摘要:

AbstractThe number of total T‐cells and the number of helper/inducer T‐cells decreased in 27 of 31 patients with immunologic disorders treated with plasmapheresis and drug immunosuppression. The number of suppressor/cytotoxic T‐cells increased in the majority of patients. The helper/inducer to suppressor/cytotoxic cell ratio, which was initially elevated in 26 of 31 patients, decreased significantly in all but 2 patients after therapy. Ten patients were already on drug immunosuppression at the time plasmapheresis was started, and all 10 showed increased helper/inducer to suppressor/cytotoxic cell ratio despite their drug therapy. The helper/inducer to suppressor/cytotoxic cell ratio decreased in all ten patients after plasma exchange. The number and the percentage of total T‐cells and helper/inducer cells decreased from prepheresis levels while the number and the percentage of suppressor/cytotoxic cells increased. Plasmapheresis, in combination with drug immunosuppression, was effective in decreasing the elevated helper/inducer to suppressor/cytotoxic cell ratio in disorders of the immune system. In contrast, patients on immunosuppressive drug therapy alone had persistently high immunoregulator

ISSN:0733-2459    

DOI:10.1002/jca.2920010202

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractPartial red cell exchange transfusion is used to manage several complications of sickle cell anemia. Reports have stressed the safety, case, and speed of red cell exchange procedures performed with blood cell separators, but little information exists concerning operating conditions for the most efficient removal of hemoglobin S (HbS) containing cells. We performed 13 red blood cell exchange transfusions with the IBM 2997 continuous flow blood cell separator on two previously transfused adult homozygous (SS) sickle cell patients. We used both a single stage and a dual stage disposable pathway and varied rotor speed, collection port, and collection interface independently. The patients' baseline percentage HbS ranged from 28 to 64% (mean = 46%); post exchange values ranged from 19.1 to 46% (mean = 32%). Thirty‐three of 34 specimens collected from the white cell or platelet port showed a higher percentage of HbS in the collection line compared to simultaneous patient samples. Mean enrichment was 9.4% (range = −4.0 to 35.5%). There was an inverse relationship between the hemoglobin concentration and the percentage of HbS in the collected specimens (p = 0.001; N = 45). Differential separation of sickle cells should decrease the volume of blood required for partial red cell exchange of selected SS patie

ISSN:0733-2459    

DOI:10.1002/jca.2920010203

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractThrombotic thrombocytopenic purpura (TTP), a syndrome of diverse etiology probably related to factors regulating platelet‐vessel wall interaction, is predominantly a disorder of women. We report our experience with 14 patients in an 11‐year period. Thirteen were female and aged between 25–69 years. Four were postmenopausal, and of the nine premenopausal women three were pregnant, one was immediately postpartum, and three were taking estrogennine premenopausal women three were pregnant, one was immediately postpartum, and three were taking estrogen‐containing oral contraceptives. A review of the literature confirms the two to one female/male preponderance and that TTP is reported in 56 women who are pregnant or recently postpartum. While this association with possible hormonal events has been noted, it has previously received little comment. We stress the similarity between TTP and some occurrences of preeclamptic toxemia, and that this may suggest not only a common etiology but that therapeutic attempts should be similar.While no single therapeutic modality is universally successful, our experience is that plasma exchange is the most effective, with five of seven patients so‐treated obtaining prolonged remission; four of five patients responded to splenectomy and corticosteroids, but one died of infection postoperatively. Five patients, including two treated exclusively with antiplatelet aggregating agents, died without achieving remission. The frequency of successful therapy is not changed by the concurrent pregnancy, but the fetal loss is high. There does seem to be an increased risk of recurrence of TTP in a subsequent pregnancy, and this might be considered when counseling premenopausal patients who have achieved remissi

ISSN:0733-2459    

DOI:10.1002/jca.2920010204

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractA new parallel plate membrane plasma exchange system (Centry TPE System) has been developed and clinically evaluated. A series of 27 consecutive plasma exchanges were performed on 14 patients with autoimmune diseases. Blood access was obtained by routine means identical to centrifugal procedures. The blood flow rate was 94±20 ml/min and plasma filtration rate was 37±9 ml/min, with an average patient hematocrit of 36%. The sieving coefficients for a wide range of plasma solutes including immunoglobulins, immune complexes, and lipids, clustered about 1.00, indicating nonselective plasma filtration. The average reduction in patient plasma solutes of 60 to 70% was in close agreement with the predicted value for unhindered plasma filtration. There was no appreciable loss of blood cells, as compared to a study with a centrifugal system showing a 56% reduction in circulating platelets. Complement activation measured by C3 conversion was undetectable in patient samples and either undetectable or minimal in plasma filtrate samples. The system was convenient to operate and problems were rare. No untoward patient effects attributable to the membrane system were observed. These results show that the parallel plate membrane plasma exchange system described in this report is capable of delivering safe, efficient plasma exchang

ISSN:0733-2459    

DOI:10.1002/jca.2920010205

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractImmunotherapy, consisting of lymphocyte depletion or plasmapheresis in combination with cyclophosphamide and prednisone, was employed in three patients with refractory pure red cell aplasia and six patients with aplastic anemia of various etiologies. All three patients with pure red cell aplasia responded to plasmapheresis. One patient with atypical aplastic anemia showed partial recovery following lymphocyte depletion; the other five patients showed no evidence of a clinical response. The effect of patients' sera or bone marrow on formation of myeloid or erythroid colonies by bone marrow from normal individuals was determined in vitro. A decline in serum inhibition of erythroid colony formation was observed in the patients with pure red cell aplasia following treatment. Any changes in serum inhibition were less marked or unrelated to treatment outcome in the patients with aplastic anemia, although the single patient who responded to lymphocyte depletion exhibited reversal of coculture bone marrow inhibition. Our experience suggests that in vitro assay methods may not adequately predict the response of patients with aplastic anemia to this form of immunotherapy, and furthermore clinical improvement was too sporadic for this treatment to be recommended. Plasmapheresis may be a useful adjunct in patients with pure red cell aplasia, but remissions may not be dramatic or sustained.

ISSN:0733-2459    

DOI:10.1002/jca.2920010206

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractThe infusion of high‐dose (275 mg/kg body weight) immune globulin intravenous (IGIV) after 466 plasma exchanges in 64 patients with autoimmune disease was studied. Side effects occurred during 15% of IGIV infusions. For the most part they were transient and mild, and could be controlled by slowing the infusion rate. Two percent of infusions had to be terminated because of more persistent or severe side effects. Chills were the most common side effect, followed by nausea, flushing, anxiety, and nausea. Serum IgG levels were immediately restored into the normal range by IGIV infusions, and they were much more effective in restoring IgG levels after plasma exchange than intramuscular injection of 9.9 g of immune serum globulin (ISG). Up to 15 weekly high‐dose IGIV infusions were well tolerated without unusual side effects. These patients did not have any major bacterial infections, but were not protected from developing Herpes zoster at the dosages used. In patients with myasthenia gravis, a short term impact of a single IGIV infusion on titers of antibody to acetylcholine receptor could not be demonstrated. This study showed IGIV to be a safe and effective preparation for the replacement of normal IgG removed during plasma excha

ISSN:0733-2459    

DOI:10.1002/jca.2920010207

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractBy premedicating the donor with 60 mg prednisone in divided doses and processing more donor blood at higher flow rates than those specified by the manufacturer, one can obtain high yields of granulocytes and platelets (mean of 3.3 × 1010and 5.9 × 1011, respectively) with the Fenwal CS‐3000 blood cell separator. The steroid effect predominates over that of processing more blood. In the case of donors who are not stimulated by steroid, processing 10 L of donor blood at flow rates of 60 to 70 ml/minute results in a significantly improved yield of granulocytes (mean of 2.2 × 1010as opposed to 1.4 in the case of 7 L) and of platelets (6.1 × 1011versus 4.7). The concentrates contain about 50 to 60% less lymphocytes when donors are given steroid. With these modifications, the leukapheresis can still be accomplished in less than three hours and with minimal adverse effects on the d

ISSN:0733-2459    

DOI:10.1002/jca.2920010208

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractWe wished to determine whether subtotal replacement of protein in plasma removed at plasma exchange would be adequate to prevent hypovolemia and hypoproteinemia. Seven well nourished outpatients with chronic progressive multiple sclerosis underwent 60 plasma exchanges in which two liters of plasma were replaced with 750 ml saline followed by 1250 ml of a 5% albumin solution (62.5% albumin replacement). Total serum protein, protein electrophoresis, and immunoglobulin levels were measured before and after each exchange. Clinically, the exchanges were well tolerated. Total serum protein dropped by a mean of only 18% during the study and mean preexchange serum albumin levels were unchanged, even though immunoglobulins decreased by 57–72%. We conclude that in well nourished patients, partial albumin replacement of this magnitude is an adequate substitute for plasma removed in a plasma exchang

ISSN:0733-2459    

DOI:10.1002/jca.2920010209

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920010201

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY