摘要:

AbstractSelected tests of lymphoid function were used to screen a population of volunteer hemapheresis donors. Testing included: 1) absolute lymphocyte numbers, and percentage of T‐cell, B‐cell, and mononuclear phagocytes, 2) serum immunoglobulins, and, 3) in vitro proliferative responses to lectin mitogens (phytohemagglutinin, concana‐valin A, and pokeweed mitogen), soluble antigens (staphylococcal filtrate, Candida, and streptococcal varidasc), and cell‐bound alloantigens (mixed lymphocyte culture). A control population of first‐time plateletpheresis donors was examined similarly. Regular donors manifested a small but statistically significant decrease in absolute lymphocyte counts (p<0.02), and IgM (p<0.02) compared to controls. Leukapheresis donors also manifested significant decreases in percentage of T cells (p<0.02). These findings are qualitatively similar to changes reported following intensive lymphocytapheresis and indicate the need for conservative policies regarding donation frequency in hemapheresis

ISSN:0733-2459    

DOI:10.1002/jca.2920020302

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractPrimary biliary cirrhosis (PBC) is a chronic nonsuppurative, destructive cholangitis, whose etiology is unknown. Morbidity arises early from pruritus and later from hypercholesterolemia with xanthoma formation. Therapy is supportive and directed at the complications of cholestasis. Plasmapheresis has been reported to benefit patients with hyperlipidemia and PBC; thus a pilot study of plasmapheresis utilizing the Haemonetics Model 30 with replacement by albumin and saline was conducted. Five patients (four female and one male) with a mean age of 43 (range 29–58) and a mean duration of illness of 9.5 years (range 6–21) with marked jaundice, xanthomas, xanthelasma, hepatomegaly, fatigability, anorexia, and pruritus, as well as mild nausea were studied. Peripheral neuropathy was present in two patients. Two patients had splenomegaly. Two patients had an associated Sjogren syndrome. All patients had high serum bilirubin, alkaline phosphatase, and cholesterol levels and mild elevations in aspartate amino transferase and alanine amino transferase activities. Immune complexes measured in four patients were present. Antimitochondrial antibody titers were significant in all patients. Patients underwent a mean of 63 plasmapheresis procedures over a mean of 112 weeks removing a mean of 94.7 liters of plasma. No serious toxicity was seen.All patients showed a reduction in pruritus, xanthomas, xanthelasmas, and serum cholesterol values. The two patients who had evidence of Sjogren syndrome noted subjective improvement. All patients who had fatigue, anorexia and nausea also noted moderate improvement. There was no change in hepatomegaly or splenomegaly in patients demonstrating such organomegaly. Liver function did not change significantly. Overall, four patients had improvement in their condition and one patient achieved stability. We strongly recommend the use of chronic plasmapheresis for patients with PBC who have failed more “conventional” r

ISSN:0733-2459    

DOI:10.1002/jca.2920020303

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThis study chronicles leukocyte‐ and erythrocyte‐depleted platelet concentrate collection by a dual. stage channel in which three variables: 1) donor peripheral blood platelet concentration, 2) total blood processed, and 3) collection volume were statistically correlated with platelet yield as determined by a multiple regression analysis of single variables. Platelet concentration in the final yield was related to donor precount and collection rate, and could be varied as indicated for individual applications. Total blood processed was established by procedure time, which in turn was defined by citrate‐induced calcium changes in the donor. Reduction in peripheral blood platelet concentration averaged 24% for a mean platelet yield of 3.8 × 10′. An average of 40% of transfused platelet concentrates were recovered in recipient peripheral blood 1 hr posttransfusion and were hemostatically effective, as determined by correction of bleeding time. Platelet yields and patient response were sustained during current collection procedures, verifying the principles described during the investigativ

ISSN:0733-2459    

DOI:10.1002/jca.2920020304

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractBone marrow transplantation results in the infusion of 150 to 360 ml of erythrocytes. While this poses no problem to a recipient of marrow from an ABO‐compatible donor, it clearly represents a serious risk of intravascular hemolysis for the recipient of an ABO‐incompatible marrow. Thus, there is a need for removing incompatible erythrocytes from the marrow preparation. We removed erythrocytes from the marrow preparations by automated centrifugation. The erythrocyte‐depleted marrow (EDM) contained a mean of 5 ml erythrocytes, representing an average reduction of 98%. The mean mononuclear cell recovery was 88%, resulting in a mean infusion of 0.6 × 108cells/Kg of recipient's body weight in a final average volume of 155 ml. EDM was infused into 22 ABO‐incompatible marrow recipients (21 patients with hematologic malignancies and one patient with aplastic anemia) without clinical evidence of hemolysis. The isohemagglutinin titers of recipients ranged from 4 to 4096 and were not lowered prior to infusion. Engraftment (i.e., recovery of peripheral leukocyte and platelet counts) and incidence of graft versus host disease were similar to those observed in recipients of ABO‐compatible marrow transplantation. Erythrocyte engraftment was significantly delayed in only one patient who had a high isohemagglutinin titer. The post‐transplantation red cell requirement was increased in EDM recipients: 9 units compared to 6 units in ABO‐compatible bone marrow transplanted patients with neither hemolysis nor interference with successf

ISSN:0733-2459    

DOI:10.1002/jca.2920020305

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractA flow‐through cartridge for indicating acidic and basic conditions during acid regeneration of immunoadsorption columns is described. Based on a pH dye covalently bound to polyacrylamide beads, it offers a direct visual indication of whether the pH of a column is in a range which is safe for use. The device, mounted in the waste line, may be reused several time

ISSN:0733-2459    

DOI:10.1002/jca.2920020306

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractSix patients with advanced squamous cell cancers of the head and neck, with serum IgA ≤ 400 mg/dl and IgE ≥ 1000 IU/ml. underwent a trial of six 2‐liter plasma exchanges over a 2–3‐week period. Disease progressed in patients 1. 2. and 4. who died on days 44. 72. and 159. The tumor in patients 3 and 6 regressed significantly. repeatedly in patient 3 over each of four courses of apheresis. Tumor recurred in both patients after cessation of treatment, and they died at days 420 and 79. Patient 5. with inoperable disease, received full‐dose radiotherapy immediately following the course of apheresis. and showed complete response in the primary lesion and a major response in the extensive lymph node metastases, dying on day 421 of apparently unrelated causes. Serum IgE in the three patients experiencing tumor regression rose paradoxically during plasmapheresis. Only patient 3 had an elevated level of soluble E‐receptor suppressor factor prepheresis: the serum of patient 6 was lymphocytotoxic prepheresis but this activity decreased or disappeared during each of the exchanges studied. Controlled trials are

ISSN:0733-2459    

DOI:10.1002/jca.2920020307

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe plasma of a patient being prepared for allogeneic bone marrow transplantation was found to be severely lymphocytotoxic to donor cells. Three isovolaemic plasma exchanges carried out using a continuous‐flow technique were required to reduce this titre to undetectable levels. Neither these procedures nor pretransplantation conditioning of the patient with 60 mg/kg or cyclophosphamide on two consecutive days resulted in overt haemolysis. However, a single identical plasmapheresis 12 hours after completing the second dose of the alkylating agent resulted in profound intravascular haemolysis requiring red cell transfusion. Subsequent studies in five patients receiving the same cyclophosphamide regimen demonstrated that red cell life span, when measured with radio‐chromium, was reduced from a normal of 25–35 days to a median of 11.5 days. Further studies in the same five patients carried out simultaneously demonstrated that red cell fragility, when assessedin vitrowith osmotic or mechanical stress, was marginally increased but became clearly abnormal in only one individual. These doses of cyclophosphamide may result in accelerated but subclinical red cell destruction, and plasma exchange in this period may be associated with rapid intravascular haemolysis. This complication should now be added to the list of those that can occur when plasmapheresis is required in this specific clinical situ

ISSN:0733-2459    

DOI:10.1002/jca.2920020308

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractA patient with osteosclerotic myeloma and POEMS syndrome, unresponsive to pulse prednisone and melphalan therapy, was admitted to the hospital for a trial of plasma exchange therapy. The presentation included IgG lambda monoclonal gammopathy, peripheral neuropathy, hepatosplenomegaly, hyperpigmentation and thickening of the skin, edema, and tense ascites. Laboratory tests confirmed hypothyroidism, hypogonadism, and adrenal insufficiency. Six exchange procedures failed to affect the clinical course, and the patient died. Greater‐than‐one‐plasma‐volume exchanges (patient's measured plasma volume, 2,703 cc) were performed. When IgG and cholesterol removal were compared to the predicted removal, based on the volume of plasma removed, significantly less reduction in concentration than predicted was measured. IgG concentrations increased postapheresis and, at 2 weeks, three‐fourths of the removed IgG had reaccumulated. A reduced efficiency of removal of both IgG and cholesterol can be explained by postulating increased vascular permeability with free exchange of soluble substances from one compartment to another. If an abnormal product is produced by the disease and is responsible for the clinical syndrome, a more intensive schedule of plasma exchange therapy may be needed to achieve a sustained depletion of the responsible soluble substance. Alternatively, neither increased vascular permeability or the clinical manifestations are responsive to removal of a soluble substance or are caused by a soluble substance produced by the m

ISSN:0733-2459    

DOI:10.1002/jca.2920020309

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractPlatelets were collected using the dual‐channel module on the IBM 2997 Blood Fraction Separator. We carried out 320 procedures to harvest platelets for therapeutic purposes and yielded 5.1 ± 1.5 × 1011platelets (mean ± SD). Infusion into previously unsensitized recipients with hypomegakaryocytic thrombocytopenia achieved increments at 1 hr of 19 ± 7.3 × 109/liter/nr (mean ± SD) and at 24 hr of 15 ± 6.3 × 109/liter/nr. The only consistent donor reaction was mild hypocalcaemia. easily corrected by calcium gluconate infusion. Changes in donor packed‐cell volume and white cell count were not statistically altered (p>0.05) but donor platelet counts fell from 216 ± 43.1 × 109/liter to 162.5 ± 41.7 × 109/liter (mean ± SD) (p<0.01). Additional plateletphereses were carried out in seven normal volunteers, using the same technique, in order that the function of the harvested platelets could be studied. Following radiochromium labelling and reinfusion into the same donors, normal in vivo recoveries were obtained at 10 min (59.4 ± 3.4%; mean ± SD) and platelet mean life span was also normal (218 ± 12 hr; mean ± SD). Furthermore, in vitro platelet factor III availability and aggregation patterns of the harvested platelets did not differ from control values and their ultrastructural a

ISSN:0733-2459    

DOI:10.1002/jca.2920020310

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920020301

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY