摘要:

AbstractThe effect of a rapid reduction of plasma lipoproteins on the alpha‐ and gamma‐tocopherol levels in plasma, erythrocytes, and platelets was studied. Sixteen successive plasma exchange procedures performed weekly in an adult with heterozygous familial hypercholesterolemia were evaluated. Plasma exchange was done by intermittent flow centrifugation, exchanging one plasma volume against a 4% human albumin solution. Plasma exchange reduced in plasma alpha‐tocopherol from 41.5 ± 8.9 to 23.6 ± 4.8 μmol/L and gamma‐tocopherol from 4.9 ± 4.1 to 2.4 ± 2.1 μmol/L, without changing their ratios to total lipids. It diminished alpha‐tocopherol in platelets from 12.97 ± 4.37 to 10.03 ± 1.78 μmol/1015cells and gamma‐tocopherol from 1.43 ± 0.55 to 1.06 ± 0.41 μmol/1013cells, but did not affect erythrocyte tocopherols. The total amount removed per procedure was 47.57 ± 13.65 μmol for alpha‐tocopherol and 4.70 ± 3.59 μmol for gamma‐tocopherol. Plasma exchange increased the number of erythrocytes from 3.67 ± 0.10.1012to 4.05 ± 0.13.1012cells/L, without affecting their volume. Platelet count did not change, but mean platelet volume decreased from 7.7 ± 0.5 to 6.9 ± 0.5 fl and platelet distribution width from 15.1 ± 0.4 to 14.9 ± 0.5. Thus, plasma exchange reduces plasma alpha‐ and gamma‐tocopherol to the same extent as total lipids, and decreases these tocopherols in circulating platelets, along with a reduction in platelet size and, compared to the change in erythrocyte count, a fall of platelet number. The total amount of both tocopherols removed per procedure equals the recommended dietary allowances of 5–11 days for men and 7–14 days for women, assuming an effective absorption of 20–40%. This suggests the need for vitamin E supplementa

ISSN:0733-2459    

DOI:10.1002/jca.2920050402

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe treatment of various complications of sickle cell disease has included red cell exchange in the past, and the development of automated pheresis equipment has greatly simplified such exchanges. Traditionally, the patient's red cells have been exchanged while their plasma was returned to them. Recently, plasma factors have been thought to play a role in the pathogenesis of vasoocclusive events. Therefore, we performed whole blood exchange, which consisted of replacement of the patient's plasma with albumin and saline in addition to the usual replacement of erythrocytes. A total of 32 whole blood exchanges were performed on 12 patients with a variety of complications of their disease. The procedure was done using standard pheresis equipment and was relatively simple to perform. There were no serious complications and the clinical outcome was good with 10 out of 12 patients experiencing improvement.

ISSN:0733-2459    

DOI:10.1002/jca.2920050403

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractTwenty‐two silicone rubber apheresis catheters were placed into the subclavian veins of 18 cancer patients to allow serial leukapheresis for collection of circulating hematopoietic stem cells. The tips of the catheters were placed in the innominate vein to avoid reinfusion of citrate into the right atrium and the resulting tendency to cardiac arrhythmias.Sixteen catheters were placed without prophylactic anticoagulation. Anticoagulation was prematurely discontinued in one patient because of the inconvenience of the portable heparin infusion pump. Six of these 17 catheters developed venographically proven thrombotic complications and five others had presumed thrombosis‐related access failure or caused symptoms of venous obstruction, but confirmation of the presence of a thrombus with venography was not obtained. Three catheters spontaneously withdrew from the vein, one during urokinase infusion for thrombosis. Only three catheters had uncomplicated apheresis courses.Prophylactic heparin infusions via portable infusion pumps were given after placement of six catheters. As long as the heparin infusions were continued all patients had uncomplicated apheresis courses. One patient's heparin was prematurely discontinued. Within 3 days of its discontinuance, radiographically proven thrombotic catheter occlusion occurred. Patients given heparin were less likely to develop complications (Plt; 0.001).No unexpected complications of apheresis were encountered as a result of the use of these catheters.Silicone rubber subclavian catheters can be used for peripheral stem cell collection but have a high frequency of thrombotic complications. Systemic anticoagulation with heparin can minimize the likelihood of these complicati

ISSN:0733-2459    

DOI:10.1002/jca.2920050404

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractWe studied the effects of intensive plasma exchange on endocrine ophthalmopathy in 12 patients with Graves' disease and one with Hashimoto's thyroiditis. All patients were euthyroid at the time of plasma exchange. All but five had concomitant treatment with azathioprine. Each patient had a treatment period consisting of six plasma exchanges performed in 2–3 weeks; two patients were treated in two periods. Each time a mean of 2.4 liters plasma was exchanged.There was a prompt reduction in the concentration of circulating immune complexes and/or thyrotropin receptor antibodies following plasma exchange. Six of the 13 patients improved their proptosis; their median duration of eye symptoms before treatment was less than 8 months. In patients suffering from eye symptoms for more than 1 year improvement was rare. Overall the Hertel values were 24.1 ± 4.4 (SD) before and 22.8 ± 3.4 after plasma exchange for the left eyes (P= 0.07) and 23.8 ± 4.0 before and 23.0 ± 3.8 after for the right eyes (P= 0.09). Nine patients altogether improved their ophthalmopathy index and periorbital oedema.In patients with disabling endocrine ophthalmopathy plasma exchange may sometimes be of value to induce a relief of the ophthalmopathy; when it is used it should be instituted before fibrotic changes occur. We suggest that concomitant immunosuppressive drugs should be given to prevent rebound phenomenon induced by plasma exchange. To establish the role of plasma exchange in the treatment of endocrine ophthalmopathy controlled studies should be perf

ISSN:0733-2459    

DOI:10.1002/jca.2920050405

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractHeparin has been used as an anticoagulant during hemodialysis and plasmapheresis. Recently, immunoadsorption with membrane plasmapheresis (IAP) has been used for treatment of myasthenia gravis and multiple sclerosis. Ten patients were examined. Plasma heparin levels were studied before IAP, 30 minutes, 60 minutes, 90 minutes, and 120 minutes after the start of IAP, and at the end of IAP. Prothrombin time, activated partial thromboplastin time (APTT), bleeding time, plasma fibrinogen levels, fibrin degradation products, and complete blood count were measured pre‐ and post‐IAP. In general, plasma heparin levels lower than 1 IU/ml during plasmapheresis are adequate. The dosage of 40 IU/kg/hr of heparin administered during IAP resulted in plasma heparin levels lower than 1 IU/ml. APTT pre‐IAP (36.8 ± 3.4 sec) were nearly one‐half values of APTT post‐IAP (6.2 ± 9.70 sec).In conclusion, 40 IU per kg of the body weight per hour is an acceptable dose of heparin

ISSN:0733-2459    

DOI:10.1002/jca.2920050406

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractMany apheresis units lack the resources to acquire customized computer software for record keeping. We have adapted a commercially available “spreadsheet” program (Lotus 1‐2‐3) to aid in quality control activities for plateletpheresis. Data are entered in a grid pattern wherein each donation occupies one row and successive columns contain numerical data derived from the donation. The last two columns contain formulas that calculate yield and collection efficiency from values entered in preceding columns. The program runs on an IBM PC or equivalent with 512 K RAM; the combined cost of a computer and software is currently under $2,000.00. Data entry requires fewer keystrokes per record than computation of yield and efficiency with a calculator, and creates an inclusive permanent record for future analysis. Data sorting and statistical functions allow rapid identification of incomplete records, and derivation of average platelet yield and/or collection efficiency for any time period of interest. The program also facilitates determining the proportion of donations that fall below any chosen cutoff. Performance characteristics of a particular instrument or operator can be assessed easily by isolating the pertinent records and analyzing them separately. The system will thus accomplish a variety of quality control activities, including those mandated by licensing agencies. It can be implemented by apheresis personnel with limited “computer literacy” and is superior to manual tabulation of quality control data in both ease of data entry and facility

ISSN:0733-2459    

DOI:10.1002/jca.2920050407

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractPlasmapheresis is being used with considerable frequency in the management of malignant and non‐malignant disorders. More recently, staphylococcal Protein A immunoadsorption has been employed in similar clinical situations. In patients with malignancy, plasmapheresis has been shown to produce alterations in plasma proteins, decrease circulating immune complexes, remove “specific” and “non‐specific” blocking factors, change immune reactivity, and affect monocyte function. Partial responses have been reported in a small number of patients with carcinoma of lung, colon, and breast following plasmapheresis. In addition, there are reports of favorable responses in patients with melanoma, head and neck tumors, lymphomas, leukemias, and Kaposi's sarcoma in acquired immune deficiency. All these responses were partial and brief, and the treatment did not alter the course of the disease. Plasmapheresis has been useful in the management of hyperviscosity and occasionally of paraneoplastic syndromes. It may also have a role in the treatment of thrombotic thrombocytopenic purpura associated with mitomycin‐C therapy. Protein A immunoadsorption, by which circulating immune complexes are selectively removed, can activate the complement system, increase blastogenic responses, and increase the natural killer cell activity. It has been shown to produce partial responses in breast and colon cancer, as well as Kaposi's sarcoma in acquired immune deficiency. It may have a useful role to play in the management of mitomycin‐C‐associated thrombotic thrombocytopenic purpura. Both plasmapheresis and Protein A immunoadsorption should be considered investigational interventions at this time. Toxicity of plasmapheresis, though uncommon, can be serious and may rarely be fatal. Toxicity of Protein A immunoadsorption is mild, consisting mainly of influenza‐lik

ISSN:0733-2459    

DOI:10.1002/jca.2920050408

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920050409

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920050410

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920050401

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY