipoprotein B were increased, and the levels of UA, TGs, and immunoglobulin G were decreased over this time. However, immunoglobulin G levels were still in the normal range. Moreover, the changes in these parameters were closely associated with the frequency of plasma donation during the study period. Repeated apheresis plasma donations can reduce plasma UA and TG levels and increase HDL-C levels; and further evaluation of the clinical significance with a larger sample size is required.
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Affiliation(s)
- Qing Liu
- Department of Plasma Proteins, Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, PR China
| | - Fengjuan Liu
- Department of Plasma Proteins, Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, PR China
| | - Pan Sun
- Department of Plasma Proteins, Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, PR China
| | - Xi Du
- Department of Plasma Proteins, Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, PR China
| | - Liyuan Zhu
- Department of Plasma Proteins, Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, PR China
| | - Jun Xu
- Research and Development Department, Shanghai RAAS Blood Products Co., Ltd., Shanghai, PR China
| | - Lu Cheng
- Research and Development Department, Shanghai RAAS Blood Products Co., Ltd., Shanghai, PR China
| | - Yaojing Huang
- Research and Development Department, Bama RAAS Apheresis Plasma Co., Ltd., Bama, Guangxi, PR China
| | - Chunyan Huang
- Research and Development Department, Bama RAAS Apheresis Plasma Co., Ltd., Bama, Guangxi, PR China
| | - Jielin Chen
- Research and Development Department,Guangdong Shuanglin Bio-pharmacy Co., Ltd., Zhanjiang, PR China
| | - Zhibo Wang
- Research and Development Department,Guangdong Shuanglin Bio-pharmacy Co., Ltd., Zhanjiang, PR China
| | - Aihong Lu
- Research and Development Department, Suixi Shuanglin Apheresis Plasma Co.,Ltd., Suixi, Guangdong, PR China
| | - Yikuan Zhu
- Research and Development Department, Lianjiang Shuanglin Apheresis Plasma Co.,Ltd., Lianjiang, Guangdong, PR China
| | - Huan Huang
- Research and Development Department, Lianjiang Shuanglin Apheresis Plasma Co.,Ltd., Lianjiang, Guangdong, PR China
| | - Junli Huang
- Research and Development Department, Pingguo Weiguang Apheresis Plasma Co.,Ltd., Pingguo, Guangxi, PR China
| | - Jufeng Pan
- Research and Development Department, Wuming RAAS Apheresis Plasma Co.,Ltd., Wuming, Guangxi, PR China
| | - Li Ma
- Department of Plasma Proteins, Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, PR China.
| | - Zongkui Wang
- Department of Plasma Proteins, Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, PR China.
| | - Changqing Li
- Department of Plasma Proteins, Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, PR China.
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10
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Meena P, Panda S, Das P, Garg A, Dayanandan M. Reusing Plasma Filters in Resource-Poor Settings: Experience From a Tertiary Care Hospital. Cureus 2024; 16:e56516. [PMID: 38646327 PMCID: PMC11026947 DOI: 10.7759/cureus.56516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) is used to manage various life-threatening illnesses. It is widely performed by nephrologists, intensivists, pathologists, or experts in transfusion medicine worldwide. However, the costs of TPE sessions are exceedingly high, and they have a huge impact on patients' financial burden. Herein, we investigated the outcomes of the reuse of plasma filters in TPE on several occasions. METHODS This is a retrospective analysis of patients receiving TPE from January 1, 2020, to April 30, 2023, in the Department of Nephrology. A formulation of 4.5% peracetic acid and 24% hydrogen peroxide acid with RO water dilution was used for reprocessing. Clinical outcomes, risks, and cost-benefit were evaluated and compared between the plasma filter reuse group (GP-1) and the no-reuse group (GP-2). RESULTS A total of 70 patients were included in this study. 200 and 112 TPE sessions were performed in GP-1 and GP-2, respectively. The most common indication for TPE in both groups was neurological. The clinical efficacy of TPE was similar in both groups. There was no difference in the clotting of the plasma filter, any allergic reaction, infection, or bleeding in the group. However, there was a significant difference in levels of fibrinogen (p=0.03) pre and post-procedure in both groups. The incidence of hypotension was found to be higher in GP-1 (26%) compared to GP-2 (15.6%), p = 0.05. The cost of overall treatment was 38% less in GP-1. CONCLUSION The reuse of plasma filters is a safe and effective method for cost minimization in patients requiring TPE. This method can be effectively utilized in resource-poor settings without any increased risk of adverse effects.
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Affiliation(s)
- Priti Meena
- Nephrology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Sandip Panda
- Nephrology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Paromita Das
- Nephrology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Anish Garg
- Nephrology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Mohit Dayanandan
- Nephrology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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11
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Chomat MR, Swanson K, Barton K, Douds M, Said AS. Management of Bivalirudin Dosing and Replacement Fluid During Therapeutic Plasma Exchange in Children on Extracorporeal Membrane Oxygenation. ASAIO J 2024; 70:e31-e37. [PMID: 38029748 DOI: 10.1097/mat.0000000000002094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
The use of bivalirudin as the primary anticoagulant for children supported on extracorporeal membrane oxygenation (ECMO) is growing. Ideal management of bivalirudin dosing during therapeutic plasma exchange (TPE) on ECMO is unknown. We performed a single-center retrospective study of ECMO patients anticoagulated with bivalirudin who underwent TPE from January 2019 to December 2021. Therapeutic plasma exchange sessions were analyzed individually by bivalirudin dosing strategy (no change [NC] versus increased dose [dose change {DC} bivalirudin group]) and replacement fluid (all fresh-frozen plasma [FFP] versus all albumin or FFP and albumin [FFP/Albumin]). Primary outcomes included bleeding, coagulopathy, and circuit thrombosis within 24 hours of TPE. Secondary outcomes included change in bivalirudin dose and coagulation parameters following TPE. There were 60 unique TPE sessions. Bivalirudin dosing or replacement fluid strategies were not associated with bleeding, coagulopathy, or thrombosis post-TPE. All albumin or fresh frozen plasma and albumin combinations (FFP/Albumin) group had longer post-TPE thromboelastography (TEG) reaction time, clot time, and more acute angle. The FFP/Albumin group had increased post-TPE international normalization ratio (INR) and partial thrombin time (PTT). Therapeutic plasma exchange for children on ECMO and bivalirudin anticoagulation is feasible; however, optimal dosing during TPE requires further investigation. Replacement fluid with FFP/Albumin is associated with more coagulopathic laboratory parameters. Patients may benefit from all FFP fluid replacement strategy. Further investigation is needed to prove generalizability.
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Affiliation(s)
- Michael R Chomat
- From the Division of Pediatric Critical Care Medicine, Washington University in Saint Louis
- Division of Cardiac Critical Care, Department of Pediatrics, University of Texas Health Austin/Dell Children's Medical Center
| | - Kerry Swanson
- Department of Surgery, Washington University in Saint Louis
| | - Kevin Barton
- Division of Pediatric Nephrology, Washington University in Saint Louis
| | | | - Ahmed S Said
- From the Division of Pediatric Critical Care Medicine, Washington University in Saint Louis
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12
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Bok J, Choi J, Lee S, Lim TH, Jang Y. Antibacterial and deodorizing effects of cold atmospheric plasma-applied electronic deodorant. Sci Rep 2024; 14:3011. [PMID: 38321059 PMCID: PMC10847499 DOI: 10.1038/s41598-024-53285-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
Axillary odor is a malodor produced by bacterial metabolism near the apocrine glands, which often causes discomfort in an individual's daily life and social interactions. A deodorant is a personal care product designed to alleviate or mask body odor. Currently, most deodorants contain antimicrobial chemicals and fragrances for odor management; however, direct application to the underarm skin can result in irritation or sensitivity. Therefore, there is a growing interest in technologies that enable disinfection and odor control without the antiperspirants or perfumes. The cold atmospheric plasma temporally generates reactive radicals that can eliminate bacteria and surrounding odors. In this study, cultured Staphylococcus hominis and Corynebacterium xerosis, the causative bacteria of axillary bromhidrosis, were killed after 90% plasma exposure for 3 min. Moreover, the electronic nose system indicated a significant reduction of approximately 51% in 3-hydroxy-3-methylhexanoic acid and approximately 34% in 3-methyl-3-sulfanylhexan-1-ol, the primary components of axillary odor, following a 5-min plasma exposure. These results support the dual function of our deodorant in eliminating bacteria and axillary odors without the chemical agents. Therefore, cold atmospheric plasma-applied deodorant devices have great potential for the treatment and management of axillary odors as a non-contact approach without chemical use in daily life.
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Affiliation(s)
- Junsoo Bok
- Department of Medical and Digital Engineering, College of Engineering, Hanyang University, Seoul, 04736, South Korea
| | - Jongbong Choi
- Department of Emergency Medicine, Hanyang University Hospital, Seoul, 04763, South Korea
| | - Solpa Lee
- Department of Medical and Digital Engineering, College of Engineering, Hanyang University, Seoul, 04736, South Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University Hospital, Seoul, 04763, South Korea
| | - Yongwoo Jang
- Department of Medical and Digital Engineering, College of Engineering, Hanyang University, Seoul, 04736, South Korea.
- Department of Pharmacology, College of Medicine, Hanyang University, Seoul, 04736, South Korea.
- Department of Medical and Digital Engineering, College of Medicine, Hanyang University, Seoul, 04763, South Korea.
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13
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Badura K, Frąk W, Hajdys J, Majchrowicz G, Młynarska E, Rysz J, Franczyk B. Hepatorenal Syndrome-Novel Insights into Diagnostics and Treatment. Int J Mol Sci 2023; 24:17469. [PMID: 38139297 PMCID: PMC10744165 DOI: 10.3390/ijms242417469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Hepatorenal syndrome (HRS) is a disorder associated with cirrhosis and renal impairment, with portal hypertension as its major underlying cause. Moreover, HRS is the third most common cause of acute kidney injury, thus creating a major public health concern. This review summarizes the available information on the pathophysiological implications of HRS. We discuss pathogenesis associated with HRS. Mechanisms such as dysfunction of the circulatory system, bacterial infection, inflammation, impaired renal autoregulation, circulatory, and others, which have been identified as critical pathways for development of HRS, have become easier to diagnose in recent years. Additionally, relatively recently, renal dysfunction biomarkers have been found indicating renal injury, which are involved in the pathophysiology of HRS. This review also summarizes the available information on the management of HRS, focusing on vasoconstrictive drugs, renal replacement therapy, and liver transplant together with currently being investigated novel therapies. Analyzing new discoveries for the underlying causes of this condition assists the general research to improve understanding of the mechanism of pathophysiology and thus prevention of HRS.
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Affiliation(s)
- Krzysztof Badura
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Weronika Frąk
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Joanna Hajdys
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Gabriela Majchrowicz
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
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14
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Ramirez S, Koerich S, Astudillo N, De Gregorio N, Al-Lahham R, Allison T, Rocha NP, Wang F, Soto C. Plasma Exchange Reduces Aβ Levels in Plasma and Decreases Amyloid Plaques in the Brain in a Mouse Model of Alzheimer's Disease. Int J Mol Sci 2023; 24:17087. [PMID: 38069410 PMCID: PMC10706894 DOI: 10.3390/ijms242317087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
Alzheimer's disease (AD) is the most common type of dementia, characterized by the abnormal accumulation of protein aggregates in the brain, known as neurofibrillary tangles and amyloid-β (Aβ) plaques. It is believed that an imbalance between cerebral and peripheral pools of Aβ may play a relevant role in the deposition of Aβ aggregates. Therefore, in this study, we aimed to evaluate the effect of the removal of Aβ from blood plasma on the accumulation of amyloid plaques in the brain. We performed monthly plasma exchange with a 5% mouse albumin solution in the APP/PS1 mouse model from 3 to 7 months old. At the endpoint, total Aβ levels were measured in the plasma, and soluble and insoluble brain fractions were analyzed using ELISA. Brains were also analyzed histologically for amyloid plaque burden, plaque size distributions, and gliosis. Our results showed a reduction in the levels of Aβ in the plasma and insoluble brain fractions. Interestingly, histological analysis showed a reduction in thioflavin-S (ThS) and amyloid immunoreactivity in the cortex and hippocampus, accompanied by a change in the size distribution of amyloid plaques, and a reduction in Iba1-positive cells. Our results provide preclinical evidence supporting the relevance of targeting Aβ in the periphery and reinforcing the potential use of plasma exchange as an alternative non-pharmacological strategy for slowing down AD pathogenesis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Claudio Soto
- Mitchell Center for Alzheimer’s Disease and Related Brain Disorders, Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX 77030, USA; (S.R.); (S.K.); (N.A.); (N.D.G.); (R.A.-L.); (T.A.); (N.P.R.); (F.W.)
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15
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Neth BJ, Winters JL, Sairaj RT, Gharibi Loron A, Rahman M, Hirte R, Riviere-Cazaux C, Ruff MW, Burns TC. Plasma exchange as a tool for removal of bevacizumab: Highlighting application for urgent surgery. Neurooncol Pract 2023; 10:592-595. [PMID: 38009115 PMCID: PMC10666800 DOI: 10.1093/nop/npad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Background Bevacizumab is commonly used to manage cerebral edema associated with brain tumors. However, its long half-life poses challenges for patients requiring urgent surgery due to wound complications. We present a case of utilizing therapeutic plasma exchange (TPE) to remove bevacizumab in a patient with recurrent glioblastoma requiring urgent surgery. Methods A 58-year-old male with recurrent glioblastoma, IDH-wildtype, presented with clinical and radiographic concern for ventriculitis requiring urgent wound washout only 4 days after his last bevacizumab infusion. TPE was performed for 3 sessions after surgery using a centrifugation-based cell separator. Replacement fluids included normal serum albumin, normal saline, and fresh frozen plasma. Bevacizumab levels were quantified using an enzyme-linked immunoabsorbent assay before and after each TPE session. Results TPE effectively removed bevacizumab, enabling safe surgery without new complications. Plasma bevacizumab levels decreased from 1087.63 to 145.35 ng/mL (13.4% of original) by the end of the last TPE session. This decline is consistent with nearly 3 half-lives, which compares favorably to the expected timeline of natural decline given the 21-day half-life. Conclusions We report a complex clinical scenario of a patient requiring urgent wound washout 4 days after last bevacizumab infusion for CNS infection. Surgery was successfully performed without new complications with use of TPE to remove bevacizumab immediately following surgery. This case highlights the feasibility of this approach, which may be utilized effectively in patients requiring surgery after having recently received bevacizumab.
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Affiliation(s)
- Bryan J Neth
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Masum Rahman
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Renee Hirte
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Michael W Ruff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Terry C Burns
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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16
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Wang L, Wang Y, Zhang RY, Wang Y, Liang W, Li TG. Management of acute carbamazepine poisoning: A narrative review. World J Psychiatry 2023; 13:816-830. [DOI: 10.5498/wjp.v13.i11.816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/23/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023] Open
Abstract
Standard management protocols are lacking and specific antidotes are unavailable for acute carbamazepine (CBZ) poisoning. The objective of this review is to provide currently available information on acute CBZ poisoning, including its management, by describing and summarizing various therapeutic methods for its treatment according to previously published studies. Several treatment methods for CBZ poisoning will be briefly introduced, their advantages and disadvantages will be analyzed and compared, and suggestions for the clinical treatment of CBZ poisoning will be provided. A literature search was performed in various English and Chinese databases. In addition, the reference lists of identified articles were screened for additional relevant studies, including non-indexed reports. Non-peer-reviewed sources were also included. In the present review, 154 articles met the inclusion criteria including case reports, case series, descriptive cohorts, pharmacokinetic studies, and in vitro studies. Data on 67 patients, including 4 fatalities, were reviewed. Based on the summary of cases reported in the included articles, the cure rate of CBZ poisoning after symptomatic treatment was 82% and the efficiency of hemoperfusion was 58.2%. Based on the literature review, CBZ is moderately dialyzable and the recommendation for CBZ poisoning is supportive management and gastric lavage. In severe cases, extracorporeal treatment is recommended, with hemodialysis as the first choice.
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Affiliation(s)
- Luan Wang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yang Wang
- Department of General Surgery, The 4th Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
| | - Ruo-Ying Zhang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yao Wang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Wei Liang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Tie-Gang Li
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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17
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García Gómez C, Navarro E, Alcázar V, López-Guzmán A, Arrieta F, Anda E, Biagetti B, Guerrero-Pérez F, Villabona C, de Assín Valverde AR, Lamas C, Lecumberri B, Rosado Sierra JA, Sastre J, Díez JJ, Iglesias P. Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study. J Clin Med 2023; 12:6556. [PMID: 37892693 PMCID: PMC10607319 DOI: 10.3390/jcm12206556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/µL) is a rare but serious complication in the treatment of hyperthyroidism. METHODOLOGY Adult patients with AIA who were followed up at 12 hospitals in Spain were retrospectively studied. A total of 29 patients were studied. The etiology of hyperthyroidism was distributed as follows: Graves' disease (n = 21), amiodarone-induced thyrotoxicosis (n = 7), and hyperfunctioning multinodular goiter (n = 1). Twenty-one patients were treated with methimazole, as well as six patients with carbimazole and two patients with propylthiouracil. RESULTS The median (IQR) time to development of agranulocytosis was 6.0 (4.0-11.5) weeks. The most common presenting sign was fever accompanied by odynophagia. All of the patients required admission, reverse isolation, and broad-spectrum antibiotics; moreover, G-CSF was administered to 26 patients (89.7%). Twenty-one patients received definitive treatment, thirteen patients received surgery, nine patients received radioiodine, and one of the patients required both treatments. Spontaneous normalization of thyroid hormone values occurred in six patients (four patients with amiodarone-induced thyrotoxicosis and two patients with Graves' disease), and two patients died of septic shock secondary to AIA. CONCLUSIONS AIA is a potentially lethal complication that usually appears around 6 weeks after the initiation of antithyroid therapy. Multiple drugs are required to control hyperthyroidism before definitive treatment; additionally, in a significant percentage of patients (mainly in those treated with amiodarone), hyperthyroidism resolved spontaneously.
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Affiliation(s)
- Carlos García Gómez
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (J.J.D.); (P.I.)
- Department of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Elena Navarro
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain;
| | - Victoria Alcázar
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, 28914 Madrid, Spain;
| | - Antonio López-Guzmán
- Department of Endocrinology and Nutrition, Complejo Asistencial de Ávila, 05004 Ávila, Spain;
| | - Francisco Arrieta
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Emma Anda
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Betina Biagetti
- Department of Endocrinology and Nutrition, Hospital Universitari Vall d’Hebrón, 08035 Barcelona, Spain;
| | - Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (C.V.)
| | - Carles Villabona
- Department of Endocrinology and Nutrition, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (C.V.)
| | - Andrés Ruiz de Assín Valverde
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Albacete, 02008 Albacete, Spain (C.L.)
| | - Cristina Lamas
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Albacete, 02008 Albacete, Spain (C.L.)
| | - Beatriz Lecumberri
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | | | - Julia Sastre
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Toledo, 45007 Toledo, Spain;
| | - Juan José Díez
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (J.J.D.); (P.I.)
- Department of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Pedro Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (J.J.D.); (P.I.)
- Department of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
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Gomez F, Mehra A, Ensrud E, Diedrich D, Laudanski K. COVID-19: a modern trigger for Guillain-Barre syndrome, myasthenia gravis, and small fiber neuropathy. Front Neurosci 2023; 17:1198327. [PMID: 37712090 PMCID: PMC10498773 DOI: 10.3389/fnins.2023.1198327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
COVID-19 infection has had a profound impact on society. During the initial phase of the pandemic, there were several suggestions that COVID-19 may lead to acute and protracted neurologic sequelae. For example, peripheral neuropathies exhibited distinctive features as compared to those observed in critical care illness. The peripheral nervous system, lacking the protection afforded by the blood-brain barrier, has been a particular site of sequelae and complications subsequent to COVID-19 infection, including Guillain-Barre syndrome, myasthenia gravis, and small fiber neuropathy. We will discuss these disorders in terms of their clinical manifestations, diagnosis, and treatment as well as the pathophysiology in relation to COVID-19.
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Affiliation(s)
- Francisco Gomez
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Ashir Mehra
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Erik Ensrud
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Daniel Diedrich
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
| | - Krzysztof Laudanski
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
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Meagher J, Hendricks J, Eatroff A. Cytokine Adsorption as an Adjunctive Treatment for Patients with Immune-Mediated Hemolytic Anemia Receiving Therapeutic Plasma Exchange: A Case Series of 3 Dogs. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2023; 14:103-110. [PMID: 37283630 PMCID: PMC10241178 DOI: 10.2147/vmrr.s407139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023]
Abstract
The use of cytokine adsorption is an emerging treatment for inflammatory diseases in human medicine. There are few reports of this treatment modality in veterinary medicine and no reports of the use of a cytokine adsorbent for immune-mediated hemolytic anemia (IMHA). These case reports illustrate the use of a cytokine adsorbent as an adjunctive treatment during therapeutic plasma exchange (TPE). All dogs were unresponsive to conventional treatment or were severely affected by rapid hemolysis of red blood cells. The aim was to treat all dogs with three sequential TPE sessions; however, one dog died before completion of three sessions and one dog required additional sessions. Preliminary evidence indicates that the use of a cytokine adsorption is well tolerated and can be considered as an adjunct in the management of IMHA that is severe or refractory to traditional treatment.
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Affiliation(s)
- John Meagher
- Advanced Critical Care Emergency and Specialty Services, Culver City, CA, USA
| | - Jeanette Hendricks
- Advanced Critical Care Emergency and Specialty Services, Culver City, CA, USA
| | - Adam Eatroff
- Advanced Critical Care Emergency and Specialty Services, Culver City, CA, USA
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Gulati K, Pusey CD. Plasma exchange as an adjunctive therapy in anti-neutrophil cytoplasm antibody-associated vasculitis. Expert Rev Clin Immunol 2023; 19:417-430. [PMID: 36860127 DOI: 10.1080/1744666x.2023.2184354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
INTRODUCTION We summarize evidence for the role of therapeutic plasma exchange (TPE) in the treatment of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). TPE rapidly removes ANCA IgG, complement and coagulation factors important in the pathogenesis of AAV. TPE has been used in patients with rapidly deteriorating renal function to achieve early disease control, allowing time for immunosuppressive agents to prevent resynthesis of ANCA. The PEXIVAS trial challenged the utility of TPE in AAV, as it did not show benefit of adjunctive TPE on a combined end point of end stage kidney disease (ESKD) and death. AREAS COVERED We analyze data from PEXIVAS and other trials of TPE in AAV, an up-to-date meta-analysis, and recently published large cohort studies. EXPERT OPINION There remains a role for the use of TPE in AAV in certain groups of patients, in particular those with severe renal involvement (Cr >500 μmol/L or dialysis-dependent). It should be considered in patients with Cr >300 μmol/L and rapidly deteriorating function, or with life-threatening pulmonary hemorrhage. A separate indication is patients double positive for anti-GBM antibodies and ANCA. TPE may have the greatest benefit as part of steroid-sparing immunosuppressive treatment strategies.
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Affiliation(s)
- Kavita Gulati
- Vasculitis Clinic, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.,Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Charles D Pusey
- Vasculitis Clinic, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.,Centre for Inflammatory Disease, Imperial College London, London, UK
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21
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Dianaty S, Khodadadi S, Alimoghaddam R, Mirzaei A. Comparison of outcomes and costs of extracorporeal blood purification therapies in critically ill COVID-19 patients. Ther Apher Dial 2022; 27:505-516. [PMID: 36324189 PMCID: PMC9878110 DOI: 10.1111/1744-9987.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/23/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Plasmapheresis and hemoperfusion are used against cytokine release syndrome in COVID-19. This study aims to compare their outcomes, costs, and side-effects. METHODS Survival, costs and side-effects were compared in intensive care unit (ICU) patients receiving plasmapheresis (n = 49), hemoperfusion (n = 20), or none (n = 107), followed until death or discharge. RESULTS Plasmapheresis survival time was higher than hemoperfusion or controls (HR = 0.764, p = 0.397 and HR = 0.483, p = 0.002, respectively), although the latter diminished after controlling for age and disease severity (p = 0.979). There was no significant difference in ICU costs for plasmapheresis and hemoperfusion (p = 0.738) while both costed more than controls (both p < 0.001). Hypocalcemia and thrombocytopenia incidence did not differ between two groups (p = 0.124 and p = 0.389, respectively) while being higher than controls in plasmapheresis (both p < 0.001) and hemoperfusion (p < 0.001 and p = 0.056, respectively). CONCLUSION Plasmapheresis and hemoperfusion do not differ significantly in patient survival, ICU costs and side-effects with a higher incidence of hypocalcemia and thrombocytopenia compared witcontrols.
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Affiliation(s)
- Soroush Dianaty
- Student Research Committee, Tehran Medical Sciences BranchIslamic Azad UniversityTehranIran,Universal Scientific Education and Research Network (USERN)TehranIran
| | - Sanaz Khodadadi
- Student Research Committee, Tehran Medical Sciences BranchIslamic Azad UniversityTehranIran
| | - Rojina Alimoghaddam
- Student Research Committee, Tehran Medical Sciences BranchIslamic Azad UniversityTehranIran
| | - Abasat Mirzaei
- Department of Health Care Management, Faculty of Health, Tehran Medical ScienceIslamic Azad UniversityTehranIran,Health Economic Policy Research Center, Tehran Medical SciencesIslamic Azad UniversityTehranIran,Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical SciencesIslamic Azad UniversityTehranIran
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曹 建, 贺 杰, 张 新, 周 雄, 肖 政. [Therapeutic plasma exchange in the pediatric intensive care unit: a single-center retrospective study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1149-1153. [PMID: 36305117 PMCID: PMC9628001 DOI: 10.7499/j.issn.1008-8830.2204172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To study the indication for therapeutic plasma exchange (TPE) and related complications in children admitted to the pediatric intensive care unit. METHODS A retrospective analysis was performed on the medical records of the children who received TPE in the Pediatric Intensive Care Unit, Hunan Children's Hospital, from March 2015 to March 2021. The indication for TPE and related complications were analyzed and compared with the American Society for Apheresis (ASFA) indication categories. RESULTS A total of 405 TPE treatment sessions were performed for 196 children, among whom 76 children (38.8%) also received continuous renal replacement therapy and 147 children (75.0%) survived. The children with neurological diseases had the highest survival rate of 93.1% (27/29). The top three indications for TPE were hematologic diseases (61/196, 31.1%), sepsis with multiple organ dysfunction (41/196, 20.9%), and liver diseases (36/196, 18.4%). The children with hematologic diseases received the highest number of 129 TPE treatment sessions. The subjects with ASFA category Ⅲ indications accounted for the highest proportion of 76.5% (150/196), followed by those with ASFA category Ⅰ indications (11.2%, 22/196), ASFA category Ⅱ indications (7.1%, 14/196), and unknown category (5.1%, 10/196), and no ASFA category Ⅳ indications were observed. The incidence rate of TPE complications was 12.3% (50/405), and the most common complications were pipeline coagulation (4.2%, 17/405) and hypotension (3.7%, 15/405). No serious adverse events were observed. CONCLUSIONS TPE can be safely used for the treatment of critically ill children with indications in an experienced pediatric intensive care unit.
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Benefits of plasma exchange on mortality in patients with COVID-19: a systematic review and meta-analysis. Int J Infect Dis 2022; 122:332-336. [PMID: 35709964 PMCID: PMC9192121 DOI: 10.1016/j.ijid.2022.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/05/2022] [Accepted: 06/10/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic continues, and the death toll continues to surge. This systematic review and meta-analysis aimed to determine the efficacy of therapeutic plasma exchange (TPE) on mortality in patients with COVID-19. METHODS A systematic search was made of PubMed, Embase, Cochrane Library, and clinicaltrials.gov, without language restrictions. Controlled clinical trials on treatment of COVID-19 with TPE, compared with standard of care, were reviewed. Studies were pooled according to risk ratios (RRs) and weighted mean differences, with 95% confidence intervals (CIs). RESULTS A total of six trials (enrolling 343 participants) met the inclusion criteria. Therapeutic plasma exchange showed significant effect on mortality (RR 0.41, 95% CI 0.24 to 0.69; P = 0.0008). CONCLUSION TPE significantly reduced mortality in hospitalized patients with moderate-to-critical COVID-19. Plasma exchange therapy should be considered for patients with COVID-19.
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Jaruratanasirikul S, Neamrat P, Jullangkoon M, Samaeng M. Impact of therapeutic plasma exchange on meropenem pharmacokinetics. Pharmacotherapy 2022; 42:659-666. [DOI: 10.1002/phar.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Sutep Jaruratanasirikul
- Division of Internal Medicine, Faculty of Medicine Prince of Songkla University Hat Yai Thailand
| | - Phangard Neamrat
- Division of Internal Medicine, Faculty of Medicine Prince of Songkla University Hat Yai Thailand
| | - Monchana Jullangkoon
- Division of Internal Medicine, Faculty of Medicine Prince of Songkla University Hat Yai Thailand
| | - Maseetoh Samaeng
- Division of Internal Medicine, Faculty of Medicine Prince of Songkla University Hat Yai Thailand
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25
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First-line immunotherapy of neuronal surface antibody-mediated autoimmune encephalitis: Assessment of therapeutic effectiveness and cost-efficiency. Mult Scler Relat Disord 2022; 66:104071. [PMID: 35917744 DOI: 10.1016/j.msard.2022.104071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/14/2022] [Accepted: 07/24/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the therapeutic effectiveness and cost-efficiency of first-line immunotherapies on neuronal surface antibody-mediated autoimmune encephalitis (AE) based on a real-world observational study in China. METHODS Our study retrospectively collected the clinical and paraclinical data of patients with definite neuronal surface antibody-mediated AE between July 2014 and July 2020. Regular follow-up was performed after administering standard regimens of first-line immunotherapies, including intravenous methylprednisolone (IVMP) and / or intravenous immunoglobulin (IVIG). Therapeutic effectiveness was reflected by modified Rankin Scale scores. The health resource utilization and direct medical costs were extracted to analyze the cost-efficiency. RESULTS Among the 78 eligible patients, 48 (61.5%) were males with a median age of 40 years. More than half (56, 71.8%) were treated with combination therapy, with the rest receiving IVMP and IVIG monotherapy (both of 11, 14.1%). Related objective variables, i.e., sex, onset age, disease course, onset symptoms, antibody types, abnormal paraclinical results, disease severity, and the health insurance, showed insignificant differences on the selection of therapy. Each therapy showed similar short-term (4-week) and long-term (1-year) therapeutic effects. Yet the single or combination of IVIG had a slightly better effectiveness but higher cost than the monotherapy of IVMP. CONCLUSION The combination of IVMP and IVIG was used more frequently than either alone, which may be associated with neurologist's personal experience and patient's wishes. Though with similar therapeutic effectiveness, the use of IVMP alone might be a better choice with a better cost-efficiency.
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Xiang Q, Cao Y, Song Z, Chen H, Hu Z, Zhou S, Zhang Y, Cui H, Luo J, Qiang Y, Wang Y, Shuai S, Yang Y, Yang M, Wei X, Xiong A. Cyclophosphamide for Treatment of Refractory Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-analysis. Clin Ther 2022; 44:1058-1070. [PMID: 35872028 DOI: 10.1016/j.clinthera.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/16/2022] [Accepted: 06/26/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE This study evaluates the tolerability and efficacy of cyclophosphamide (CYC) for the treatment of refractory chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS We searched PubMed, Embase, Cochrane Library, and 2 Chinese databases (Chinese National Knowledge Infrastructure and SinoMed) for studies published between database inception and September 30, 2021. Articles obtained using the appropriate keywords were independently selected by 2 reviewers on the basis of the established inclusion and exclusion criteria. FINDINGS In total, 240 records that were eventually curtailed to 13 studies with 83 patients were retrieved and subsequently included in this evaluation. All 13 studies were included in the systematic review, 7 of which were included in the meta-analysis. The pooled estimate of the response rate was 68% (95% CI, 45%-90%). The pooled estimate of the adverse reaction rate was 8% (95% CI, 0%-15%). The disease duration before the first CYC treatment was negatively correlated with the reduction in the modified Rankin Scale score (r = -0.76, P < 0.001). However, the response rates did not differ significantly between patients of different sexes (P = 0.716) or between patients who received and those who did not receive concurrent glucocorticoids (P = 0.617). IMPLICATIONS CYC might be a recommended therapeutic option for patients with refractory CIDP, especially those who are unable to accept rituximab treatment. Earlier CYC treatment yields better therapeutic outcomes in patients with refractory CIDP without CYC-related contraindications.
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Affiliation(s)
- Qilang Xiang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yuzi Cao
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhuoyao Song
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Huini Chen
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Ziyi Hu
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Shifeng Zhou
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yan Zhang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Hongxu Cui
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Jie Luo
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yiying Qiang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Ye Wang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Shiquan Shuai
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China; Inflammation and Immunology Key Laboratory of Nanchong City, Sichuan, China
| | - Yuan Yang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Min Yang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Ophthalmology, West China Hospital, Sichuan University; Chengdu, China
| | - Anji Xiong
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China; Inflammation and Immunology Key Laboratory of Nanchong City, Sichuan, China.
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Lewandowska M, Englert-Golon M, Krasiński Z, Jagodziński PP, Sajdak S. A Rare Case of HELLP Syndrome with Hematomas of Spleen and Liver, Eclampsia, Severe Hypertension and Prolonged Coagulopathy-A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137681. [PMID: 35805359 PMCID: PMC9265485 DOI: 10.3390/ijerph19137681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 02/05/2023]
Abstract
The HELLP syndrome (hemolysis, liver damage and thrombocytopenia) is a rare (0.5−0.9%) but serious complication of pregnancy or puerperium associated with a higher risk of maternal and fetal mortality and morbidity. Liver and spleen hematomas rarely entangle (<2%) HELLP cases, but rupture of the hematomas presents an immediate threat to life. We present the history of a 35-year old pregnant woman (at the 31st week) admitted to our hospital due to the risk of premature delivery. On the first day, the patient did not report any complains, and the only abnormality was thrombocytopenia 106 G/L. However, within several hours, tests showed platelet levels of 40.0 G/L, LDH 2862.0 U/L and AST 2051.6 U/L, and the woman was diagnosed with severe HELLP syndrome, complicated by hematomas of the liver and spleen, seizures (eclampsia), severe arterial hypertension and coagulation disorders. The purpose of this article is to highlight the need for early investigation of the causes of thrombocytopenia and the differentiation of HELLP from other thrombotic microangiopathies (TMAs).
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Affiliation(s)
- Małgorzata Lewandowska
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 60-781 Poznan, Poland;
- Division of Gynecological Surgery, University Hospital, 33 Polna Str., 60-535 Poznan, Poland
- Correspondence:
| | - Monika Englert-Golon
- Department of Gynaecology Obstetrics and Gynaecological Oncology, Division of Gynecological Surgery, Poznan University of Medical Sciences, 60-535 Poznan, Poland; (M.E.-G.); (S.S.)
| | - Zbigniew Krasiński
- Department of Vascular, Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, 61-848 Poznan, Poland;
| | - Paweł Piotr Jagodziński
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 60-781 Poznan, Poland;
| | - Stefan Sajdak
- Department of Gynaecology Obstetrics and Gynaecological Oncology, Division of Gynecological Surgery, Poznan University of Medical Sciences, 60-535 Poznan, Poland; (M.E.-G.); (S.S.)
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Youk HJ, Ryu HY, Seo SW, Kim JS, Chung Y, Kim H, Hwang SH, Oh HB, Min WK, Ko DH. A New Trial to Measure ABO Antibodies Using Complement-Dependent Cytotoxicity. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060830. [PMID: 35744093 PMCID: PMC9231086 DOI: 10.3390/medicina58060830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
Abstract
Background and objectives: The ABO antibody (Ab) titration tests are used in monitoring in ABO-incompatible (ABOi) solid organ transplantation (SOT). However, currently developed ABO Ab tests show Ab binding reactions. This study attempted to measure ABO Ab level using complement-dependent cytotoxicity (CDC). Materials and methods: We studied 93 blood group O serum samples from patients who underwent ABOi SOT from January 2019 to May 2021. Patients’ sera were incubated with A1 or B cells and added to a human complement solution. Supernatants were collected after centrifugation, and free hemoglobin (Hb) was measured by spectrophotometry. We converted plasma Hb value to hemolysis (%), which were compared with ABO Ab titer. Results: We found a mild correlation between hemolysis and ABO Ab titers. In simple regression analysis, the correlation coefficients were within 0.3660−0.4968 (p < 0.0001) before transplantation. In multiple linear regression analysis, anti-A hemolysis (%) was higher in immunoglobulin M (IgM) (β = 12.9) than in immunoglobulin G (IgG) (β = −3.4) (R2 = 0.5216). Anti-B hemolysis was higher in IgM (β = 8.7) than in IgG (β = 0.0) (R2 = 0.5114). There was a large variation in hemolysis within the same Ab titer. Conclusions: CDC can be used in a new trial for ABO Ab measurement. Furthermore, IgM rather than IgG seems to play a significant role in vivo activity, consistent with previous knowledge. Thus, this study may help in the development of the ABO Ab titration supplement test for post-transplant treatment policy establishment and pre-transplant desensitization.
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Affiliation(s)
- Hee-Jeong Youk
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.-J.Y.); (H.-y.R.); (S.W.S.); (J.S.K.); (S.-H.H.); (H.-B.O.); (W.-K.M.)
| | - Ho-yoon Ryu
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.-J.Y.); (H.-y.R.); (S.W.S.); (J.S.K.); (S.-H.H.); (H.-B.O.); (W.-K.M.)
| | - Suk Won Seo
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.-J.Y.); (H.-y.R.); (S.W.S.); (J.S.K.); (S.-H.H.); (H.-B.O.); (W.-K.M.)
| | - Jin Seok Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.-J.Y.); (H.-y.R.); (S.W.S.); (J.S.K.); (S.-H.H.); (H.-B.O.); (W.-K.M.)
| | - Yousun Chung
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Seoul 05355, Korea;
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul 03080, Korea;
| | - Sang-Hyun Hwang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.-J.Y.); (H.-y.R.); (S.W.S.); (J.S.K.); (S.-H.H.); (H.-B.O.); (W.-K.M.)
| | - Heung-Bum Oh
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.-J.Y.); (H.-y.R.); (S.W.S.); (J.S.K.); (S.-H.H.); (H.-B.O.); (W.-K.M.)
| | - Won-Ki Min
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.-J.Y.); (H.-y.R.); (S.W.S.); (J.S.K.); (S.-H.H.); (H.-B.O.); (W.-K.M.)
| | - Dae-Hyun Ko
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.-J.Y.); (H.-y.R.); (S.W.S.); (J.S.K.); (S.-H.H.); (H.-B.O.); (W.-K.M.)
- Correspondence:
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Baldwin I, Todd S. Therapeutic plasma exchange in the intensive care unit and with the critically ill, a focus on clinical nursing considerations. J Clin Apher 2022; 37:397-404. [PMID: 35385601 PMCID: PMC9539889 DOI: 10.1002/jca.21984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/31/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
Abstract
Therapeutic plasma exchange (TPE) is a blood purification technique removing antibodies and plasma proteins to modulate disease and promote recovery. The procedure has different methods, using a membrane or plasma separator with many elements similar to continuous renal replacement therapy (CCRT) in the Intensive Care Unit (ICU). These nursing knowledge and skill sets apply where ICU nurses are providing TPE with increasing need. However, different care models are also in place where TPE is the responsibility of apheresis and nephrology teams visiting the ICU. The plasma replacement volume and prescribing is aligned with published guidelines but is variable when critical illness overlays the primary indication for TPE. There are some important considerations for TPE with respect to anticoagulation, machine settings, prescribing, and associated nursing management. TPE can be performed concurrent with CRRT in acute situations using Y‐piece and valve connectors and is a new and recent advanced blood purification for the ICU.
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Affiliation(s)
- Ian Baldwin
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria
| | - Sarah Todd
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria
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30
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Cegolon L, Einollahi B, Panahi Y, Imanizadeh S, Rezapour M, Javanbakht M, Nikpouraghdam M, Abolghasemi H, Mastrangelo G. On Therapeutic Plasma Exchange Against Severe COVID-19-Associated Pneumonia: An Observational Clinical Study. Front Nutr 2022; 9:809823. [PMID: 35308291 PMCID: PMC8926159 DOI: 10.3389/fnut.2022.809823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/10/2022] [Indexed: 12/17/2022] Open
Abstract
BackgroundThere is a risk of novel mutations of SARS-CoV-2 that may render COVID-19 resistant to most of the therapies, including antiviral drugs and vaccines. The evidence around the application of therapeutic plasma exchange (TPE) for the management of critically ill patients with COVID-19 is still provisional, and further investigations are needed to confirm its eventual beneficial effects.AimsTo assess the effect of TPE on the risk of mortality in patients with COVID-19-associated pneumonia, using three statistical procedures to rule out any threats to validity.MethodsWe therefore carried out a single-centered retrospective observational non-placebo-controlled trial enrolling 73 inpatients from Baqiyatallah Hospital in Tehran (Iran) with the diagnosis of COVID-19-associated pneumonia confirmed by real-time polymerase chain reaction (RT-qPCR) on nasopharyngeal swabs and high-resolution computerized tomography chest scan. These patients were broken down into two groups: Group 1 (30 patients) receiving standard care (corticosteroids, ceftriaxone, azithromycin, pantoprazole, hydroxychloroquine, lopinavir/ritonavir), and Group 2 (43 patients) receiving the above regimen plus TPE (replacing 2 l of patients' plasma by a solution, 50% of normal plasma, and 50% of albumin at 5%) administered according to various time schedules. The follow-up time was 30 days and all-cause mortality was the endpoint.ResultsDeaths were 6 (14%) in Group 2 and 14 (47%) in Group 1. However, different harmful risk factors prevailed among patients not receiving TPE rather than being equally split between the intervention and control group. We used an algorithm of structural equation modeling (of STATA) to summarize a large pool of potential confounders into a single score (called with the descriptive name “severity”). Disease severity was lower (Wilkinson rank-sum test p < 0.001) among patients with COVID-19 undergoing TPE (median: −2.82; range: −5.18; 7.96) as compared to those not receiving TPE (median: −1.35; range: −3.89; 8.84), confirming that treatment assignment involved a selection bias of patients according to the severity of COVID-19 at hospital admission. The adjustment for confounding was carried out using severity as the covariate in Cox regression models. The univariate hazard ratio (HR) of 0.68 (95%CI: 0.26; 1.80; p = 0.441) for TPE turned to 1.19 (95%CI: 0.43; 3.29; p = 0.741) after adjusting for severity.ConclusionsIn this study sample, the lower mortality observed among patients receiving TPE was due to a lower severity of COVID-19 rather than the TPE effects.
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Affiliation(s)
- Luca Cegolon
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Public Health Department, University Health Agency Giuliano-Isontina (ASUGI), Trieste, Italy
- *Correspondence: Luca Cegolon ;
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Behzad Einollahi
| | - Yunes Panahi
- Pharmacotherapy Department, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sina Imanizadeh
- Student Research Committee (SRC), Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Rezapour
- Student Research Committee (SRC), Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Nikpouraghdam
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hassan Abolghasemi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Giuseppe Mastrangelo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University, Padua, Italy
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Josephson CD, Goldstein S, Askenazi D, Cohn CS, Spinella PC, Metjian A, Fasano RM, Music‐Aplenc L. Safety and tolerability of solvent/detergent‐treated plasma for pediatric patients requiring therapeutic plasma exchange: An open‐label, multicenter, postmarketing study. Transfusion 2021; 62:396-405. [PMID: 34931321 PMCID: PMC9299645 DOI: 10.1111/trf.16775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/19/2021] [Accepted: 12/08/2021] [Indexed: 12/11/2022]
Abstract
Background This study investigated the real‐world safety and tolerability of solvent/detergent‐treated (S/D) plasma for pediatric patients requiring therapeutic plasma exchange (TPE). Study design and methods LAS‐213 was a multicenter, open‐label, interventional, phase 4 study. Patients (≥2 to ≤20 years) receiving TPE therapy were eligible. A total plasma volume of 40–60 ml/kg was recommended, with an infusion rate not exceeding 0.020–0.025 citrate/kg body weight/min (<1 ml/kg body weight/min). The primary endpoint was assessment of safety, monitoring the following: serious adverse events (SAEs), adverse drug reactions (ADRs), thrombotic events (TEs), thromboembolic events (TEEs), and specific laboratory tests. Results In total, 41 children (2 to <12 years [n = 15]; 12 to <17 years [n = 13]; ≥17 years [n = 13]) underwent 102 TPEs with a total of 135,137 ml of S/D plasma exchanged. Each patient group received between 1 and 6 TPEs (mean: 2.5 TPEs). Actual dose administered per TPE was 4–72 ml/kg (mean: 28.6 ml/kg), with a mean total volume of 1324.9 ml (range: 113–4000 ml). Overall safety was excellent for 96/102 (94.0%) TPEs. Six TPEs had a “moderate” safety profile for four patients experiencing eight ADRs. Of these, seven were mild in intensity and one (pyrexia) was moderate, all resolving by study end. Mild citrate toxicity (n = 2) was the most common ADR. One SAE was reported but was unrelated to the study drug. No TEs, TEEs, or changes in laboratory safety parameters were reported. Conclusion S/D plasma was well tolerated and demonstrated favorable safety, supporting the use of S/D plasma for TPE in pediatrics.
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Affiliation(s)
- Cassandra D. Josephson
- Departments of Pathology and Laboratory Medicine and Pediatrics Center for Transfusion and Cellular Therapies and Aflac Cancer and Blood Disorders Center, Emory University School of Medicine Atlanta Georgia USA
| | | | - David Askenazi
- Children's of Alabama, University of Alabama at Birmingham Birmingham Alabama USA
| | | | | | - Ara Metjian
- University of Colorado, Anschutz Medical Campus Aurora Colorado USA
| | - Ross M. Fasano
- Departments of Pathology and Laboratory Medicine and Pediatrics Center for Transfusion and Cellular Therapies and Aflac Cancer and Blood Disorders Center, Emory University School of Medicine Atlanta Georgia USA
| | - Lejla Music‐Aplenc
- University of Missouri‐Kansas City School of Medicine Kansas City Missouri USA
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Cui Y, Hu C, Cheng Y, Han X, Wang W. Plasmapheresis: a feasible choice for bullous pemphigoid patients infected with SARS-CoV-2. Int J Dermatol 2021; 61:252-256. [PMID: 34520570 PMCID: PMC8653043 DOI: 10.1111/ijd.15892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 12/15/2022]
Abstract
Bullous pemphigoid (BP) patients were vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection because they have similar risk factors, so we should pay attention to patients with BP during the epidemic of coronavirus disease-19 (COVID-19). As far as treatment is concerned, many strategies for BP were changed during the epidemic. Plasmapheresis not only has been included in the guidelines for BP but also has been used successfully to rescue COVID-19 patients, especially in severe cases. Therefore, it is a feasible choice for BP patients, especially for refractory BP patients, infected with SARS-CoV-2. Apart from these, we have reviewed some points for attention during the plasmapheresis session.
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Affiliation(s)
- Yu Cui
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Caixia Hu
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Yi Cheng
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Xiaomei Han
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Wenqing Wang
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
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Lemarquis A, Campbell T, Aranda-Guillén M, Hennings V, Brodin P, Kämpe O, Blennow K, Zetterberg H, Wennerås C, Eriksson K, Landegren N, Bryceson Y, Berg S, Ekwall O. Severe COVID-19 in an APS1 patient with interferon autoantibodies treated with plasmapheresis. J Allergy Clin Immunol 2021; 148:96-98. [PMID: 33892926 PMCID: PMC8051851 DOI: 10.1016/j.jaci.2021.03.034] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Andri Lemarquis
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Tessa Campbell
- Centre for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maribel Aranda-Guillén
- Centre for Molecular Medicine, Department of Medicine (Solna), Karolinska Institute, Stockholm, Sweden
| | - Viktoria Hennings
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Petter Brodin
- Science for Life Laboratory, Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Olle Kämpe
- Centre for Molecular Medicine, Department of Medicine (Solna), Karolinska Institute, Stockholm, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, United Kingdom; UK Dementia Research Institute at UCL, London, United Kingdom
| | - Christine Wennerås
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Eriksson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nils Landegren
- Centre for Molecular Medicine, Department of Medicine (Solna), Karolinska Institute, Stockholm, Sweden; Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Yenan Bryceson
- Centre for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden; Broegelmann Research Laboratory, Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Stefan Berg
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olov Ekwall
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Chung CH, Tsai IJ, Tseng MH, Chou HH, Tain YL, Tsai JD, Chiou YY, Chiou YH, Lin CY. Clinical characteristics, triggering etiologies, and response of plasmapheresis in thrombotic microangiopathy in Taiwan. Medicine (Baltimore) 2021; 100:e25986. [PMID: 34011089 PMCID: PMC8137071 DOI: 10.1097/md.0000000000025986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023] Open
Abstract
Thrombotic microangiopathy (TMA) syndromes are extraordinarily diverse in clinical presentations and etiologies. However, there are still a limited number of large cohort studies focusing on the underlying causes, outcomes, and response to plasmapheresis.A retrospective study was designed to understand trigger etiologies, organ dysfunctions, clinical outcomes, and efficacy of plasmapheresis in patients with TMA. The whole population of Taiwan was set up into 2 cohorts: 875 patients with TMA in the 2006 cohort (2006-2010) and 1352 patients with TMA in the 2011 cohort (2011-2015). One hundred ninety-five patients in the 2006 cohort and 272 patients in the 2011 cohort were under plasmapheresis treatment.The common underlying etiologies were pregnancy, followed by systemic lupus erythematosus, rheumatoid arthritis, transplantation and drugs, which were significantly higher than the control group. Stroke, seizure, arterial thrombosis, vascular stenosis, hypertension, myocardial infarction, and pancreatitis were the main clinical signs and extra-renal involvements. In the multivariate regression analysis, stroke, arterial thrombosis, peripheral arterial disease, and uremia were significantly higher compared with the control group. The mortality rate in TMA under plasmapheresis was significantly higher than all TMA cases (39.33% vs 15.39% in the 2006 cohort and 39.27% vs 15.06% in the 2011 cohort).This study indicated the spectrum of underlying causes, extra-renal characteristics, and the response to plasmapheresis of patients with TMA in Taiwan. Of note, the poor clinical outcomes of plasmapheresis in patients with TMA might highlight the masked underlying etiology or worse disease condition that should be noticed.
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Affiliation(s)
- Ching-Hu Chung
- Department of Medicine, Mackay Medical College, New Taipei City
| | - I-Jung Tsai
- Division of Nephrology, Department of Pediatrics, National Taiwan University Children Hospital, Taipei
| | - Min-Hua Tseng
- Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pediatrics, Xiamen Chang Gung Hospital, Ximen, China
| | - Hsin-Hsu Chou
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi
- Department of Bioinformatics and Medical Engineering, College of Information and Electrical Engineering, Asia University, Taichung
| | - You-Lin Tain
- Division of Pediatric Nephrology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung
| | - Jeng-Daw Tsai
- Division of Nephrology, Department of Pediatrics, MacKay Children's Hospital, Taipei
| | - Yuan-Yow Chiou
- Departments of Pediatrics, Institute of Clinical Medicine, National Cheng Kung University Medical College and Hospital, Tainan 704
| | - Yee-Hsuan Chiou
- Department of Pediatrics, Kaohsiung Veterans General Hospital
- Department of Medical Technology, Fooyin University, Kaohsiung 831
| | - Ching-Yuang Lin
- Clinical Immunological Center, Children's Hospital, China Medical University, Taichung, Taiwan
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Shang P, Feng J, Wu W, Zhang HL. Intensive Care and Treatment of Severe Guillain-Barré Syndrome. Front Pharmacol 2021; 12:608130. [PMID: 33995011 PMCID: PMC8113987 DOI: 10.3389/fphar.2021.608130] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute polyneuropathy mostly characterized by acute flaccid paralysis with or without sensory/autonomous nerve dysfunction. Current immuno therapies including intravenous immunoglobulin (IVIg), plasma exchange (PE), and newly developed biological drugs benefit patients by alleviating hyperreactive immune responses. Up to 30% of patients develop respiratory failure during hospitalization and require mechanical ventilation and intensive care. Immunotherapies, mechanical ventilation, supportive care, and complication management during the intensive care unit (ICU) stay are equally emphasized. The most important aspect of intensive care and treatment of severe GBS, that is, mechanical ventilation, has been extensively reviewed elsewhere. In contrast to immunotherapies, care and treatment of GBS in the ICU setting are largely empirical. In this review, we intend to stress the importance of intensive care and treatment, other than mechanical ventilation in patients with severe GBS. We summarize the up-to-date knowledge of pharmacological therapies and ICU management of patients with severe GBS. We aim to answer some key clinical questions related to the management of severe GBS patients including but not limited to: Is IVIg better than PE or vice versa? Whether combinations of immune therapies benefit more? How about the emerging therapies promising for GBS? When to perform tracheal intubation or tracheostomy? How to provide multidisciplinary supportive care for severe cases? How to avert life-threatening complications in severe cases?
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University, Changchun, China
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Wei Wu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
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Tabibi S, Tabibi T, Conic RRZ, Banisaeed N, Streiff MB. Therapeutic Plasma Exchange: A potential Management Strategy for Critically Ill COVID-19 Patients. J Intensive Care Med 2020; 35:827-835. [PMID: 32666875 PMCID: PMC7391476 DOI: 10.1177/0885066620940259] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/27/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023]
Abstract
In the 5 months since initial reports of COVID-19 came to light, the death toll due to SARS-CoV-2 has rapidly increased. The morbidity and mortality of the infection varies based upon patient age, comorbid conditions, viral load, and the availability of effective treatments. Findings from limited autopsies, clinical observations, and laboratory data suggest that high cytokine levels and a procoagulant state can precipitate acute respiratory distress syndrome and multi-organ dysfunction syndrome in critically ill patients. To complicate matters, comorbidities may affect the response to medical treatments currently in use, all of which are still in trial phase. Therapeutic plasma exchange (TPE) merits consideration in the treatment of critically ill COVID-19 patients and is an avenue for clinical trials to pursue. If efficacious, faster recovery of patients may lead to shorter intensive care unit stays and less time on mechanical ventilation. Herein, we briefly discuss some of the various approaches currently being investigated for the treatment of SARS-CoV-2 with a focus on potential benefits of TPE for selected critically ill patients.
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Affiliation(s)
- Seena Tabibi
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tara Tabibi
- St. Louis University School of Medicine, St. Louis, MO, USA
| | | | - Nassim Banisaeed
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Michael B. Streiff
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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37
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Therapeutic Plasma Exchange as a Treatment for Autoimmune Neurological Disease. Autoimmune Dis 2020; 2020:3484659. [PMID: 32802495 PMCID: PMC7415086 DOI: 10.1155/2020/3484659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Therapeutic plasma exchange (TPE) is commonly used as treatment of certain autoimmune neurological diseases (ANDs), and its main objective is the removal of pathogenic autoantibodies. Our aim was to describe the clinical profile and the experience with the usage of TPE in patients with ANDs at our institution. Methods This is an observational retrospective study, including medical records of patients with diagnosis of ANDs who received TPE, between 2011 and 2018. Characteristics of TPE, such as number of cycles, type of replacement solution, and adverse effects, were evaluated. The modified Rankin Scale (mRS) was applied to measure the clinical response after the therapy. Results 187 patients were included with the following diagnoses: myasthenia gravis (MG), n = 70 (37%); Guillain–Barré syndrome (GBS), n = 53 (28.3%), neuromyelitis optica spectrum disorders (NMOSD), n = 35 (18.7%); chronic inflammatory demyelinating polyneuropathy (CIDP), n = 23 (12.2%); and autoimmune encephalitis (AE), n = 6 (3.2%). The most used types of replacement solution were albumin (n = 131, 70%) and succinylated gelatin (n = 45, 24%). All patients received a median of five cycles (IQR 5-5). Hypotension and hydroelectrolytic disorders were the main complications. After TPE, 99 patients (52.9%) showed improvement in the mRS scores and a statistical significance (p < 0.05) was seen between the admission score and after TPE for every diagnosis except for CIDP. Conclusion TPE has an adequate safety profile, and improvement in functionality in treated patients reflects its effectiveness.
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Wang L, Zheng C, Zhao D. Successful management of germanium poisoning-induced multiple organ dysfunctions by combined blood purification therapy. Curr Med Res Opin 2020; 36:687-691. [PMID: 31951756 DOI: 10.1080/03007995.2020.1717452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Blood purification therapy has not been applied in the detoxification of germanium compounds. This report described a case of germanium poisoning with renal failure, liver dysfunction, and acute pancreatitis which was successfully treated by continuous venovenous hemodiafiltration (CVVHDF) combined with plasmapheresis.Case report: A 58-year-old male was admitted to a local hospital due to polydipsia, polyuria, and weight loss for 2 months. The patient was definitely diagnosed with germanium poisoning and was treated with blood purification therapy, CVVHDF combined with plasmapheresis. The blood and urinary germanium concentrations decreased rapidly during the first week after the combined blood purification therapy. The blood germanium concentration gradually reduced to within the normal range within the next three weeks and fluctuated at a normal level. However, the urinary germanium concentration exceeded the normal level after three months, indicating an accumulation of germanium in the organs and tissues. The patient's clinical symptoms ameliorated and the functions of kidney, liver and pancreatitis gradually recovered.Conclusion: Combined CVVHDF with plasmapheresis is an effective treatment for germanium poisoning and the associated multiple organ dysfunctions.
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Affiliation(s)
- Luyun Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Changlong Zheng
- Department of Emergency, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Daqiang Zhao
- Department of Organ Transplantation, Renmin Hospital, Wuhan University, Wuhan, China
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, USA
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