摘要:

AbstractMononuclear cell separation and collection by continuous‐flow centrifugation relates to centrifugal acceleration, total blood processed, peripheral blood concentration, and probable mobilization from extravascular sites during the procedure. At low‐G forces, 70–80% of mononuclear cells are cleared. As G forces are increased, 95–100% of mononuclear cells can be cleared, but excessive platelet depletion occurs. An average of three billion cells were harvested from 2–3 liters of blood, rising to nine billion when 6 liters were processed. The total blood processed is defined by citrate infusion rates and ionized calcium changes. Large quantities of mononuclear cells were collected from normal donors without any significant depletion. If the objective of harvesting mononuclear cells is depletion, intensive schedules may

ISSN:0733-2459    

DOI:10.1002/jca.2920010402

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractWe have inserted Shiley Vas‐Caths® into the subclavian veins of 20 patients. These indwelling catheters are used for apheresis and some were maintained up to 3 months. Of the 430 apheresis procedures performed, 30 (6.9%) had good peripheral vein access while 400 (93.1%) required subclavian vein catheterization. No complications, including infection and blood clotting, have been recorded. The only contamination noted was normal skin flora cultured on the outside of the exposed portion of the cannula. We attribute our success to limited catheter manipulation, frequent dressing changes, and adhering to strict, sterile procedur

ISSN:0733-2459    

DOI:10.1002/jca.2920010403

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractSix female patients with stage I and II vascular scleroderma and Raynaud's phenomenon were treated with plasma exchange and placebo plasma exchange. Placebo exchange consisted of the return of the patient's own separated plasma. No consistent long‐term objective improvement was demonstrated in patients treated with either plasma exchange or placebo plasma exchange. Immediate increases in pulse volume, digital blood pressure, and skin temperature occurred in some patients with both procedures. Mechanisms of change remain unexplained, and further study is warrante

ISSN:0733-2459    

DOI:10.1002/jca.2920010404

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractStandard apheresis techniques require modification of use in children, particularly those with serious concurrent medical problems, as they are prone to apheresis‐induced disturbances of volume, metabolism, and coagulation. We report 112 plasma exchanges (TPE) on 11 children, 9 of whom weighed less than 20 kg and 7 of whom were critically ill. All were treated on continuous flow apparatus; seven on centrifugal systems (CS), two on a membrane filtration system (MFS), and two on both. Perturbations of blood and red blood cell (RBC) volume were prevented by priming the extracorporeal circuits with a red cell saline mixture having an hematocrit equal to or greater than the patient's hematocrit. Priming volume and minimal flow rates were 170 ml and 40 cc/min (MFS) and 350 ml and 10 cc/min (CS). TPE dose varied from 1.3 to 3 plasma volumes. Immunoglobulins fell by the following amounts: IgG 43.7%, IgA 36.7%, and IgM 41% per plasma volume. Platelets fell by 20–90% (CS) and 5–7% (MFS). Vascular access was obtained by various means including Thomas shunts, dialysis catheters, and standard 16–19 gauge butterflies and angiocaths. Bleeding in patients with coagulopathies was prevented by using repeated small boluses of heparin to maintain a clotting time of 2.5–3 minutes. Morbidity from TPE was limited to citrate toxicity (2 patients) and transient pulmonary edema (1 patient).Treatment outcome was successful in 8 out of 11 patients. We have shown that if PEX is otherwise indicated, it should not be withheld solely for patient size or the complexity of concurrent medical

ISSN:0733-2459    

DOI:10.1002/jca.2920010405

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractA new flat‐plate membrane plasma separation system specifically designed for therapeutic plasma exchange (TPE) was clinically evaluated in both research and routine clinical settings. The study included a comparison to a currently available centrifugal cell separation system employed for TPE. A total of 267 membrane procedures were performed on 39 patients over a 14‐month period.Both qualitative and quantitative studies showed that membrane plasma exchange procedures were equivalent to centrifugal procedures in the removal of plasma constitutents from patients. A notable difference between the two types of procedure was the effect on the peripheral blood platelet count: the plasma filtrate from the membrane system was essentially cell‐free and platelet counts fell only 11% during the procedure, compared to a 53% decrease during the centrifugation runs.Patient responses to both types of procedure were similar and the frequency of side‐effects was low. A sampling of patient opinion revealed a preference for the membrane system for a variety of reasons. Procedure times were shorter with the membrane system because of higher achievable blood flow rates, and thus higher plasma exchange rates, while the overall nursing time requirement was lower.The results show that this flat‐plate membrane TPE system enables rapid and effective plasma exchange therapy, and offered a number of monitoring and control functions that provided a safer, more efficient therapeutic procedure in the majority of patient treatments performed in t

ISSN:0733-2459    

DOI:10.1002/jca.2920010406

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractPlasma exchange therapy in autoimmune hemolytic anemia (AIHA) was used in four patients (two with warm hemolytic anemia and two with cold hemolytic anemia). The size of each plasma exchange approximated 1 plasma volume; three consecutive daily exchanges removed 80–90% of the immunoglobulins—immunoglobulin G (IgG) and immunoglobulin M (IgM)—. complement (C3, C4), and reduced antibody titers. Transfusion requirements dramatically decreased after plasma exchange in each case. In two patients, red blood cell (RBC) survival studies were performed to more accurately assess the effect of plasma exchange therapy, since steroid and/or immunosuppressive therapy was given concomitantly. In one case of cold AIHA, homologous51Cr‐RBC were injected 4 days prior to plasma exchange and repeat injection (same donor) following completion of plasma exchange. The survival curve prior to plasma exchange therapy had a T 1/2 = 7.8 days (r = −0.988) and after plasma exchange therapy had a T 1/2 = 20.4 days (r = −0.925). RBC survival studies using homologous51Cr‐RBC were also performed in a patient with warm AIHA. The survival curve before plasma exchange had a T 1/2 = 2 days (r = −0.95), and postplasma exchange a T 1/2 = 1.8 days (r = −0.91). Plasma exchange therapy seems to have a beneficial effect in cold rather than warm autoimmune

ISSN:0733-2459    

DOI:10.1002/jca.2920010407

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractThe role of therapeutic reductive lymphapheresis in 59 patients with chronic lymphocytic leukemia (CLL) was reviewed. Reduction in lymphocytosis, lymphadenopathy and hepatosplenomegaly was noted in 50%–60% of the patients studied. In addition to mobilization of the lymphoid tumor load, 40% of the patients showed an improvement in their hemogram. Although apheresis‐induced anemia can occur, reported complications were minimal. These studies suggest that a majority of CLL patients might benefit from therapeutic lymphaphere

ISSN:0733-2459    

DOI:10.1002/jca.2920010408

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920010401

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY