ISSN:0733-2459    

DOI:10.1002/jca.2920070202

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractA large animal model is needed to evaluate new apheresis technologies. These technologies include novel methods of harvesting the blood mononuclear cell population which contains the hematopoietic stem cells needed to restore hematopoiesis in recipients of hematopoietically lethal therapy and the use of cytokines to provide a safe and predictable method of manipulating these circulating hematopoietic stem cells. We describe the methods used to collect mononuclear cells by leukapheresis from Yucatan miniature swine. These animals are of sufficient size to tolerate the procedures and have many physiologic and hematologic similarities to man. They are of good temperament and are easily trained. Long‐term venous access was obtained using single lumen silicone rubber catheters placed in the inferior vena cava. The animals were apheresed while fully awake using a Haemonetics Model V50 machine and a modified lymphocyte collection protocol. The procedure was highly efficient for the collection of mononuclear cells and a 10 pass procedure yielded a product which contained 19.7 × 109mononuclear cells, 10.7 × 109granulocytes, and 17 ml of erythrocytes in a volume of approximately 100 ml. This product can be cryopreserved and used for subsequent transplantation. The content of four apheresis procedures provides hematopoietic reconstitution of lethally irradiated swine on a time scale equivalent to transplantation of optimal numbers of bone marrow cells. © 1992 Wiley‐Lis

ISSN:0733-2459    

DOI:10.1002/jca.2920070203

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe large number of unsolved problems in plasma exchange therapy makes an apheresis registry appear useful. The results of such an open prospective observational study from 1987 to 1989 in East Germany are presented in this paper. With 1,945 procedures in a total of 419 patients (on average 4.1 treatments per patient) about 80% of all treatments in the country were registered. Exchange volume averaged 2.7 (± 0.78) 1 or 43 (± 13.9) ml/kg body weight. Substitutes were albumin (51% of the cases), FFP (22%), and both (22%), Nephrological (25%) and neurological (23%) diagnoses prevailed among the treated diseases. Haematologic diseases (12%) were underrepresented and hepatic coma (20%) was overrepresented. Minor side effects occurred in 22% of all treatments and severe complications in 38 treatments (2%). Four fatalities probably resulted from plasmapheresis therapy. The registry permits an assessment of the treatment results and of several trends during the period of observation. © 1992 Wiley‐Liss,

ISSN:0733-2459    

DOI:10.1002/jca.2920070204

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractA retrospective study was carried out on 2,500 therapeutic hemapheresis procedures performed at a community teaching hospital from 1980 to 1990. Seventy‐six percent of the procedures consisted of plasmapheresis (PE). The most frequently treated conditions were myasthenia gravis (MG), Guillain‐Barré syndrome (GB), hyperviscosity (HV), and thrombotic thrombocytopenia purpura (TTP). Therapeutic results and clinical implications for these four conditions are discussed. © 1992 Wiley‐Li

ISSN:0733-2459    

DOI:10.1002/jca.2920070205

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe recent introduction of low‐density lipoprotein (LDL)/very low‐density lipoprotein (VLDL) selective‐removal systems offers an alternative to plasma exchange (PE). For the last 10 years, we have treated a inale homozygous hypercholesterolemia type IIA patient with PE using 5% normal serum albumin (NSA) replacement. PE using 6% hydroxyethyl starch (HES) replacement, single dextran sulfate cellulose bead affinity column (DSAC) (Kaneka LA‐40), and double DSAC. This report compares the performance of these systems in cholesterol reduction (total, LDL + VLDL), and high‐density lipoprotein [HDL] and their effect on the total protein, albumin, and hematocrit levels. The number of procedures and average volume of plasma treated using PE‐NSA, PE‐HES, I‐DSAC, and 2‐DSAC were 113, 64, 15, 90 and 3,939, 3,270, 3,519. and 3,588 ml, respectively. The average pretreatment total cholesterol levels were baseline 864 mg/dL, PE‐NSA 606 mg/dL, PE‐HES 610 mg/dL, I‐DSAC 467 mg/dL, and 2‐DSAC 395 mg/dL with plasma reductions of 59%, S7%, 47%, and SS%, respectively. Average LDL + VLDL plasma reductions were PE‐NSA 58%, PE‐HES 59% (N = I), I‐DSAC 4670, and 2‐DSAC 56%. Average HDL plasma reductions were PE‐NSA 58%, PE‐HES 69% (N = I ), I‐DSAC 58, and 2‐DSAC 17%. The average total cholesterol and LDL + VLDL reductions were comparable for both types of PE and the 2‐DSAC system. The average HDL loss was 53% lower for the DSAC systems than for PE systems. Of the four systems compared in this study, the 2‐DSAC system offers equivalent efficiency in LDL + VLDL reductions as PE while retaining more of the beneficial HDL than PE without the use of

ISSN:0733-2459    

DOI:10.1002/jca.2920070206

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractExtracorporeal immune adsorption with staphylococcal protein A (SPA) columns can remove immune complexes and immunoglobulins in the treatment of a variety of diseases. We present the case of an elderly man with neuropathy associated with monoclonal gammopathy, treated by 3 on‐line SPA procedures. At the completion of these treatments his neuropathy relapsed, progressing to near‐total paralysis. Return to a baseline clinical status required several months. The reason for this severe relapse is not clear. Possible explanations include SPA activation of T‐lymphocytes, with release of gamma interferon and increased antigen recognition, or removal of an anti‐idiotype control mechanism. We advise caution in the application of immunoadsorption to conditions in which it has not yet been evaluated. © 1992 Wiley

ISSN:0733-2459    

DOI:10.1002/jca.2920070207

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractDonor exposure can be strikingly reduced for patients with classical hemophilia A and von Willebrand's disease when large volumes of potent cryoprecipitated AHF are prepared from donors following DDAVP (1‐deamino‐8‐D‐arginine vasopressin) stimulation and automated plasmapheresis—a procedure called “plasma exchange donation.” Although this procedure has been reported to be relatively safe for donors, data are limited. Accordingly, we studied 20 donors during 48 procedures using DDAVP (0.3 μg/kg IV) followed by 2–3 L plasma collection. Replacement fluid for each initial plasma exchange donation was plasma protein fraction; autologous cryoprecipitate‐poor plasma was used for subsequent procedures. Mild reactions, particularly facial flushing, were noted in all 48 procedures. No procedure was discontinued, but four were modified due to either an increased pulse rate (≤20/min from baseline) or a fall in systolic or diastolic blood pressure (≤20 mm Hg from baseline). No donor was deferred or withdrew from the program. Based on our modest experience, DDAVP stimulated plasma exchange donation appears to be a safe and effective method for collecting large quantities of plasma from which potent cryoprecipitated AHF can be prepared.

ISSN:0733-2459    

DOI:10.1002/jca.2920070208

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe removal of anti‐acetylcholine receptor antibody (anti‐AChR Ab) by the plasma fractionator, Kuraray EVAL 2A, was measured as a function of the filtration temperature (4 and 37°C). Plasmas procured from eight myasthenia gravis (MG) patients undergoing routine plasma exchanges (PE: membrane plasma filtration: n = 4, and centrifugation: n = 4) were used in the studies. Plasma flow rate was 20 ml/min, and plasma perfusion in single pass was terminated when the transmembrane pressure of the filter reached 300 mm Hg. Solute concentration data from before and after perfusion were used to assess the sieving coefficient (SC) of each solute. Results show that the SCs for anti‐AChR Ab and albumin were significantly (P<.0002) lower at 4°C (0.15 and 0.52, respectively) as compared to 37°C (0.44 and 0.72, respectively). The SC of anti‐AChR Ab (0.15) was significantly lower than the SC of IgG (0.42;P<.006) at 4°C, even though it also belongs to the IgG class. The ratio of the SC of anti‐AChR Ab to albumin at 4°C (0.29) was significantly lower than that at 37°C (0.57;P<.003). These data indicate that the selectivity of removal of anti‐AChR Ab from albumin is higher at 4°C than that at 37°C. The volume treated at 4°C was significantly lower than that treated at 37°C, and it was less than that required for a clinical treatment; however, it was shown that filter backwashing is possible without loss of solute removal selectivity. Membrane filtration at 4°C for the removal of anti‐AChR Abs in MG patients could provide an alternative to PE and reduce the demand on plasma replacement products

ISSN:0733-2459    

DOI:10.1002/jca.2920070209

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractDuring membrane plasma fractionation therapy there are reported incidences of membrane plugging requiring the corrective actions of either filter replacement or backwashing (BW) in order to continue the treatment. In this preliminary study, a simple BW procedure to allow for on‐line reuse of the filter (Asahi AP06M) during the treatment was evaluated to assess its efficacy and safety in cryofiltration (CF).Evaluations were carried out on two patients treated for rheumatoid arthritis. Seven tests, each using 1 L or 2 L warmed saline as a BW solution were performed to evaluate the decrease of the transmembrane pressure (TMP) between just before and after backwashing and TMP change during cryofiltration procedures between before and after backwashing. Sieving coefficients of total protein, albumin, immunoglobulins (G, M, A), fibrinogen, and rheumatoid factor were also calculated at 1,000 ml plasma volume processed.Results showed statistically significant decreases of TMP from 300 mm Hg to 70 mm Hg between just before and after both backwashing procedures, and that there were no significant changes in the TMP increase during the cryofiltration procedure between pre‐ and post‐BW. The protein sievings were not significantly affected by BW. The use of a second liter for rinsing did not reduce the inlet pressure further suggesting that 1 L BW was adequate. The accumulated solutes did not affect significantly the effective mean pore size. The BW procedure did not affect the overall patient safety during therapy.In conclusion, this simple BW procedure using 1 L of normal saline and accomplished in approximately 11 minutes by a manual procedure proved reliable to rinse the filter and to prolong its clinical use. This procedure obviated the need for filter replac

ISSN:0733-2459    

DOI:10.1002/jca.2920070210

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractMalaria has become a very uncommon disease in Italy. Recently a variety of circumstances, such as travel to tropical countries as well as immigration from Asia and Africa, have combined to increase the number of malaria cases recorded annually. In this report we describe the use of red cell exchange transfusion and plasma exchange in the treatment of a patient with hyperparasitemic malaria (51% erythrocytes or more parasitized). When first observed the patient was in shock and had signs of cerebral malaria, disseminated intravascular coagulation, and acute respiratory distress syndrome, which in the following 2 days were complicated by acute renal failure. After mefloquine therapy combined with 3 red blood cell exchanges, 2 plasma exchanges, and 10 dialysis sessions over 14 days, the patient recovered completely. This case of severe malaria with multiple complications, treated with mefloquine in conjunction with both exchange transfusion and plasmapheresis, had a successful outcome and lends further support to the possible beneficial role of exchange transfusion in complicated malaria. © 1992 Wiley‐Liss, I

ISSN:0733-2459    

DOI:10.1002/jca.2920070211

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY