摘要:

AbstractThe use of therapeutic plasma exchange, particularly for management of patients with neurological disorders, has steadily increased in our hospital since 1991, thus highlighting the need for continuing quality assurance of these services. We have reviewed the hemapheresis records of all 381 therapeutic plasma exchange procedures performed on a total of 63 patients from January 1991 through December 1992. Patients were referred for therapeutic plasma exchange for the following indications: acute Guillain‐Barre syndrome, 31 patients (49.2%); chronic inflammatory demyelinating polyneuropathy, 15 patients (23.8%); myasthenia gravis, five patients (7.94%); paraproteinemic neuropathy, five patients (7.94%); thrombotic microangiopathies, six patients (9.52%) and Goodpasture syndrome, one patient (1.6%). Overall, 89% of patients were treated for neurological disorders. Complications of plasma exchange were noted during 17% (n = 65) of procedures involving 49% (n = 31) of patients treated. Approximately 91% of complications were classified as mild (55.4%) or moderately severe (35.4%) and did not prevent successful completion of the procedure. These were largely related to use of citrate‐containing anticoagulants and additionally may have reflected the autonomic instability of many of the neuropathy patients. All four (6.15%) severe complications and one of two fatalities were related to the use of central venous access catheters. We conclude that therapeutic plasma exchange can be performed safely with acceptable toxicity caused by mild and moderately severe complications. Major complications may be minimized by careful management of central venous catheters when required for access. © 1994 Wiley‐Lis

ISSN:0733-2459    

DOI:10.1002/jca.2920090102

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractTo evaluate changes in feto‐placental markers with plasma exchange in pregnancy, two patients at varying stages of pregnancy referred to a tertiary care hospital and requiring plasma exchange for intercurrent problems were evaluated. Alpha‐fetoprotein, human chorionic gonadotropin, and free estriol were sequentially measured in the patients' plasma and in the fluid removed, thus permitting calculations of permeability rates and clearances. Despite markedly different molecular weights, all three feto‐placental markers had similar permeabilities and clearances. While in both patients maternal levels of alpha‐fetoprotein and human chorionic gonadotropin decreased rapidly with plasma separation and rebounded rapidly to baseline, free estriol responded differently and did not appear to decrease with therapy. Maternal levels of feto‐placental markers only transiently changed with plasma exchange during pregnancy and rapidly returned to baseline with no apparent consequences to the pregnancy. © 1994 Wiley

ISSN:0733-2459    

DOI:10.1002/jca.2920090103

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe extent and duration of in vivo platelet activation were determined in 12 volunteer donors undergoing automated plasmapheresis. Expression of P‐selectin, activated GpIIb/IIIa, and platelet microparticle formation were measured by flow cytometry on peripheral blood samples obtained immediately before and after plasmapheresis and at 24 hour intervals thereafter for up to 3 days. Although no adverse effects were noted in any donor, immediately after apheresis 3 87% of circulating platelets expressed P‐selectin: by 48 hours. 0.5 50% expressed P‐selectin; and by 72 hours, all donors studied had fewer than 5% P‐selectin expression on circulating platelets. Results were similar for the expression of the activated conformation of GpIIb/IIIa. There was a positive correlation with in vitro P‐selectin expression in response to ADP in the pre‐apheresis sample and the number of platelet microparticles detected in the donor following plasmapheresis. In addition, the percent expression of P‐selectin and activated GpIIb/IIIa in response to ADP was reproducible in each individual studied on five separate occasions (CV ≤ 8%). Platelets activated during plasmapheresis using an automated device may circulate for at least 48 hours, and pre‐plasmapheresis response of platelets to the agonist ADP correlated with platelet microparticle formation post‐plasmapheresis. ©

ISSN:0733-2459    

DOI:10.1002/jca.2920090104

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe collection efficiency (CE) of the Fenwal CS3000 in collecting peripheral blood stem cells during post‐chemotherapy recovery phase ranges from 58% to 73%. Recently filgrastim (recombinant methionyl human granulocyte colony‐stimulating factor [G‐CSF]) has also been shown to be effective as a mobilization agent although mobilization occurs during elevated and not low normal leukocyte counts. We compared the mononuclear cell (MNC) CE and the myeloid progenitor cell (CFU‐GM) CE among 11 patients with G‐CSF mobilization (33 procedures) and 19 patients during recovery following myelosuppression chemotherapy (93 procedures). Pre‐apheresis leukocyte, neutrophil, MNC, and PB CFU‐GM counts were significantly higher in the G‐CSF group, while the granulocyte percentage in the apheresis products was similar in both groups. Both MNC CE (81.8 ± 4.5% vs. 64 ± 2.4%) and CFU‐GM CE (79.5 ± 10.5% vs. 55.8 ± 3.5%) were higher in the G‐CSF group. Only the pre‐apheresis MNC count showed an independently significant correlation for both CE (P<.001). The higher CE in the G‐CSF group can only be partly explained by a rise in MNC count during apheresis. These data suggest that the blood cell separator works better with leukocytosis, and especially with a higher MNC count. The improvement in CE is another benefit of G‐CSF mobilization over chemotherapy mobiliz

ISSN:0733-2459    

DOI:10.1002/jca.2920090105

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractImmunologic studies were carried out in a patient with polymyositis (PM), who showed increasing muscle strength and decreasing serum creatine phosphokinase levels during 20 weeks of treatment with plasmapheresis in conjunction with prednisone and cyclophosphamide. After an initial rise, serum IgG declined with treatment. Natural killer (NK) lymphocytes were reduced by 74%, B cells by 95%, and T cells by 38%. Spontaneous proliferation of peripheral blood mononuclear cells increased dramatically. Within the CD4+ T cell subset there was increasing maturation as shown by a rise in percent mature (CD29+) cells and reciprocal decline of immature (CD45RA+) cells. At the same time CD4+ T cells became increasingly activated as shown by HLA‐DR expression.The percentage of CD8+ T cells increased strongly with treatment, and they showed increased activation and expression of the cytotoxic CD29+ and CD11b‐ phenotypes. CD8+ T cells exhibiting CD45RA or CD11b+ suppressor phenotypes were overall unchanged; however, on follow‐up a proportion of CD8+ cells expressed the activated suppressor effector (CD11b—CD28—) phenotype. In addition to control of PM by the possible deletion of activated autoreactive B and T lymphocyte clones with cyclophosphamide, the activation and maturation of CD4+ T cells during treatment may have downregulated the autoreactive disease process, either through direct antiidiotypic suppression or by induction of the observed increase in cytotoxic and suppressor CD8+ T cells. © 1994 Wiley

ISSN:0733-2459    

DOI:10.1002/jca.2920090106

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920090107

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractPhotopheresis is a pheresis‐based therapy that is currently available at approximately 70 medical centers worldwide. Recent evidence indicates that extracorporeal photopheresis can significantly prolong life, as well as induce a 60–75% response rate among individuals with advanced cutaneous T‐cell lymphoma (CTCL). Moreover, a 10–15% cure rate, in response to photopheresis alone, or in combination with interferon alfa, has been obtained at our institution. These complete responses have been characterized by the complete disappearance of morphologically atypical cells from the skin and blood. Southern blot analysis of peripheral blood specimens have also confirmed the indefinite disappearance of the malignant T‐cell clone from the blood of patients with complete responses. Current immunological data obtained from in vitro human studies and from animal models suggest that the basis for the responses of CTCL patients are related to activation of treated macrophages resulting in release of cytokines, including substantial levels of TNF alfa, and, perhaps, to the induction of anti‐clonotypic immunity directed against pathogenic clones of T‐lymphocytes. In addition to the treatment of CTCL, a potential role for photopheresis in the therapy of autoimmune disease has been suggested by recent pilot studies of pemphigus vulgaris, rheumatoid arthritis, and systemic lupus erythematosus. Furthermore, a randomized, single‐blinded trial involving 79 patients with early onset, aggressive systemic sclerosis suggested that photopheresis could beneficially effect the course of the cutaneous thickening in this form of the disease. Lastly, two independent pilot studies of cardiac transplantation have indicated that photopheresis can reverse acute cardiac allograft rejection and potentially suppress ongoing chronic rejection. Randomized, controlled trials for these new indications for photopheresis therapy are currently in the early stages of implementation. © 1994

ISSN:0733-2459    

DOI:10.1002/jca.2920090108

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractStaphylococcal protein A efficiently binds immunoglobulins and circulating immune complexes (CIC) and provides an effective medium to remove immunoglobulins and CICs from plasma while sparing albumin and most coagulation proteins. Although it activates the complement system its clinical use abrogates the need for plasma expanders necessitated by plasma exchange. Despite anecdotal reports of utility in several hematologic syndromes, publications of clinical trials are available only for autoimmune thrombocytopenic purpura (AITP) and refractoriness to platelet transfusions (RFT) associated with alloimmunization. In the former situation Snyder et al. (Blood79:2237–2245, 1992) reported on 72 patients with AITP all of whom had failed at least two previous therapies including splenectomy in 68%. Forty‐six percent achieved improved platelet counts following treatment. The response was durable (8–26 mo) in all but 10%. Spleen‐intact patients could not be differentiated from those who had been splenectomized. Both responders and nonresponders showed significant decreases in CIC and platelet‐directed immunoglobulin (PDIG), but responders achieved near‐normal levels. The beneficial response of these factors, particularly in spleen‐intact patients, warrants a prospective study. In our studies at the University of Minnesota twelve patients with thrombocytopenia secondary to bone marrow failure who were refractory to platelet transfusion were treated with protein A immunoadsorption. Ten had demonstrable antiplatelet Abs (Anti‐HLA, HPA, ABO). Seven of 12 demonstrated improved platelet counts and post‐transfusion corrected count increments after treatment. This was associated with decreased platelet utilization and clinical bleeding. A prospective controlled clinical trial is justified. © 19

ISSN:0733-2459    

DOI:10.1002/jca.2920090109

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe collection of peripheral blood stem cells by apheresis is a procedure used with increasing frequency in bone marrow transplant. The Spectra Apheresis System is an automated machine allowing the procedure to be tailored to every patient for optimal safety and comfort. The ability to constantly view the products allows the operator flexibility to control the results for an optimal result. © 1994 Wiley‐Liss, I

ISSN:0733-2459    

DOI:10.1002/jca.2920090110

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920090111

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY