摘要:

AbstractTo examine the hypothesis that addition of therapeutic plasma exchange (TPEX) to an immunosuppressive drug regimen increases that regimen's efficacy to halt the progression of chronic progressive multiple sclerosis (CPMS). METHODS: The literature was searched for prospective controlled clinical trials evaluating the efficacy of TPEX in CPMS. Six studies were eligible for meta‐analysis. Their results were combined, using Cochran's and Peto's methods. Three outcome measures were studied: 1) the change in Kurtzke's disability status scale (DSS) scores, 2) the relative odds of neurologic decline by 1 or more DSS grades, and 3) the relative odds of neurologic improvement by 1 or more DSS grades, in the treatment versus the comparison group of patients. Reported results of neurologic evaluations at 6, 12, 24, and 36 months of follow‐up were analyzed separately. RESULTS: TPEX significantly (Plt; .05) reduced the proportion of patients who experienced neurologic decline (by 1 or more DSS grades) at 12 months of follow‐up (relative odds of decline = 0.441, 95% confidence interval = 0.210–0.929). CONCLUSIONS: There is a need for further clinical research into the possibility of a beneficial effect of TPEX in patients with CPMS likely to experience neurologic decline over the ensuring 12 months. Targeting treatment to a particular subgroup of CPMS patients may be necessary for TPEX to prove ef

ISSN:0733-2459    

DOI:10.1002/jca.2920100402

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractEight pediatric patients with fulminant meningococcemia, purpura, and disseminated intravascular coagulation who by multiple prognostic scoring systems were anticipated to have a poor outcome underwent intensive plasma exchange (IPE) or whole blood exchange (WBE) in addition to standard medical therapy. IPE/WBE was initiated shortly after admission with a mixture of both fresh frozen plasma and cryoprecipitate as the replacement solution. All IPE procedures were performed using a continuous flow system and a red cell prime. The mean fibrinogen level increased from 62 to 192 mg/dl, the prothrombin time (PT) decreased from a mean of 32.4 seconds to 15.1 seconds, and the mean activated partial thromboplastin time (APTT) decreased from 89.5 seconds to 40.1 seconds following completion of the initial IPE/WBE. There was a corresponding improvement in all coagulation factor levels but only slight improvement in antithrombin III (ATIII) and protein C levels. Seven of eight patients survived (87.5%) their initial presentation with the sole early death attributed to meningitis with cerebral edema. Mean fluid balance after the procedure was + 10.8 ± 5.87 cc/kg. There were no significant bleeding or cardiovascular complications during the procedure. There was no clinical or radiographic evidence of fluid overload after the procedure.This experience demonstrates that IPE/WBE may be conducted safely in critically ill, unstable pediatric patients and is effective in rapidly improving coagulopathy without fluid overload

ISSN:0733-2459    

DOI:10.1002/jca.2920100403

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThrombotic thrombocytopenic purpura (TTP) is a potentially lethal disease that may respond favorably to plasma infusion or therapeutic plasma exchange (TPE) with frozen plasma (FP) as the exchange fluid. Frozen plasma from which the cryo‐precipitated fraction has been removed (cryopoor plasma, CP) has reportedly been useful in refractory cases in which a response to FP is not being observed. We report a retrospective analysis of all cases of TTP treated by TPE with either FP (1985–1989) or CP (1989–1993) as exchange fluid at a large tertiary care hospital between the years 1985 and 1993. A severity score index was compiled for each patient using the platelet count, mental status, hematocrit, and renal function at the time of diagnosis. Nineteen patients were treated with FP (group I) and 18 patients with CP (group 2). Groups did not differ in age, gender, race, hematologic parameters, or severity scores. Patients treated with CP, however, had more plasma exchanges (14 ± 10 vs. 12 ± 8, respectively) and more fluid exchanged than these treated with FP (50 L ± 36 vs. 37 L ± 40, respectively). Survival was 72% in the CP group and 47% in the FP group.Although a survival advantage for the use of CP as exchange fluid in the treatment of TTP is suggested by our observations, the retrospective nature of the study, lack of randomization, and sequential rather than concurrent use of FP and CP indicates caution in interpretation. The data do indicate, however, that use of CP is acceptable as the initial exchange flu

ISSN:0733-2459    

DOI:10.1002/jca.2920100404

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractA “snapshot” survey of physician coverage for evaluation and supervision of therapeutic apheresis procedures shows significant variation in current clinical practice between 39 blood center‐ and 41 non‐blood center‐based programs. Whereas 56% of blood center‐based programs usually require physician's “in person” evaluation of the patient, 86% of non‐blood center programs do (P<.005). Similarly, non‐blood center‐based programs were more likely to have physicians on the premises to supervise first and subsequent procedures and to bill separately for medical coverage. These differences were unrelated to location of the procedure (in hospital, blood bank, outpatient department, or other), the size of the program, or any information provided

ISSN:0733-2459    

DOI:10.1002/jca.2920100405

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractFifteen patients with prolonged neutropenia (a median of 23 days with granulocyte [PMN] ≤ 500/μl) and established fungal infections that had not responded to adequate antifungal therapy were transfused with PMN concentrates collected from 35 cytokine‐primed granulocyte colony‐stimulating factor (GCSF) donors. Patients received a median of six transfusions. Leukocytosis and granulocytosis were observed within 24 hours of the first GCSF injection, which yielded concentrates averaging 55 × 109white blood cells and 41 × 109PMN. Data analysis suggested that response might be related to the duration of neutropenia and known infection, as patients given PMN tx earlier in the infectious course tended to have a better response. No significant toxicity was observed i

ISSN:0733-2459    

DOI:10.1002/jca.2920100406

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractOur practice is to defer donors with blood platelet (PLT) counts of<180 × 109/L because PLT yields are low, when compared to PLT units collected from donors with higher counts. In an attempt to minimize deferral, we determined whether 33 donors, who repeatedly demonstrated low‐normal PLT counts (150–180 × 109/L) on multiple occasions during the prestudy period, might safely donate satisfactory apheresis PLT units simply by extending the apheresis collection time by 20 min (men) and 40 min (women). Repeat plateletpheresis procedures were scheduled at ≥28‐day intervals. The mean PLT yield (N = 92) was 5.8 × 1011with 97% of units containing ≥4.0 × 109PLTs. Although donors entered the study only after they had repeatedly exhibited predonation PLT counts of<180 × 109/L, PLT counts were not always below this level at the time of study collections. However, analyzing only donations with true predonation PLT counts of<180 × 109/L (N = 35), the mean PLT yield was excellent—5.4 × 1011with 97% of units containing ≥4.0 × 1011PLTs. The average fall in donor blood PLT counts (pre‐ vs. postdonation) was 36%, with only ten of 99 postdonation counts being<100 × 109/L; the lowest was 69 × 109/L. Thus, extending the apheresis collection time permitted donors who in the past were routinely deferred because of low PLT counts to safely dona

ISSN:0733-2459    

DOI:10.1002/jca.2920100407

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe efficacy of 6% hydroxyethyl starch (hetastarch, HS) in enhancing granulocyte harvest by centrifugal leukapheresis has been described by a simple equation which predicts the granulocyte collection efficiency (GCE) based on an intrinsic donor variable, the erythrocyte sedimentation rate (ESR): GCE (%) = 1.3 ESR (mm/hr) + 45. Ten percent low molecular weight hydroxyethyl starch (pentastarch, PS) has been reported to be as effective as HS with potentially fewer adverse donor reactions (ADR). The derivation of an analogous equation for PS under conditions previously reported for HS may quantify PS efficacy and allow comparison to HS. We prospectively measured the in vitro and the in vivo effects of PS on the donor ESR in 53 granulocyte collections from 44 donors using the model CS‐3000 Plus blood cell separator (CS). We then correlated the findings with the GCE of each procedure and derived an equation which expresses GCE in terms of baseline donor ESR. The in vitro addition of PS increased the donor ESR 2.4‐fold, but its administration to a donor during a collection procedure did not appreciably change the ESR. Higher baseline donor ESR was more likely to result in more efficient cell collections: GCE (%) = 0.8 ESR (mm/hr) + 20; (r = 0.37). For granulocyte harvests using the CS and PS as the sedimenting agent 1) baseline donor ESR affects granulocyte harvests, but the poor correlation does not allow an accurate prediction of GCE and cell yield from the baseline donor ESR; 2) in comparison with HS (results from a previous study), PS may be less effective in vitro and not effective in vivo in elevating ESR, and may be less effective in enhancing granulocyte harvest; and 3) the parameters (slope, y‐intercept, correlation coefficient) which define the linear relationship between baseline donor ESR and GCE may serve collectively as a quantitative measure of the effectiveness of different hydroxyethyl starch agents in enhancing granulocyte harvests. These parameters may be helpful in rapidly assessing the clinical efficacy of new, potentially useful hydroxyethyl starch agents prior to initiating a randomized, controlled clinical

ISSN:0733-2459    

DOI:10.1002/jca.2920100408

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractConsistent and accurate delivery of anticoagulant (AC) with the Fenwal CS3000 Plus has been difficult to maintain. We have modified and evaluated methods to deliver AC more accurately and consistently at a 11:1 ratio on the Fenwal CS 3000 Plus. Two modifications (shortened AC tubing, shortened AC tubing with modified drip chamber) and two unmodified methods (unmodified right‐hand string, unmodified double string) were compared (n = 20 platelet apheresis procedures each), resulting in average AC ratios of 11.4 ± 0.5, 11.2 ± 0.4, 11.6 ± 1.3, and 12.1 ± 0.7:1, respectively. There was a significantly higher incidence of ratios within ±10% of 11:1 using the modified methods, 90% and 100%, versus the unmodified methods, 50% and 55%, respectively. Comparison of 36 plateletapheresis (each) using 15‐, 30‐, and 90‐minute intervals in AC drip rate monitoring revealed no significant difference. However, the 30‐minute interval had a better ratio, 11,4 ± 1.0 versus 11.6 ± 0.8 or 11.7 ± 1.1, and higher frequency of 11 ± 10%:1 at 81% versus 75% and 72% and was more practical to use than 15‐minute interval; the 90‐minute interval did require adjustments in 8% of the procedures. The use of a spring scale versus AC bag graduations (n = 75 plateletapheresis) to measure AC volume was significantly superior in measuring volume (343 ± 64 versus 373 ± 72 ml), ratio (11.2 ± 1.5 versus 10.2 ± 1.6), and ratios 11 ± 10%:1 (71% versus 52%). For more accurate and consistent AC delivery with the Fenwal CS 3000 Plus, we recommend three courses of action: 1) Shorten the AC line and modify the AC drip chamber, 2) use a 30‐minute interval to monitor AC drip rate and adjust only if off by more than 3 drops/15 sec, 3) use a spring scale rather than AC bag graduations to obtain more accurate

ISSN:0733-2459    

DOI:10.1002/jca.2920100409

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractEvidence for accelerated specific antibody (Ab) rebound or overshoot after single or multiple therapeutic plasmapheresis (TP) is fragmentary but suggested by both clinical and experimental evidence. In vitro studies showing increased peripheral blood lymphocyte turnover and total immunoglobulin production after a series of TP without immunosup‐pression may signify a generalized immunostimulation through removal of regulatory molecules by TP. It is known that IgG class Ab can down regulate B cells by cross linkage of their Ag and Fc receptors. Cyclophosphamide and other cytotoxic immunosuppressive agents effectively delete proliferating lymphocytes. TP could particularly foster deletion of lymphocytes actively mediating autoimmunity, since they would be more readily stimulated to proliferation by removal of Ab or other inhibitory factors than the generally resting normal immune system. This is supported by a relatively greater reduction of autoantibody levels than total immunoglobulin after treatment with TP and cytotoxic immunosuppressive

ISSN:0733-2459    

DOI:10.1002/jca.2920100410

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920100411

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY