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Atay G, Hasbal C, Türk M, Erdoğan S, Sözeri B. The Role of Therapeutic Plasma Exchange (TPE) in Multisystem Inflammatory Syndrome in Children (MIS-C). Children (Basel) 2021; 8:498. [PMID: 34208141 DOI: 10.3390/children8060498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 12/27/2022]
Abstract
Multisystemic inflammatory syndrome in children (MIS-C) is a new potentially life-threatening disease that is related to coronavirus disease 2019 (COVID-19). The aim of this study is to reveal the clinical and laboratory results of MIS-C and the role of therapeutic plasma exchange (TPE) in its treatment. Clinical, laboratory and radiological characteristics of the patients who were admitted to the pediatric ward and pediatric intensive care unit (PICU) of a tertiary hospital with a diagnosis of MIS-C between April 2020 and March 2021 were included in the study. Forty-one patients were admitted to our hospital with a diagnosis of MIS-C. Twenty-one (51.2%) patients were admitted to the PICU. Six patients needed invasive mechanical ventilation (14.6%), 10 patients (24.4%) TPE and 3 patients (7.3%) needed extracorporeal membrane oxygenation (ECMO). The patients were grouped according to need for PICU admission (Group 1: no need for PICU, Group 2: need for PICU admission). Group 2 had significantly higher levels of C-reactive protein (CRP), alanine aminotransferase (ALT), ferritin, D-dimer, pro-B type natriuretic peptide (pro BNP) and lactate (p < 0.05). Hyponatremia found to be an independent risk factor for inpatient MIS-C in the PICU. We think that dynamic laboratory trending is beneficial in determining the need for PICU admission and TPE may be effective in critically ill patients.
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Crysandt M, Soysal H, Jennes E, Holtick U, Mrotzek M, Rehnelt S, Holderried TAW, Wessiepe M, Kunter U, Wilop S, Silling G, Gecht J, Beier F, Brümmendorf TH, Jost E. Selective ABO immunoadsorption in hematopoietic stem cell transplantation with major ABO incompatibility. Eur J Haematol 2021; 107:324-332. [PMID: 34022082 DOI: 10.1111/ejh.13668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE ABO mismatch between donor and recipient occurs in 40% of allogeneic hematopoietic stem cell transplantations (HCT). Different strategies have been described to reduce isohemagglutinins (IHA) before HCT. We describe the effect of selective ABO immunoadsorption (ABO IA) on erythrocyte transfusion rate and the development of post-transplant pure red cell aplasia (ptPRCA). METHODS 63 patients with major ABO incompatibility were retrospectively analyzed. Nine patients with major ABO incompatibility and high-IHA titer were treated by ABO IA before HCT. We analyzed the need for transfusion and the occurrence of ptPRCA. We compared the outcome with patients treated by other methods to reduce IHA. RESULTS In all nine patients treated by ABO IA, IHA decreased in a median four times. PtPRCA occurred in one patient. The median number of transfusions was 8 (range: 0-36) between d0 and d100. In 25 patients with high-IHA titer without treatment or treated by other methods to reduce IHA, the need for transfusions was comparable. No difference in the incidence of ptPRCA was observed. CONCLUSIONS Selective ABO IA is a feasible, safe, and effective method to reduce IHA before HCT in major ABO incompatibility. No effect on transfusion rate or ptPRCA compared to other strategies could be observed.
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Affiliation(s)
- Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Hatice Soysal
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Eva Jennes
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Udo Holtick
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany.,Department I of Internal Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Matthias Mrotzek
- Institute of Transfusion Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Susanne Rehnelt
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany.,Department of Oncology, Hematology, Immuno-Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Tobias A W Holderried
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany.,Department of Oncology, Hematology, Immuno-Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Martina Wessiepe
- Division of Transfusion Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Uta Kunter
- Department of Nephrology and Clinical Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Stefan Wilop
- MVZ West GmbH Würselen, Hämatologie-Onkologie, Würselen, Germany
| | - Gerda Silling
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Judith Gecht
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Fabian Beier
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Edgar Jost
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
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103
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Ture Z, Kalin-Unuvar G. A case of Crimean Congo hemorrhagic fever complicated with acute pulmonary embolism. J Med Virol 2021; 93:3925-3928. [PMID: 32716057 DOI: 10.1002/jmv.26358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Crimean-Congo hemorrhagic fever (CCHF) is one of the common causes of tick-borne hemorrhagic infections. The study aims to report a case of a female patient with severe CCHF with pulmonary embolism. CASE REPORT A 61-year-old woman admitted to the emergency department with complaints of high fever, nausea, and weakness. The patient was dealing with animal husbandry and had a tick bite history. At laboratory findings, bicytopenia, abnormal liver function tests, and elevated coagulation parameters were observed. Real-time plymerase chain reaction confirmed the diagnosis of CCHF. Three sessions of plasmapheresis were performed due to continued fever and worsening in laboratory values. Pulmonary embolism was detected in computerized thorax tomography carried out due to respiratory alkalosis on the 6th day. She was successfully treated with supportive and anticoagulation therapy. CONCLUSION CCHF demonstrates different types of clinical presentations apart from fever and hemorrhage. Acute pulmonary embolism is a rare complication that has not been reported before.
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Affiliation(s)
- Zeynep Ture
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gamze Kalin-Unuvar
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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104
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Gayretli Aydin ZG, Yesilbas O, Reis GP, Guven B. The first pediatric case of hemophagocytic lymphohistiocytosis secondary to Crimean-Congo haemorrhagic fever successfully treated with therapeutic plasma exchange accompanying ribavirin and intravenous immunoglobulin. J Clin Apher 2021; 36:780-784. [PMID: 34061376 DOI: 10.1002/jca.21915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 01/25/2023]
Abstract
Although Crimean-Congo hemorrhagic fever (CCHF) is mild and self-limited in children, some patients may develop excessive bleeding, massive liver necrosis, and multiple organ failure associated with secondary hemophagocytic lymphohistiocytosis (HLH) induced by cytokine storm. Treatment of CCHF is mainly symptomatic and supportive. The efficacy of ribavirin, which is the only antiviral drug in the treatment of CCHF, remains controversial. Although therapeutic plasma exchange (TPE) has been shown to beneficial in small case series with primary and secondary HLH, there is no pediatric patient with HLH secondary to CCHF treated with TPE in the literature. In this report, we describe the first pediatric patient who was successfully recovered from HLH secondary to CCHF with ribavirin, intravenous immunoglobulin, and TPE.
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Affiliation(s)
- Zeynep Gokce Gayretli Aydin
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Karadeniz Technical University, Trabzon, Turkey
| | - Osman Yesilbas
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gokce Pinar Reis
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology, Karadeniz Technical University, Trabzon, Turkey
| | - Burcu Guven
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Pediatric Gastroenterology Hepatology and Nutrition, Karadeniz Technical University, Trabzon, Turkey
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105
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Zhuang Y, Wei X, Yu Y, Wang D. Exogenous insulin antibody syndrome treated with plasma exchange after an incomplete response to immunosuppressive therapy. J Clin Apher 2021; 36:664-667. [PMID: 34013991 PMCID: PMC8453898 DOI: 10.1002/jca.21905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
A 43‐year‐old man with a 23‐year history of type II diabetes presented with uncontrolled hyperglycemia with frequent episodes of ketoacidosis. He was diagnosed with exogenous insulin antibody syndrome, and received high‐dose methylprednisolone to treat insulin resistance. Ketoacidosis relapsed 2 years later, and the patient showed an incomplete response to glucocorticoids. We decided to administer therapeutic plasma exchange, which resulted in rapid lowering of the daily insulin requirement and improved glycemic control.
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Affiliation(s)
- Yuan Zhuang
- Department of Blood Transfusion, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xudong Wei
- Department of Endocrinology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Endocrinology, TCM Hospital of Shi Jia Zhuang City, Shijiazhuang, Hebei, China
| | - Yang Yu
- Department of Blood Transfusion, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Deqing Wang
- Department of Blood Transfusion, First Medical Center of Chinese PLA General Hospital, Beijing, China
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106
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Yang JJ, Ryu KS, Kim JS, Chung Y, Kim H, Hwang SH, Oh HB, Ko DH. Evaluation of safety of using incompatible plasma for therapeutic plasma exchange during shortage of AB plasma. J Clin Apher 2021; 36:628-633. [PMID: 33950554 DOI: 10.1002/jca.21904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/17/2021] [Accepted: 04/26/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Criteria for selection of FFP blood type has not been clearly established and use of group AB plasma is preferred by numerous transplantation protocols. AIMS This study assesses the safety and efficacy of alternative group A or B plasma in ABO incompatible solid organ transplantation. MATERIALS & METHODS Alternative use of group A or B plasma (incompatible plasma) was inevitable during the shortage of group AB plasma. Experience from select number of patients during the period of extreme group AB plasma shortage is described. RESULTS The result of alternative use of group A or B plasma was within expectation, showing effective reduction of isoagglutinin titers for pre-operative desensitization and efficacy for treatment of post-operative patients. No immediate hemolytic transfusion reaction was reported. DISCUSSION While validation in a larger cohort of patients is necessary, our limited experience have shown satisfactory clinical outcomes without adverse events. CONCLUSIONS Use of incompatible group A or B plasma is a viable option when group AB plasma is limited.
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Affiliation(s)
- John Jeongseok Yang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyong-Suk Ryu
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Seok Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yousun Chung
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hyun Hwang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heung-Bum Oh
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae-Hyun Ko
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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107
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Green AP, Gonzalez AC, Alperin JB, Burner JD, Yates SG. The utility of therapeutic plasma exchange in Hyperviscosity syndrome associated with juvenile rheumatoid arthritis: A case report. J Clin Apher 2021; 36:658-663. [PMID: 33945169 DOI: 10.1002/jca.21903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 11/09/2022]
Abstract
Hyperviscosity syndrome (HVS) is a life-threatening syndrome caused by high concentrations of large plasma proteins like IgM, rheumatoid factor, and other immune complexes, leading to increased blood viscosity and symptoms such as visual abnormalities, neurological impairment, bleeding diathesis, and thrombosis. While Waldenström's macroglobulinemia accounts for 80% to 90% of cases, HVS may develop in other clinical settings characterized by elevations in plasma proteins. Limited evidence currently exists describing the safety and efficacy of therapeutic plasma exchange (TPE) for the management of HVS secondary to non-neoplastic conditions. We report a case of recurrent HVS associated with juvenile rheumatoid arthritis and Felty syndrome that demonstrated improvement in clinical symptoms following initiation of TPE. These findings suggest that TPE may be utilized as an adjunct treatment option in patients with HVS secondary to autoimmune disorders.
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Affiliation(s)
- Allen P Green
- Department of Pathology, Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Adam C Gonzalez
- Department of Pathology, Division of Transfusion Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jack B Alperin
- Departments of Internal Medicine and Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - James D Burner
- Department of Pathology, Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sean G Yates
- Department of Pathology, Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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108
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Butty EM, McKinney CA, Prisk AJ. Treatment of a flunixin meglumine overdose with intravenous administration of lipid emulsion and therapeutic plasma exchange in a Nigerian dwarf buck kid (Capra aegagrus hircus). J Vet Intern Med 2021; 35:1626-1630. [PMID: 33934401 PMCID: PMC8163127 DOI: 10.1111/jvim.16124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/30/2022] Open
Abstract
A 12 week‐old Nigerian dwarf (Capra aegagrus hircus) buck kid was hospitalized for management of obstructive urolithiasis. Postoperatively, he was inadvertently administered 16‐times greater than his calculated dose of a nonsteroidal anti‐inflammatory drug (NSAID; 17.5 mg/kg flunixin meglumine, IV). The goat was treated with intravenous administration of lipid emulsion (ILE) prior to membrane‐based therapeutic plasma exchange (mTPE) under general anesthesia. The increased coagulability inherent to small ruminants in comparison with dogs and cats warranted specific adjustments in the prescription of anticoagulation, blood flow, and filtration fraction to avoid circuit clotting during mTPE. Serum flunixin meglumine concentration measured before, during, and after mTPE revealed marked reduction in drug concentration. After the combined treatments, no clinical evidence of NSAID gastrointestinal or renal toxicosis was detected. This case report describes successful management of flunixin meglumine overdose in a small ruminant using combined ILE and mTPE.
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Affiliation(s)
- Emmanuelle Marie Butty
- Department of Clinical Sciences, Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Caroline Ann McKinney
- Department of Clinical Sciences, Large Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Amanda Jane Prisk
- Department of Clinical Sciences, Large Animal Surgery, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
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109
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Cho H, Bae J, Yoon HK, Lee HJ, Yang SM, Choe SH, Jung CW, Suh KS, Kim WH. Perioperative ABO Blood Group Isoagglutinin Titer and the Risk of Acute Kidney Injury after ABO-Incompatible Living Donor Liver Transplantation. J Clin Med 2021; 10:1679. [PMID: 33919744 DOI: 10.3390/jcm10081679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/04/2021] [Accepted: 04/10/2021] [Indexed: 01/28/2023] Open
Abstract
For ABO-incompatible liver transplantation (ABO-i LT), therapeutic plasma exchange (TPE) is performed preoperatively to reduce the isoagglutinin titer of anti-ABO blood type antibodies. We evaluated whether perioperative high isoagglutinin titer is associated with postoperative risk of acute kidney injury (AKI). In 130 cases of ABO-i LT, we collected immunoglobulin (Ig) G and Ig M isoagglutinin titers of baseline, pre-LT, and postoperative peak values. These values were compared between the patients with and without postoperative AKI. Multivariable logistic regression analysis was used to evaluate the association between perioperative isoagglutinin titers and postoperative AKI. Clinical and graft-related outcomes were compared between high and low baseline and postoperative peak isoagglutinin groups. The incidence of AKI was 42.3%. Preoperative baseline and postoperative peak isoagglutinin titers of both Ig M and Ig G were significantly higher in the patients with AKI than those without AKI. Multivariable logistic regression analysis showed that preoperative baseline and postoperative peak Ig M isoagglutinin titers were significantly associated with the risk of AKI (baseline: odds ratio 1.06, 95% confidence interval 1.02 to 1.09; postoperative peak: odds ratio 1.08, 95% confidence interval 1.04 to 1.13). Cubic spline function curves show a positive relationship between the baseline and postoperative peak isoagglutinin titers and the risk of AKI. Clinical outcomes other than AKI were not significantly different according to the baseline and postoperative peak isoagglutinin titers. Preoperative high initial and postoperative peak Ig M isoagglutinin titers were significantly associated with the development of AKI. As the causal relationship between high isoagglutinin titers and risk of AKI is unclear, the high baseline and postoperative isoagglutinin titers could be used simply as a warning sign for the risk of AKI after liver transplantation.
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110
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Czempik PF, Gawryluk J, Wiórek A, Krzystanek E, Krzych ŁJ. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome. Open Med (Wars) 2021; 16:526-531. [PMID: 33821220 PMCID: PMC8010154 DOI: 10.1515/med-2021-0220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/20/2020] [Accepted: 01/08/2021] [Indexed: 12/29/2022] Open
Abstract
The stiff person syndrome (SPS) is an extremely rare neurological disorder with primarily immune-mediated etiology. The cardinal symptoms are progressive, fluctuating axial/proximal limb muscle stiffness and spasms. The diagnosis is based on the clinical picture, electromyography examination and detection of antibodies to glutamic acid decarboxylase (anti-GAD). Adverse effects of medications might preclude its use or increase in dosing, therefore symptomatic and/or immunomodulatory medical therapy might be ineffective in acute exacerbation of the disease. We present a case of a 49-year-old female with exacerbation of SPS, in whom some standard pharmacotherapy could not be introduced (clonazepam, baclofen used in the past) and doses of existing standard medications could not be increased (diazepam, gabapentin, and levetiracetam) due to adverse effects. Moreover, a newly introduced medication (methylprednisolone) also led to a serious adverse effect (severe hyperglycemia). The patient underwent therapeutic plasma exchange (TPE) with good effect and no complications. We review the literature regarding the efficacy and safety profile of TPE in exacerbation of SPS unresponsive to medical therapy. The procedure seems to have a good safety profile as an adjunct therapy for exacerbation of SPS not responding to standard medical therapy in this patient population.
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Affiliation(s)
- Piotr F Czempik
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, Katowice, 40-752, Poland
| | - Justyna Gawryluk
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, Katowice, 40-752, Poland
| | - Agnieszka Wiórek
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, Katowice, 40-752, Poland
| | - Ewa Krzystanek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, Katowice, 40-752, Poland
| | - Łukasz J Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, Katowice, 40-752, Poland
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111
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Dogra A, Rana K, Rathod C, Prakash S. Outcome of therapeutic plasma exchange in Myasthenia gravis patients. J Family Med Prim Care 2021; 9:5971-5975. [PMID: 33681028 PMCID: PMC7928125 DOI: 10.4103/jfmpc.jfmpc_1026_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022] Open
Abstract
Aims: The aim of this study was to evaluate the indications, adverse reactions, and outcome of therapeutic plasma exchange (TPE) in myasthenia gravis (MG) patients. Settings and Design: Retrospective Observational study. Methods and Material: A total of 18 patients of MG had undergone 18 cycles and 87 session of TPE at our Institution, a tertiary care center in Western India. It was performed using a single volume plasma exchange with intermittent cell separator (Freseniouscomtec), subclavian central line access, and with alternate day interval. Outcome was assessed shortly after each session and overall outcome at the time of discharge. Results: Total of 68 patients of MG were admitted to Neurology Intensive care unit (ICU) during the study period [January 2016–December 2019]. Out of them, TPE was done in 18 patients. Among the 18 patients, 11 patients had myasthenic crisis and 7 patients had worsening of MG. The mean number of TPE session was 4.2(SD ± 1.2), volume exchange was 2215 ml (SD ± 435); overall incidence of adverse reaction was 33.3%. All patients had immediate benefits of each TPE cycle. Good acceptance of procedure was observed in 72.2% of patients. Conclusions: TPE is cost-effective rapid therapy for myasthenic crisis and progressive myasthenia gravis. It reduces ICU stays and improves outcome.
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Affiliation(s)
- Ashu Dogra
- Department of Transfusion Medicine, SBKS Medical College, Sumandeep University, Pipariya, India
| | - Kaushik Rana
- Department of Neurology, SBKS Medical College, Sumandeep University, Pipariya, India
| | - Chirag Rathod
- Department of Medicine, GMERS Medical College, Gotri, Vadodara, Gujarat, India
| | - Sanjay Prakash
- Department of Neurology, SBKS Medical College, Sumandeep University, Pipariya, India
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112
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Compton F, He L, Sarode R, Wodajo A, Usmani A, Burner J, Berlacher M, De Simone N. Immune checkpoint inhibitor toxicity: A new indication for therapeutic plasma exchange? J Clin Apher 2021; 36:645-648. [PMID: 33648026 DOI: 10.1002/jca.21890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/04/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022]
Abstract
Novel immune-modulating anticancer drugs are being used with increasing frequency. With increased use, there are more frequent cases of toxicities caused by these drugs, termed immune-related adverse events (irAEs). We present a case in which we successfully treated a case of severe, steroid-refractory, nivolumab-induced myocarditis with therapeutic plasma exchange (TPE). Nivolumab is an immune checkpoint inhibitor (ICI) which blocks programmed death receptor-1 (PD-1). This blockade allows for enhanced T-cell function and increased anti-tumor response. The patient presented with signs and symptoms of heart failure and was found to have a significantly depressed cardiac ejection fraction. Over the course of her five TPE procedures, she improved clinically and was discharged home with improved left ventricular ejection function. This case suggests an emerging role of TPE in the management of severe ICI-induced toxicity, such as myocarditis.
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Affiliation(s)
| | - Lin He
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ravi Sarode
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine (Hematology/Oncology), UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amelework Wodajo
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amena Usmani
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - James Burner
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mark Berlacher
- Department of Internal Medicine (Cardiology), UT Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole De Simone
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
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113
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Stoian A, Șerban G, Bajko Z, Andone S, Mosora O, Bălașa A. Therapeutic plasma exchange as a first-choice therapy for axonal Guillain-Barré syndrome: A case-based review of the literature (Review). Exp Ther Med 2021; 21:265. [PMID: 33603872 PMCID: PMC7851665 DOI: 10.3892/etm.2021.9696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/04/2020] [Indexed: 12/04/2022] Open
Abstract
Guillain-Barré syndrome is an acute immune-mediated disease that affects the peripheral nervous system, with progressive motor deficit in the limbs, sometimes involvement of the cranial nerves and possible impairment of the autonomic nervous system. Due to the respiratory and autonomic nervous dysfunction, the disease has the potential to be fatal. Although modern methods of treatment have significantly improved patient prognosis, many patients nevertheless experience significant neurological sequelae. The practical applicability of plasmapheresis was illustrated in our case report. We report the case of a 27-year-old man who had a mild viral respiratory tract infection 1 week prior to the onset of disease with gradual development of a motor deficit, urinary retention, slight swallowing difficulties and mild respiratory dysfunction. Nerve conduction studies were performed and the diagnosis of acute motor axonal neuropathy phenotypic variant of Guillain-Barré syndrome was established. Autoimmune and inflammatory diseases, infectious diseases, endocrinopathies, neoplastic diseases, intoxications, metabolic diseases and vitamin deficiencies were ruled out. Our patient attended four sessions of therapeutic plasma exchange performed using peripheral venous approach with two needles with significant recovery of the motor deficit. The patient was discharged 1 week later on maintenance kinetotherapy with further favorable evolution. In conclusion, we report a good evolution as a result of therapeutic plasma exchange in a patient with acute motor axonal neuropathy phenotypic variant of Guillain-Barré syndrome. The procedure is well-tolerated and can be performed safely by peripheral approach not only in the intensive care unit but also in a neurology clinic.
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Affiliation(s)
- Adina Stoian
- Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Pathophysiology, University of Medicine and Pharmacy Targu Mures, 540136 Targu Mures, Romania
| | - Georgiana Șerban
- Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
| | - Zoltan Bajko
- Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurology, University of Medicine and Pharmacy Targu Mures, 540136 Targu Mures, Romania
| | - Sebastian Andone
- Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
| | - Oana Mosora
- Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
| | - Adrian Bălașa
- Neurosurgery Clinic, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurosurgery, University of Medicine and Pharmacy Targu Mures, 540136 Targu Mures, Romania
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114
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Timofeeva OA, Choe J, Alsammak M, Yoon EJ, Geier SS, Mathew L, McCollick A, Carney K, Au J, Diamond A, Galli JA, Shenoy K, Mamary A, Sehgal S, Mulhall P, Toyoda Y, Shigemura N, Cordova F, Criner G, Brown JC. Guiding therapeutic plasma exchange for antibody-mediated rejection treatment in lung transplant recipients - a retrospective study. Transpl Int 2021; 34:700-708. [PMID: 33469943 DOI: 10.1111/tri.13825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/09/2020] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
Antibody-Mediated Rejection (AMR) due to donor-specific antibodies (DSA) is associated with poor outcomes after lung transplantation. Currently, there are no guidelines regarding the selection of treatment protocols. We studied how DSA characteristics including titers, C1q, and mean fluorescence intensity (MFI) values in undiluted and diluted sera may predict a response to therapeutic plasma exchange (TPE) and inform patient prognosis after treatment. Among 357 patients consecutively transplanted without detectable pre-existing DSAs between 01/01/16 and 12/31/18, 10 patients were treated with a standardized protocol of five TPE sessions with IVIG. Based on DSA characteristics after treatment, all patients were divided into three groups as responders, partial responders, and nonresponders. Kaplan-Meier Survival analyses showed a statistically significant difference in patient survival between those groups (P = 0.0104). Statistical analyses showed that MFI in pre-TPE 1:16 diluted sera was predictive of a response to standardized protocol (R2 = 0.9182) and patient survival (P = 0.0098). Patients predicted to be nonresponders who underwent treatment with a more aggressive protocol of eight TPE sessions with IVIG and bortezomib showed improvements in treatment response (P = 0.0074) and patient survival (P = 0.0253). Dilutions may guide clinicians as to which patients would be expected to respond to a standards protocol or require more aggressive treatment.
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Affiliation(s)
- Olga A Timofeeva
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jason Choe
- Department of Pharmacy Services, Temple University Hospital, Philadelphia, PA, USA
| | - Mohamed Alsammak
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Edward J Yoon
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Steven S Geier
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Leena Mathew
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Amanda McCollick
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Kevin Carney
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Jenny Au
- Department of Pharmacy Services, Temple University Hospital, Philadelphia, PA, USA
| | - Adam Diamond
- Department of Pharmacy Services, Temple University Hospital, Philadelphia, PA, USA
| | - Jonathan A Galli
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Kartik Shenoy
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Albert Mamary
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Sameep Sehgal
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Patrick Mulhall
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Yoshiya Toyoda
- Department of Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Norihisa Shigemura
- Department of Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Francis Cordova
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Gerald Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - James C Brown
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
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115
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Puelz C, Danial Z, Raval JS, Marinaro JL, Griffith BE, Peskin CS. Models for plasma kinetics during simultaneous therapeutic plasma exchange and extracorporeal membrane oxygenation. Math Med Biol 2021; 38:255-271. [PMID: 33626571 DOI: 10.1093/imammb/dqab003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/17/2020] [Accepted: 01/24/2021] [Indexed: 11/13/2022]
Abstract
This paper focuses on the derivation and simulation of mathematical models describing new plasma fraction in blood for patients undergoing simultaneous extracorporeal membrane oxygenation and therapeutic plasma exchange. Models for plasma exchange with either veno-arterial or veno-venous extracorporeal membrane oxygenation are considered. Two classes of models are derived for each case, one in the form of an algebraic delay equation and another in the form of a system of delay differential equations. In special cases, our models reduce to single compartment ones for plasma exchange that have been validated with experimental data (Randerson et al., 1982, Artif. Organs, 6, 43-49). We also show that the algebraic differential equations are forward Euler discretizations of the delay differential equations, with timesteps equal to transit times through model compartments. Numerical simulations are performed to compare different model types, to investigate the impact of plasma device port switching on the efficiency of the exchange process, and to study the sensitivity of the models to their parameters.
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Affiliation(s)
- Charles Puelz
- Department of Pediatrics, Section of Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Zach Danial
- Courant Institute of Mathematical Sciences, New York University, New York, NY, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Jonathan L Marinaro
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Boyce E Griffith
- Departments of Mathematics, Applied Physical Sciences, and Biomedical Engineering, University of North Carolina; Carolina Center for Interdisciplinary Applied Mathematics, University of North Carolina; Computational Medicine Program, University of North Carolina, and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Charles S Peskin
- Courant Institute of Mathematical Sciences, New York University, New York, NY, USA
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116
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Fine A, Karp JK, Peedin AR. The role of therapeutic plasma exchange in clinically amyopathic dermatomyositis with MDA-5 antibody: A case report and review of the literature. J Clin Apher 2021; 35:483-487. [PMID: 33617011 DOI: 10.1002/jca.21815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/12/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022]
Abstract
Clinically amyopathic dermatomyositis (CADM) is a rare, aggressive variant of dermatomyositis associated with interstitial lung disease (ILD) and refractoriness to immunosuppressants. Antibodies against melanoma differentiation-associated gene 5 (MDA-5) are often found in patients with CADM. We report a patient with advanced CADM with ILD and MDA-5 antibodies who failed to improve with immunosuppressants. We performed 2 TPE over 3 days, using 5% albumin as replacement fluid. Although five total TPE were planned, he was transferred for lung transplant evaluation after the second TPE; he died 16 days after transfer without receiving a transplant. A literature review identified four patients with CADM and MDA-5 antibodies treated with TPE; all experienced symptomatic improvement of their ILD. We attribute our patient's outcome to the advanced nature of his disease rather than a failure of TPE. Additional research may indicate a possible reclassification of CADM with MDA-5 antibodies in future ASFA guidelines.
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Affiliation(s)
- Alexander Fine
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julie K Karp
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexis R Peedin
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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117
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Marchetti M, Zermatten MG, Bertaggia Calderara D, Aliotta A, Alberio L. Heparin-Induced Thrombocytopenia: A Review of New Concepts in Pathogenesis, Diagnosis, and Management. J Clin Med 2021; 10:683. [PMID: 33578859 DOI: 10.3390/jcm10040683] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/17/2022] Open
Abstract
Knowledge on heparin-induced thrombocytopenia keeps increasing. Recent progress on diagnosis and management as well as several discoveries concerning its pathogenesis have been made. However, many aspects of heparin-induced thrombocytopenia remain partly unknown, and exact application of these new insights still need to be addressed. This article reviews the main new concepts in pathogenesis, diagnosis, and management of heparin-induced thrombocytopenia.
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118
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MacDougall KN, Schwartz B, Harewood J, Bukhari Z, Neculiseanu E. A Case of Gemcitabine-Induced Thrombotic Microangiopathy Treated With Ravulizumab in a Patient With Stage IV Pancreatic Cancer. Cureus 2021; 13:e13031. [PMID: 33680585 PMCID: PMC7931775 DOI: 10.7759/cureus.13031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 47-year-old male with stage IV pancreatic cancer developed gemcitabine-induced thrombotic microangiopathy (GiTMA) after treatment with gemcitabine and nab-paclitaxel. GiTMA is a rare and life-threatening complication with an incidence ranging from 0.015% to 1.4% and reported mortality rate ranging from 50% to 90%. Clinically, GiTMA manifests as microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. Early identification of GiTMA is essential to initiate early treatment and improve survival. Treatment of GiTMA includes discontinuation of gemcitabine, along with initiation of steroids, therapeutic plasma exchange (TPE), rituximab, and eculizumab. To our knowledge, this is the first case of GiTMA treated with ravulizumab, a long-acting complement inhibitor. Given the increasing number of patients treated with gemcitabine and seriousness of this complication, it is important for physicians to be aware of this disease entity and maintain a high index of suspicion when evaluating patients with microangiopathic hemolytic anemia, thrombocytopenia, and renal failure.
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Affiliation(s)
| | - Benjamin Schwartz
- Hematology and Oncology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Janine Harewood
- Hematology and Oncology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Zaheer Bukhari
- Pathology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Elvira Neculiseanu
- Hematology and Oncology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
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119
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Beştepe Dursun Z, Korkmaz S, Türe Z, Kaynar L, Dursun A, Çelik İ. Efficacy of therapeutic plasma exchange in patients with Crimean-Congo hemorrhagic fever. J Clin Apher 2021; 36:390-397. [PMID: 33485278 DOI: 10.1002/jca.21875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the efficacy of therapeutic plasma exchange (TPE) in patients critically ill with Crimean-Congo hemorrhagic fever (CCHF). METHODS Patients with CCHF received supportive treatment (ST) or TPE. After laboratory and clinical evaluations, the patients were divided into mild, moderate, and severe CCHF groups according to the severity score index (SSI). To assess the efficacy of TPE, the incubation period, time of admission to hospital, hospitalization duration, mortality rate and times to recovery of the platelet count and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were compared between patients receiving ST and TPE. RESULT A total of 119 confirmed CCHF cases was analyzed. The median SSIs were 7 in the TPE group and 5 in the ST group. The SSI stages, median incubation times and admission times were similar in the two groups. However, the duration of hospitalization was longer in the TPE group. The overall mortality rates were 9% (3 of 33 patients) in the TPE group and 16% (5 of 31 patients) in the ST group; the difference was significant. The platelet count recovered after a median of 6 (4-7) days in the ST group. CONCLUSION The mortality rate was lower in the TPE group than in the ST group, but the duration of hospitalization and the time to platelet recovery were longer in the TPE group than in the ST group. TPE did not contribute significantly to the prognosis of patients with intermediate-severity CCHF. However, TPE might be efficacious in patients with severe CCHF.
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Affiliation(s)
- Zehra Beştepe Dursun
- Department of Infectious Disease, Kayseri City Hospital, University of Health Science University, Kayseri, Turkey
| | - Serdal Korkmaz
- Department of Hematology, Kayseri City Hospital, University of Health Science University, Kayseri, Turkey
| | - Zeynep Türe
- Department of Infectious Disease, Faculty of Medicine, University of Erciyes, Kayseri, Turkey
| | - Leylagül Kaynar
- Department of Hematology, Faculty of Medicine, University of Erciyes, Kayseri, Turkey
| | - Adem Dursun
- Department of Paediatrics, Division of Pediatric Intensive Care, Erzurum City Hospital, University of Health Science University, Erzurum, Turkey
| | - İlhami Çelik
- Department of Infectious Disease, Kayseri City Hospital, University of Health Science University, Kayseri, Turkey
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120
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Solanki A, Singh A, Chauhan A, Agarwal D, Himanshu D, Chandra T. Therapeutic plasma exchange an emerging treatment modality: A 3-year retrospective analysis of patients admitted in a multispecialty hospital of North India. Asian J Transfus Sci 2021; 15:46-51. [PMID: 34349456 PMCID: PMC8294433 DOI: 10.4103/ajts.ajts_125_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/10/2020] [Accepted: 03/21/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Therapeutic plasma exchange (TPE) is increasingly used throughout the medical field. We aimed to analyze the various aspects of TPE practices at our hospital in terms of clinical indications, technical feasibility, safety, outcome as well as complications associated with the procedures. MATERIALS AND METHODS The data included demographic profiles, clinical parameters, and technical characteristics of each TPE procedure. All the information was noted in data spread sheet (Microsoft Excel 2013) for further analysis. RESULTS This is a 3-year retrospective study of total 266 TPE procedures carried out on 92 patients with different clinical conditions. Out of them, 55 (59.8%) were male and 37 (40.2%) were female patients. There were six major categories such as (1) neurological, (2) hematological, (3) gastrological, (4) renal, (5) rheumatic, and (6) others. The TPE treatment was highest in neurology group (60.2%), followed by gastrology group (24.4%). Most of the procedures (82.6%) were according to the American society of apheresis 2016 I or II categories (76/92 patients). CONCLUSION TPE is beneficial and used as primary or secondary adjunctive therapy for a wide spectrum of various diseases and syndromes. TPE is considered as safe, cost-effective, and life-saving treatment modality in various diseases.
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Affiliation(s)
- Archana Solanki
- Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashutosh Singh
- Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Abhishek Chauhan
- Department of Radiodiagnosis, Dr RML Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Devisha Agarwal
- Department of ENT, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D. Himanshu
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tulika Chandra
- Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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121
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Lim SL, Wang K, Lui PL, Ramanathan K, Yang SP. Crash Landing of Thyroid Storm: A Case Report and Review of the Role of Extra-Corporeal Systems. Front Endocrinol (Lausanne) 2021; 12:725559. [PMID: 34489870 PMCID: PMC8417732 DOI: 10.3389/fendo.2021.725559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/06/2021] [Indexed: 01/09/2023] Open
Abstract
Thyroid storm is a rare but life-threatening endocrinological emergency with significant mortality ranging from 10-30% with multi-organ involvement and failure. In view of the rarity of this condition and efficacy of established first line medical treatment, use of extra-corporeal treatments are uncommon, not well-studied, and its available evidence exists only from case reports and case series. We describe a 28-year-old man who presented with an out-of-hospital cardiac arrest secondary to thyroid storm. Despite conventional first-line pharmacotherapy, he developed cardiogenic shock and circulatory collapse with intravenous esmolol infusion, as well as multi-organ failure. He required therapeutic plasma exchange, concurrent renal replacement therapy, and veno-arterial extra-corporeal membrane oxygenation, one of the few reported cases in the literature. While there was clinical stabilization and improvement in tri-iodothyronine levels on three extra-corporeal systems, he suffered irreversible hypoxic-ischemic brain injury. We reviewed the use of early therapeutic plasma exchange and extra-corporeal membrane oxygenation, as well as the development of other novel extra-corporeal modalities when conventional pharmacotherapy is unsuccessful or contraindicated. This case also highlights the complexities in the management of thyroid storm, calling for caution with beta-blockade use in thyrocardiac disease, with close monitoring and prompt organ support.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Center, Singapore, Singapore
- *Correspondence: Shir Lynn Lim,
| | - Kangjie Wang
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Pak Ling Lui
- Department of Hematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, National University Heart Center, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Samantha Peiling Yang
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
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122
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Weng J, Chen M, Fang D, Liu D, Guo R, Yang S. Therapeutic Plasma Exchange Protects Patients with Sepsis-Associated Disseminated Intravascular Coagulation by Improving Endothelial Function. Clin Appl Thromb Hemost 2021; 27:10760296211053313. [PMID: 34775801 PMCID: PMC8597066 DOI: 10.1177/10760296211053313] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/12/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
The mortality rate of sepsis-associated disseminated intravascular coagulation (DIC) is high. This study aimed to explore the efficacy of therapeutic plasma exchange (TPE) in sepsis-associated DIC patients by improving endothelial function. A total of 112 sepsis-associated DIC patients were randomly divided into the TPE group (n = 40), the heparin (HP) group (n = 36), and the SHAM group (n = 36). The SHAM group received conventional treatment; the HP group was treated with HP based on conventional treatment; and the TPE group received conventional treatment plus TPE. The differences in thromboelastogram (TEG), platelet (PLT), coagulation function, and the endothelial cell (EC) injury biomarkers at 6 h, 24 h, 48 h, 72 h, and 7 days after TPE were compared among the three groups, and the three groups were compared in terms of Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sepsis-Related Organ Failure Assessment (SOFA) score, the length of intensive care unit (ICU) hospitalization, 28-day mortality rate, 28-day cumulative survival rate, the incidence of bleeding events, the incidence of acute kidney injury (AKI), and acute respiratory distress syndrome (ARDS). The efficacy of TPE is superior to the HP in increasing PLT, improving coagulation function, increasing the 28-day cumulative survival rate, and reducing the length of ICU hospitalization, 28-day mortality, and the incidence of bleeding events, AKI, and ARDS with statistically significant differences (P < .05). Moreover, the effect of TPE outperforms HP on the EC injury biomarkers with statistically significant differences (P < .05). Our results suggest that TPE may be more effective than HP in the treatment of patients with sepsis-associated DIC. The possible mechanism is via improving endothelial function.
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Affiliation(s)
- Junting Weng
- Affiliated Hospital of Putian University, Putian, China
| | - Min Chen
- Affiliated Hospital of Putian University, Putian, China
| | - Dexiang Fang
- Affiliated Hospital of Putian University, Putian, China
| | - Danjuan Liu
- Affiliated Hospital of Putian University, Putian, China
| | - Rongjie Guo
- Affiliated Hospital of Putian University, Putian, China
| | - Shuzhen Yang
- Affiliated Hospital of Putian University, Putian, China
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123
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Kassif Lerner R, Pollak U. The use of therapeutic plasma exchange for pediatric patients supported on extracorporeal membranous oxygenator therapy: A narrative review. Perfusion 2020; 37:113-122. [PMID: 33349141 DOI: 10.1177/0267659120974324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Therapeutic plasma exchange in children is increasingly recognized as a life-saving treatment and is challenged by some technical considerations. As extracorporeal membrane oxygenation has been used for nearly half a century for refractory reversible respiratory and/or cardiac failure in both pediatric and adult populations, it may serve as an extracorporeal platform for therapeutic plasma exchange. It is most commonly described in patients with sepsis with multiple organ failure or thrombocytopenia associated multi organ failure. Additional pathophysiological processes of inflammatory and immunological storms might benefit from the combination of extracorporeal membrane oxygenation and plasma exchange. This is a nonmethodological review of English-language reports of therapeutic plasma exchange performed in patients supported by extracorporeal membrane oxygenation, both pediatric and adult, searching six databases, MEDLINE, Clinical Key, GOOGLE SCHOLAR, CINAHL, Cochrane library, and EMBASE.
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Affiliation(s)
- Reut Kassif Lerner
- Department of pediatric intensive care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Pollak
- Pediatric Cardiac Critical Care Unit, Hadassah University Medical Center, Ein Kerem, Jerusalem, Israel.,Pediatric Cardiology, Hadassah University Medical Center, Ein Kerem, Jerusalem, Israel.,Pediatric Extracorporeal Support Program, Hadassah University Medical Center, Ein Kerem, Jerusalem, Israel.,The Hebrew University Hadassah Medical School, Jerusalem, Israel
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124
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Solanki A, Singh A, Chauhan A, Chandra T, Himanshu D. Therapeutic plasma exchange: A life-saving modality in Wegener's granulomatosis. Asian J Transfus Sci 2020; 14:203-205. [PMID: 33767553 PMCID: PMC7983145 DOI: 10.4103/ajts.ajts_89_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/14/2020] [Accepted: 03/01/2020] [Indexed: 12/04/2022] Open
Abstract
We report a case of Wegener's granulomatosis (WG) who very well responded to the combination strategy of therapeutic plasma exchange (TPE) and immunosuppression. The patient was a 38-year-old female, diagnosed with severe form of WG. A total of seven cycles was performed with 1.3 total plasma volumes (TPVs) on every alternate day. Standard induction therapy was also started that comprised of a combination of 500 mg intravenous (i.v.) cyclophosphamide and methylprednisolone 1 g slow i.v. daily for 3 days followed by oral prednisolone 60 mg daily for 4 weeks. After seven cycles of TPE, the patient improved and hence TPE was stopped.
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Affiliation(s)
- Archana Solanki
- Department of Transfusion Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | - Ashutosh Singh
- Department of Transfusion Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | - Abhishek Chauhan
- Department of Radiodiagnosis, Dr. RML institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tulika Chandra
- Department of Transfusion Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | - D Himanshu
- Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
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Pandey P, Setya D, Sinha VK, Devra AK, Bhatt AP, Pande A, Kumar P, Singh MK, Ranjan S. Outcome of desensitization in human leukocyte antigen and ABO incompatible living donor kidney transplantation: Single center experience of first 200 incompatible transplants. J Clin Apher 2020; 36:299-312. [PMID: 33316838 DOI: 10.1002/jca.21860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/20/2020] [Accepted: 11/12/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Although desensitization is well established, concerns about graft outcome, patient survival and rejection still exist. The present study aims at comparing outcomes of renal transplant recipients across simultaneous ABO and human leukocyte antigen (HLA) incompatibility barriers to those with ABO or HLA incompatibility alone. MATERIALS AND METHODS This was a retrospective study conducted from October 2015 to December 2018. All patients with a clinical diagnosis of chronic kidney disease, who were prospective HLA incompatible (HLAi) and/or ABO incompatible (ABOi) renal transplant recipients were included. A total of 400 cases including 36 ABOi transplants, 154 HLAi transplants, 10 simultaneously ABO and HLA incompatible transplants, and 200 ABO (ABOc) and HLA (HLAc) compatible kidney transplants from living donors were included. RESULTS There were significantly more number of blood transfusions, previous transplants and pregnancies in HLAi transplant recipients relative to the ABOi or the control group. Mean number of therapeutic plasma exchange procedures per patient and mean plasma volume processed per procedure were slightly higher in the ABOi + HLAi category. The incidence of graft dysfunction due to suspected antibody-mediated rejection during first year was highest in the ABOi + HLAi group, followed by ABOc + HLAi and ABOi + HLAc, lowest in the ABOc + HLAc category. Mean time to first episode of graft dysfunction was significantly shorter with incompatible transplants. There were no kidney transplant recipient deaths in the study. CONCLUSION Patient outcome and graft outcomes observed with incompatible transplants were not worse than those observed with compatible transplants.
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Affiliation(s)
- Prashant Pandey
- Department of Transfusion Medicine, Histocompatibility and Molecular Biology, Jaypee Hospital, Noida, India
| | - Divya Setya
- Department of Transfusion Medicine, Histocompatibility and Molecular Biology, Jaypee Hospital, Noida, India
| | - Vijay Kumar Sinha
- Department of Nephrology and Renal Transplantation, Jaypee Hospital, Noida, India
| | - Amit K Devra
- Department of Nephrology and Renal Transplantation, Jaypee Hospital, Noida, India
| | - Anil Prasad Bhatt
- Department of Nephrology and Renal Transplantation, Jaypee Hospital, Noida, India
| | - Amit Pande
- Department of Transfusion Medicine, Histocompatibility and Molecular Biology, Jaypee Hospital, Noida, India
| | - Praveen Kumar
- Department of Transfusion Medicine, Histocompatibility and Molecular Biology, Jaypee Hospital, Noida, India
| | - Mukesh Kumar Singh
- Department of Transfusion Medicine, Histocompatibility and Molecular Biology, Jaypee Hospital, Noida, India
| | - Shweta Ranjan
- Department of Transfusion Medicine, Histocompatibility and Molecular Biology, Jaypee Hospital, Noida, India
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Faqihi F, Alharthy A, Memish ZA, Kutsogiannis DJ, Brindley PG, Karakitsos D. Peripheral neuropathy in severe COVID-19 resolved with therapeutic plasma exchange. Clin Case Rep 2020; 8:3234-3239. [PMID: 33230414 PMCID: PMC7675564 DOI: 10.1002/ccr3.3397] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022] Open
Abstract
Peripheral neuropathies including Guillain-Barré syndrome may be linked to life-threatening COVID-19. Plasma exchange is a safe rescue therapy in severe COVID-19 with associated neurological manifestations and thromboinflammation.
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Affiliation(s)
- Fahad Faqihi
- Critical Care DepartmentKing Saud Medical CityRiyadhSaudi Arabia
| | | | - Ziad A. Memish
- Research and Innovation CenterKing Saud Medical CityRiyadhSaudi Arabia
| | - Demetrios J. Kutsogiannis
- Department of Critical CareFaculty of Medicine and DentistryThe University of AlbertaEdmontonALCanada
| | - Peter G. Brindley
- Department of Critical CareFaculty of Medicine and DentistryThe University of AlbertaEdmontonALCanada
| | - Dimitrios Karakitsos
- Critical Care DepartmentKing Saud Medical CityRiyadhSaudi Arabia
- Critical Care DepartmentKeck School of MedicineUSCLos AngelesCAUSA
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García-García I, Cid J, Palomino A, Giné E, Alvarez-Larrán A, Cibeira MT, Lozano M. Role of therapeutic plasma exchanges in refractory severe warm autoimmune hemolytic anemia: Presentation of two case reports. Transfusion 2020; 60:2753-2757. [PMID: 33089904 DOI: 10.1111/trf.16143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Warm autoimmune hemolytic anemia (WAIHA) is a disorder with a usually good response to corticosteroid treatment, whereas in some cases first-line treatment's response is poor and other therapies such as intravenous immunoglobulins (IVIGs), rituximab, or splenectomy must be applied. STUDY DESIGN AND METHODS Herein, we describe two patients with severe WAIHA treated at our center, who obtained a response after therapeutic plasma exchanges (TPEs) combined with low doses of IVIG. RESULTS The first patient was an 18-year-old man with no relevant past medical history who was diagnosed with WAIHA. The patient presented a progressive clinical worsening despite treatment with prednisone, IVIG, and rituximab. After starting TPEs, signs of hemolysis rapidly improved and hemoglobin started to recover. The second patient was a 38-year-old man with a past history of immune thrombocytopenia and WAIHA. The patient presented a new flare of WAIHA, with no response after 2 weeks of treatment with corticosteroids, IVIG, and rituximab. After initiation of TPEs, the patient had an improvement in hemolysis biomarkers and recovery of hemoglobin concentration. CONCLUSION Combination of TPEs with rituximab and IVIG might be considered as a therapeutic option in patients with severe WAIHA without response to corticosteroid and IVIG treatment.
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Affiliation(s)
- Irene García-García
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Hematology and Hemotherapy, Hospital Ramón y Cajal, Madrid, Spain
| | - Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alicia Palomino
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Eva Giné
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alberto Alvarez-Larrán
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - María T Cibeira
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
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128
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Alharthy A, Faqihi F, Balhamar A, Memish ZA, Karakitsos D. Life-threatening COVID-19 presenting as stroke with antiphospholipid antibodies and low ADAMTS-13 activity, and the role of therapeutic plasma exchange: A case series. SAGE Open Med Case Rep 2020; 8:2050313X20964089. [PMID: 33101686 PMCID: PMC7550946 DOI: 10.1177/2050313x20964089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
We present a case series of three patients with COVID-19 who were admitted to our intensive care unit due to acute respiratory distress syndrome, brain infarction, pulmonary embolism, and antiphospholipid antibodies. We applied therapeutic plasma exchange on all cases. On intensive care unit admission, all patients had low (<10) Glasgow Coma Scale, and central nervous imaging showed multiple brain infarctions. COVID-19 was confirmed by reverse transcriptase polymerase chain reaction assays. Patients underwent rescue therapeutic plasma exchange using the Spectra OptiaTM Apheresis System (Terumo BCT Inc., USA), which operates with acid-citrate dextrose anticoagulant as per Kidney Disease Improving Global Outcomes 2019 guidelines. A dose of 1.5 plasma volume was used for the first dose and then 1 plasma volume daily for a total of five doses. Plasma was replaced with Octaplas LG® (Octapharma AG, USA), which is an artificial fresh frozen plasma product that has undergone viral inactivation by prion reduction technology. We administered ARDS-net/prone positioning ventilation, empiric antiviral treatment, therapeutic anticoagulation, and intensive care unit supportive care. Laboratory tests showed lymphocytopenia; elevated levels of D-dimer, fibrinogen, total bilirubin, C-reactive protein, lactate dehydrogenase, and ferritin; as well as low levels of ADAMTS-13 activity and antibody. Serology tests depicted positive IgM and IgG antiphospholipid antibodies (anti-cardiolipin and anti-β2-glycoprotein I antibodies). No side effects of therapeutic plasma exchange were recorded. After the completion of therapeutic plasma exchange, patients improved clinically and gradually recovered neurologically (after 27-32 days). To conclude, in life-threatening COVID-19, especially when immune dysregulation features such as antiphospholipid antibodies exist, therapeutic plasma exchange could be an effective rescue therapy.
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Affiliation(s)
| | - Fahad Faqihi
- Critical Care Department, King Saud
Medical City, Riyadh, Saudi Arabia
| | - Abdullah Balhamar
- Critical Care Department, King Saud
Medical City, Riyadh, Saudi Arabia
| | - Ziad A Memish
- Research and Innovation Center, King
Saud Medical City, Riyadh, Saudi Arabia
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129
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Wijewickrama ES, Gooneratne LV, Gnanathasan A, Gawarammana I, Gunatilake M, Isbister GK. Thrombotic microangiopathy and acute kidney injury following Sri Lankan Daboia russelii and Hypnale species envenoming. Clin Toxicol (Phila) 2020; 58:997-1003. [PMID: 32067496 DOI: 10.1080/15563650.2020.1717509] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/18/2019] [Accepted: 01/12/2020] [Indexed: 10/25/2022]
Abstract
Context: Thrombotic microangiopathy (TMA) resulting in acute kidney injury (AKI) is an important complication of venomous snakebites. We aimed to describe TMA secondary to Russell's viper (Daboia russelli) and hump-nosed viper (Hypnale spp.) bites and assess the effect of different treatments.Materials and methods: We undertook a prospective observational study of patients with AKI secondary to snakebite over a two-year period. Data recorded included: demographic details, clinical and laboratory features, treatment, complications and outcomes, until hospital discharge and at three months post-discharge. TMA was defined as the development of microangiopathic hemolytic anemia and thrombocytopenia along with AKI. Treatment with therapeutic plasma exchange (TPE; also known as plasmapheresis) and/or fresh frozen plasma (FFP) was determined by the treating clinician. Antivenom was given to all patients with evidence of systemic envenoming following Russell's viper bites.Results: Fifty-nine patients were included in the analysis. Thirty-three (56%) were males and median age was 56 years. Forty-five (76%) developed TMA while a further 11 and two developed isolated thrombocytopenia and microangiopathic hemolytic anemia, respectively. Presence of TMA was associated with increased dialysis requirements (5 vs. 3) and longer hospital stay (18 vs. 12 days). Of the patients with TMA, nine received TPE with or without FFP infusions. The use of TPE was not associated with improved outcomes in patients with TMA based on requirement for blood transfusion, recovery of thrombocytopenia, requirement of dialysis and duration of hospital stay. Patients who did not receive TPE had better renal function at three months compared to patients who received this treatment.Conclusion: Presence of TMA in patients with Daboia and Hypnale bites was associated with a more prolonged course of AKI. Patients with TMA who were treated with TPE did not have improved early or late outcomes compared to patients who were not treated with TPE.
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Affiliation(s)
- Eranga S Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Lalindra V Gooneratne
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ariaranee Gnanathasan
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Indika Gawarammana
- Department of Medicine and South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Mangala Gunatilake
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Pongsittisak W, Satpanich P, Kurathong S. Therapeutic plasma exchange with standard hemodialysis machine as an alternative to dedicated apheresis device: A 5-year experience. J Clin Apher 2020; 36:183-185. [PMID: 32947645 DOI: 10.1002/jca.21841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/29/2020] [Accepted: 09/07/2020] [Indexed: 11/06/2022]
Abstract
Patients suffering from various diseases have been shown to benefit from therapeutic plasma exchange (TPE). However, in developing countries, there are many obstacles hindering the establishment and initiation of TPE programs. These include inadequate funding and lack of government healthcare coverage. Our center in Thailand practices a unique membrane plasma separator technique using a hemodialysis machine incorporated with a plasma separator. Over a 5 year period, there were 130 such sessions conducted in 24 patients. The indications for TPE treatment included neurological, hematological, and nephrological diseases. Overall, response to TPE was good. Some TPE-related adverse events did occur, but none were life-threatening. Unfortunately, infection remained a problem and was sometimes a cause of death. Future challenges include minimization of infection rates and making TPE treatment readily accessible to patients.
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Affiliation(s)
- Wanjak Pongsittisak
- Renal Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Panchalee Satpanich
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sathit Kurathong
- Renal Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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131
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Keith PD, Scott LK, Weaver KE, Day M, Choe C, Perkins L, Moyer L, Hays E, French M, Hewitt K, Gravel G, Guffey A, Goldberg C, Carcillo J. Treatment of Critically Ill Coronavirus Disease 2019 Patients With Adjunct Therapeutic Plasma Exchange: A Single-Center Retrospective Case Series. Crit Care Explor 2020; 2:e0223. [PMID: 32984840 PMCID: PMC7505331 DOI: 10.1097/cce.0000000000000223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Philip D Keith
- Critical Care Medicine, Lexington Medical Center, West Columbia, SC
| | - L Keith Scott
- Division of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Kathryn E Weaver
- Departments of Social Sciences and Health Policy & Implementation Science, Wake Forest School of Medicine, Winston Salem, NC
| | - Matthew Day
- Critical Care Medicine, Lexington Medical Center, West Columbia, SC
| | - Carol Choe
- Critical Care Medicine, Lexington Medical Center, West Columbia, SC
| | - Linda Perkins
- Critical Care Medicine, Lexington Medical Center, West Columbia, SC
| | - Louis Moyer
- Critical Care Medicine, Lexington Medical Center, West Columbia, SC
| | - Erin Hays
- Critical Care Medicine, Lexington Medical Center, West Columbia, SC
| | - Marshall French
- Critical Care Medicine, Lexington Medical Center, West Columbia, SC
| | - Kristi Hewitt
- Critical Care Medicine, Lexington Medical Center, West Columbia, SC
| | - Gretchen Gravel
- Critical Care Medicine, Lexington Medical Center, West Columbia, SC
| | - Amanda Guffey
- Critical Care Clinical Pharmacy, Lexington Medical Center, West Columbia, SC
| | | | - Joseph Carcillo
- Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
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Chuliber FA, Penchasky D, Santoro DM, Viñuales S, Otero V, Villagra Iturre M, Privitera V, Mezzarobba D, Burgos Pratx L, López MS, Barrera L, Schutz N, Arbelbide J, Martinuzzo M. Acquired factor XIII deficiency in patients under therapeutic plasma exchange: A poorly explored etiology. J Clin Apher 2020; 36:59-66. [PMID: 32942343 DOI: 10.1002/jca.21840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/19/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Factor XIII (FXIII) deficiency may cause bleeding under certain clinical circumstances. Therapeutic plasma exchange (TPE) may lead to a transient deficiency. OBJECTIVES To describe the clinical evolution of patients with acquired FXIII deficiency secondary to TPE. METHODS We respectively studied a cohort of consecutive patients from 2014 to 2019 who were treated with TPE with FXIII levels <50%. The FXIII was measured after the start of the TPE course, on days between the TPE sessions, due to suspected acquired deficiency. All TPE were performed using continuous flow cell separator. In all cases, the initial replacement fluid applied was albumin. Apheresis procedures were held at 24to 48 hours intervals. RESULTS Eighteen patients were included, 13 of them were recipients of kidney transplants. The main TPE prescription was humoral rejection. Median FXIII at diagnosis (measured on days between sessions of the TPE course) was 19%(IQR17-25). The median of apheresis procedures before measurement of FXIII was 3(IQR2-4). Among the total cohort, 10 patients suffered hemorrhages. None of the patients without history of kidney transplants had bleeding (n = 5), however, 10/13 with kidney transplants did. Five kidney transplant patients received therapy with FXIII concentrate because of life-threatening bleeding. In all cases, the bleeding stopped within the first 24 hours. All patients had their FXIII levels measured again after finishing the TPE course, with normal results. CONCLUSIONS TPE is an under-diagnosed cause of acquired FXIII deficiency since routine coagulation tests remain unaltered. It might cause major bleeding, particularly in patients with a recent history of surgery like kidney transplants.
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Affiliation(s)
| | - Diana Penchasky
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Mario Santoro
- Service of Transfusion Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Susana Viñuales
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Otero
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Verónica Privitera
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniela Mezzarobba
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Leandro Burgos Pratx
- Service of Transfusion Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marina Sol López
- Department of Applied Biochemistry, Section of Hematology and Hemostasis, Central Laboratory, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
| | - Luis Barrera
- Department of Applied Biochemistry, Section of Hematology and Hemostasis, Central Laboratory, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
| | - Natalia Schutz
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Arbelbide
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marta Martinuzzo
- Department of Applied Biochemistry, Section of Hematology and Hemostasis, Central Laboratory, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
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Dorst J, Fillies F, Dreyhaupt J, Senel M, Tumani H. Safety and Tolerability of Plasma Exchange and Immunoadsorption in Neuroinflammatory Diseases. J Clin Med 2020; 9:jcm9092874. [PMID: 32899499 PMCID: PMC7565027 DOI: 10.3390/jcm9092874] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022] Open
Abstract
Plasma exchange (PE) and immunoadsorption (IA) are frequently used for treatment of various autoimmune-mediated neurological diseases, including multiple sclerosis (MS), chronic inflammatory demyelinating polyneuropathy (CIDP), and Guillain-Barré syndrome (GBS). Although both methods are generally regarded as well-tolerated treatment options, evidence for safety and tolerability is low for most indications and largely relies on small case series. In this study, we retrospectively analysed adverse events (AEs) and laboratory changes in 284 patients with various neurological indications who received either PE (n = 65, 113 cycles) or IA (n = 219, 435 cycles) between 2013 and 2020 in our Neurology department. One standard treatment cycle for PE as well as IA consisted of five treatments on five consecutive days. During every treatment, the 2.0-2.5-fold individual plasma volume (PV) was treated in IA, while in PE, the 0.7-fold individual PV was replaced by human albumin solution. Overall, both methods showed an excellent safety profile; no deaths of life-threatening adverse events were recorded. Severe AEs (corresponding to grade 3 on the Common Terminology Criteria for Adverse Events grading scale v5.0) including three patients with sepsis, one pneumonia, and one pneumothorax were present in 5/435 IA cycles (1.1%); in the PE group, no severe AEs were recorded. Furthermore, although advantageous tolerability is generally considered the main advantage of IA over PE, we found that overall frequency of AEs (including grades 1 and 2) was higher in IA (67.1% of all cycles) compared to PE (35.4%; p < 0.001). The low incidence of AEs in PE might be caused by the lower PV exchanged during each treatment (0.7-fold) compared to previous studies which predominantly exchanged the 1.0-1.5-fold PV. In order to verify this hypothesis as well as confirming the efficacy of this lower-dosed scheme, prospective studies comparing different treatment regimens are needed.
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Affiliation(s)
- Johannes Dorst
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (F.F.); (M.S.); (H.T.)
- Correspondence:
| | - Frank Fillies
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (F.F.); (M.S.); (H.T.)
| | - Jens Dreyhaupt
- Institute for Epidemiology and Medical Biometry, University of Ulm, 89081 Ulm, Germany;
| | - Makbule Senel
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (F.F.); (M.S.); (H.T.)
| | - Hayrettin Tumani
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (F.F.); (M.S.); (H.T.)
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Saito T, Mizobuchi M, Miwa Y, Sugiyama M, Mima Y, Iida A, Kanazawa N, Morikawa T, Hayashi J, Fukuda K, Shikida Y, Suzuki T, Honda H. Anti-MDA-5 antibody-positive clinically amyopathic dermatomyositis with rapidly progressive interstitial lung disease treated with therapeutic plasma exchange: A case series. J Clin Apher 2020; 36:196-205. [PMID: 32823371 DOI: 10.1002/jca.21833] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 01/14/2023]
Abstract
We present six cases of antimelanoma differentiation-associated gene 5 antibody (anti-MDA5-Ab)-positive clinically amyopathic dermatomyositis (CADM) with rapidly progressive interstitial lung disease (RP-ILD), which is known to have a poor prognosis. The outcomes of these cases are described after treatment with therapeutic plasma exchange (TPE). Clinical and therapeutic data for patients with CADM with RP-ILD were collected retrospectively from medical records. All six patients received early intensive care including high-dose corticosteroids, intravenous cyclophosphamide, and a calcineurin inhibitor, but lung disease and hypoxia became more severe. TPE was performed over a median of 9.5 sessions (range 3-14) per patient, and the median duration from admission to TPE was 23 days. Three patients received combined direct hemoperfusion using a polymyxin B-immobilized fiber column (PMX-DHP) therapy on successive days to manage acute respiratory failure. Four patients survived and two died due to respiratory failure. In the survival cases, ferritin decreased, and ferritin and KL-6 were lower at diagnosis. The patients who died had a higher alveolar-arterial oxygen difference and more severe lung lesions at the time of initiation of TPE. These findings indicate that a combination of conventional therapy and TPE may be useful for improvement of the prognosis of CADM with RP-ILD at the early stage of onset.
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Affiliation(s)
- Tomohiro Saito
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Masahide Mizobuchi
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Yusuke Miwa
- Department of Medicine, Division of Rheumatology, Showa University School of Medicine, Tokyo, Japan
| | - Motonori Sugiyama
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Yuuki Mima
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Ayana Iida
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Nobuhiro Kanazawa
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Tomoki Morikawa
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Junichi Hayashi
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Kei Fukuda
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Yasuto Shikida
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Taihei Suzuki
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Hirokazu Honda
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
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135
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Tan AWK, Lim BSP, Hoe JKM, Hoi WH, Leow MKS. Therapeutic plasma exchange for control of thyroid storm. J Clin Apher 2020; 36:189-195. [PMID: 32823374 DOI: 10.1002/jca.21832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/23/2020] [Accepted: 08/06/2020] [Indexed: 12/26/2022]
Abstract
Therapeutic plasma exchange (TPE) for thyroid storm has recently been upgraded to a category II indication after decades though its recommendation level still remains at Grade 2C according to the American Society for Apheresis (ASFA). In the absence of prospective randomized controlled trials due to the rarity of thyroid storm, retrospective data from case series continue to elevate the clinical evidence supporting TPE as a life-saving modality for complicated thyroid storm patients. We report three cases of life-threatening thyroid storm from Graves' disease rescued by TPE via rapid reduction in circulating thyroid hormones. Each patient underwent TPE when it was judged that other thyroid storm treatment options were futile or unsafe. The first patient received 4 cycles of TPE while the second patient received 9 cycles of TPE, and the third patient received 2 cycles of TPE with satisfactory clinical improvement. Plasma FT4 and TSH receptor antibody levels of the first case declined by 41.3% and >50% respectively right after the first round of TPE; plasma FT4 of the second patient dropped by up to 31.6% during the course of TPE; plasma FT4 and TSH receptor antibody of the third patient declined by 66% and 56.2% respectively after the first cycle of TPE. This demonstrates the safety, efficacy, and feasibility of TPE in thyroid storm especially when other therapeutic interventions are contraindicated. TPE operates via the elimination of serum proteins-bound thyroid hormones, thyroid autoantibodies, cytokines, and catecholamines in addition to increasing unsaturated binding sites for thyroid hormones.
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Affiliation(s)
- Alvin W K Tan
- Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Brenda S P Lim
- Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Jeremy K M Hoe
- Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Wai H Hoi
- Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Melvin K S Leow
- Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore, Republic of Singapore.,Lee Kong Chian School of Medicine, Singapore, Republic of Singapore.,Duke-NUS Medical School, Singapore, Republic of Singapore.,Yong Loo Lin School of Medicine, Singapore, Republic of Singapore.,Singapore Institute for Clinical Sciences, A*STAR, Singapore, Republic of Singapore
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136
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Yamagata A, Arita M, Tanaka A, Tokioka F, Yoshida T, Nishimura K, Ishida T. Therapeutic plasma exchange for clinically amyopathic dermatomyositis (CADM) associated with rapidly progressive interstitial pneumonia. J Clin Apher 2020; 35:435-443. [PMID: 32810902 DOI: 10.1002/jca.21824] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients with clinically amyopathic dermatomyositis (CADM) with anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab) frequently develop rapidly progressive interstitial pneumonia (RPIP), often with fatal outcomes. Therapeutic plasma exchange (TPE) has been reported as effective against CADM-RPIP refractory to conventional immunosuppressive therapy. However, the detailed mechanisms by which TPE improves disease activity of CADM-RPIP remain unclear. AIM To elucidate the clinical and demographic characteristics of patients with anti-MDA5 Ab-positive CADM-RPIP treated with TPE and to analyze changes in laboratory findings before, during, and after TPE. MATERIALS & METHODS Patients hospitalized for CADM-RPIP and treated with TPE in 2017 and 2018 were analyzed retrospectively. RESULTS Three patients were successfully treated with TPE, with good tolerance. Anti-MDA5 Ab titers decreased significantly over the course of TPE. CONCLUSION We emphasize that TPE could represent an effective treatment option for CADM-RPIP refractory to traditional therapy. Removal of anti-MDA5 Ab and other pathogenic factors may facilitate favorable outcomes.
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Affiliation(s)
- Akira Yamagata
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Machiko Arita
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Ayaka Tanaka
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Fumiaki Tokioka
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Tomohiro Yoshida
- Department of Endocrinology and Rheumatology, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Keisuke Nishimura
- Department of Endocrinology and Rheumatology, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
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137
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Svedung Wettervik T, Kumlien E, Rostami E, Howells T, von Seth M, Velickaite V, Lewén A, Enblad P. Intracranial Pressure Dynamics and Cerebral Vasomotor Reactivity in Coronavirus Disease 2019 Patient With Acute Encephalitis. Crit Care Explor 2020; 2:e0197. [PMID: 32885174 DOI: 10.1097/CCE.0000000000000197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We describe the intracranial pressure dynamics and cerebral vasomotor reactivity in a coronavirus disease 2019 patient with acute encephalitis treated with cerebrospinal fluid drainage and therapeutic plasma exchange.
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138
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James TE, Martin LJ, Warkentin TE, Crowther MA. Catastrophic antiphospholipid syndrome refractory to high-dose intravenous immunoglobulin responsive to therapeutic plasma exchange. Platelets 2020; 32:828-831. [PMID: 32762580 DOI: 10.1080/09537104.2020.1802414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Catastrophic antiphospholipid syndrome (CAPS) involves sudden multiorgan dysfunction from thrombosis due to antibodies that cause platelet activation and endothelial dysfunction. Treatment variably combines anticoagulation, corticosteroid use, therapeutic plasma exchange (TPE), and high-dose intravenous immunoglobulin (IVIG). A 42-year-old male with antiphospholipid syndrome (APS) presented with severe thrombocytopenia, encephalopathy, cardiac ischemia, and acral purpuric cutaneous lesions. CAPS was identified and he received heparin infusion, methylprednisolone, and IVIG. On day 7 he developed new purpuric lesions on his right foot despite detectable arterial pulses representing new microthrombosis refractory to IVIG. He was treated with TPE which resolved the right foot ischemia and eventually his CAPS. To our knowledge, this is the first patient with CAPS reported that failed initial treatment with IVIG and subsequently had excellent response to TPE. Our observations also support recent literature indicating that onset of thrombocytopenia in APS is a warning of progression to CAPS requiring treatment escalation.
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Affiliation(s)
- Tyler E James
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Leslie J Martin
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Theodore E Warkentin
- Department of Medicine, McMaster University, Hamilton, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.,Division of Hematology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Mark A Crowther
- Department of Medicine, McMaster University, Hamilton, Canada.,Division of Hematology, Department of Medicine, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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139
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Yesilbas O, Yozgat CY, Akinci N, Sonmez S, Tekin E, Talebazadeh F, Jafarov U, Temur HO, Yozgat Y. Acute Myocarditis and Eculizumab Caused Severe Cholestasis in a 17-Month-Old Child Who Has Hemolytic Uremic Syndrome Associated with Shiga Toxin-Producing Escherichia coli. J Pediatr Intensive Care 2020; 10:216-220. [PMID: 34395040 DOI: 10.1055/s-0040-1713111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/02/2020] [Indexed: 10/23/2022] Open
Abstract
Cardiovascular involvement is uncommon in pediatric patients with hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC-HUS). In this case report we presented a case of 17-month-old toddler who had a sporadic type of STEC-HUS complicated by acute myocarditis. The patient was successfully treated by a single dose of eculizumab after six doses of therapeutic plasma exchange (TPE) were inefficient to prevent the cardiac complication. Hepatotoxicity was observed after a single dose of eculizumab. Hepatic and cholestatic enzyme levels slowly returned to normal within 6 months. To the best of our knowledge, this is the first case of myocarditis/cardiomyopathy treated with eculizumab in STEC-HUS. This case illustrates the need for vigilance regarding myocardial involvement and eculizumab-induced hepatotoxicity in STEC-HUS.
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Affiliation(s)
- Osman Yesilbas
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Nurver Akinci
- Department of Pediatric Nephrology, Bezmialem Vakif University, Istanbul, Turkey
| | - Sirin Sonmez
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Eser Tekin
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Faraz Talebazadeh
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Uzeyir Jafarov
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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140
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Atay G, Demirkol D. Therapeutic Plasma Exchange Application in Children Requires Individual Decision. J Pediatr Intensive Care 2020; 10:106-109. [PMID: 33884210 DOI: 10.1055/s-0040-1714098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/03/2020] [Indexed: 01/27/2023] Open
Abstract
Therapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain-Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.
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Affiliation(s)
- Gürkan Atay
- Department of Pediatric Intensive Care, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Demet Demirkol
- Department of Pediatric Intensive Care, Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Child Health Institute, Istanbul University, Istanbul, Turkey
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141
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Noppakun K, Kittipanyaworakun T, Ruengorn C, Vongsanim S, Saikam A, Khamlueang N. Plasma volume treated with double filtration plasmapheresis and outcomes of acute antibody-mediated rejection in kidney transplant recipients: A retrospective cohort study. Ther Apher Dial 2020; 25:341-349. [PMID: 32666667 DOI: 10.1111/1744-9987.13560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022]
Abstract
A retrospective cohort study was conducted to evaluate the association between the plasma volume treated by double filtration plasmapheresis and allograft outcomes for the treatment of acute antibody-mediated rejection in kidney transplant recipients. Patients were divided into two groups: group 1, plasma volume treated between 1 and <1.3 total plasma volume and group 2, plasma volume treated ≥1.3 total plasma volume. Primary outcome was ≥50% reduction of serum creatinine rising from baseline value at 1 month. A total of 32 courses (146 sessions) of double filtration plasmapheresis were performed; 17 and 15 courses in group 1 and group 2, respectively. Primary outcome occurred in 41% of group 1 and 40% of group 2 (adjusted risk ratio 1.15 [95%CI, 0.48-2.76]). Graft loss at 1 year did not differ between the two groups (adjusted hazard ratio 0.65 [95%CI, 0.23-1.87]). Infection tendency seemed to be higher in group 2 (40% vs 18%, P = .243).
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Affiliation(s)
- Kajohnsak Noppakun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Kidney Transplant and Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Thanapat Kittipanyaworakun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Surachet Vongsanim
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Kidney Transplant and Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anchalee Saikam
- Kidney Transplant and Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nikhom Khamlueang
- Kidney Transplant and Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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142
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Pandey PK, Bhatt AP, Sinha VK, Agarwal N, Agrawal G. Role of plasma exchange in management of patients clinically diagnosed of postpartum thrombotic microangiopathies: A retrospective observation from a tertiary health-care center. Asian J Transfus Sci 2020; 14:142-148. [PMID: 33767541 PMCID: PMC7983147 DOI: 10.4103/ajts.ajts_43_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/09/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction: Diagnosis of postpartum thrombotic microangiopathies in pregnancy is a challenge, but plasma exchange (PE) is life-saving in such cases. This study was conducted with the aim to find the result of the early start of PE in such patients. MATERIALS AND METHODS: There were a total of seven clinically diagnosed cases of post partum thrombotic microangiopathies (PP-TMA) where PE was done. The diagnosis of PP-HUS and decision to start PE in such cases were based on the classical triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. All the PE procedures were done using fully automatic COM.TEC (Fresenius Kabi, Germany). RESULTS: Immediately before the start of PE, the mean platelet count and serum lactate dehydrogenase (LDH) and hemoglobin (Hb) were 53.1 × 109/L, 10,943 IU/L, and 6.4 gm%, respectively. After seven sessions of PE, platelet count improved to 158 × 109/L and LDH dropped to 609 IU/L, and Hb improved to 10.3 gm% (P < 0.05). We got a positive renal response in four patients in whom serum creatinine value reached within normal range while in the remaining three patients, no positive renal response was obtained and serum creatinine remained above normal range. Thus, the response of PE was shown to be inadequate in three patients. Compliance to PE was good. Patients were discharged after 20 days (mean) of hospital admission. CONCLUSION: PE is life-saving in PP-HUS. High degree of clinical suspicion to it and early start of PE were crucial for successful outcome in our patient population.
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Affiliation(s)
| | - Anil Prasad Bhatt
- Department of Nephrology, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - Vijay Kumar Sinha
- Department of Nephrology, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - Nitin Agarwal
- Department of Transfusion Medicine, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - Gyanendra Agrawal
- Department of Nephrology, Jaypee Hospital, Noida, Uttar Pradesh, India
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143
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Gala-Błądzińska A, Mazur K, Dębiec A, Gargasz K, Bartosik-Psujek H. Safety and tolerability of therapeutic plasma exchange in autoimmune neurological diseases - a retrospective single-centre analysis. Neurol Neurochir Pol 2020; 54:344-349. [PMID: 32557528 DOI: 10.5603/pjnns.a2020.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/20/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
CLINICAL RATIONALE FOR STUDY The sudden onset of autoimmune neurological diseases often threatens life. In such clinical situations, fast, effective and safe treatment is needed. Therapeutic plasma exchange (TPE) is an option in the treatment of autoimmune disorders. AIM OF STUDY The aim was to assess the tolerability and safety of membrane-based therapeutic plasma exchange (mTPE) in patients with autoimmune neurological diseases. MATERIALS AND METHODS A total of 410 TPE treatments were performed in 91 adult patients. The main reasons for performing TPE were: Guillain-Barre syndrome (39.56%), chronic inflammatory demyelinating polyradiculoneuropathy (20.88%), and myasthenia gravis (17.58%). RESULTS A total of 183 (44.6%) mTPE treatments were performed without complications. In 18 (19.8%) patients, there were no complications observed in any of the mTPE procedures (a total of 83 procedures). Serious and life-threatening complications occurred during four (0.97%) mTPEs. The most common abnormality in laboratory tests was hypocalcaemia. In patients with a fibrinogen c oncentration ≥ 2 .63 g /L, m easured before the second plasmapheresis, coagulation in the TPE filter was more f requently o bserved (p = 0 .04). CONCLUSIONS AND CLINICAL IMPLICATIONS Our study proves that the use of plasmapheresis conducted by filtration in the treatment of autoimmune neurological diseases is safe and well tolerated.
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Affiliation(s)
- Agnieszka Gala-Błądzińska
- University of Rzeszow, Collegium Medicum, Institute of Medical Sciences, Al. W. Kopisto 2A, 35-959 Rzeszów, Poland. .,Department of Internal Medicine, Nephrology and Endocrinology, St. Queen Jadwiga Clinical District Hospital No2 in Rzeszów, ul. Lwowska 60, 35-301 Rzeszów, Poland.
| | - Katarzyna Mazur
- Department of Internal Medicine, Nephrology and Endocrinology, St. Queen Jadwiga Clinical District Hospital No2 in Rzeszów, ul. Lwowska 60, 35-301 Rzeszów, Poland
| | - Adam Dębiec
- Neurology Clinic, St. Queen Jadwiga Clinical District Hospital No. 2 in Rzeszow, ul. Lwowska 60, 35-301 Rzeszów, Poland
| | - Krzysztof Gargasz
- University of Rzeszow, Collegium Medicum, Institute of Medical Sciences, Al. W. Kopisto 2A, 35-959 Rzeszów, Poland
| | - Halina Bartosik-Psujek
- University of Rzeszow, Collegium Medicum, Institute of Medical Sciences, Al. W. Kopisto 2A, 35-959 Rzeszów, Poland.,Neurology Clinic, St. Queen Jadwiga Clinical District Hospital No. 2 in Rzeszow, ul. Lwowska 60, 35-301 Rzeszów, Poland
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144
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Keith P, Day M, Choe C, Perkins L, Moyer L, Hays E, French M, Hewitt K, Gravel G, Guffey A, Scott LK. The successful use of therapeutic plasma exchange for severe COVID-19 acute respiratory distress syndrome with multiple organ failure. SAGE Open Med Case Rep 2020; 8:2050313X20933473. [PMID: 32595974 PMCID: PMC7303771 DOI: 10.1177/2050313x20933473] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has brought about an urgent need for effective treatment, while conserving vital resources such as intensive care unit beds and ventilators. Antivirals, convalescent plasma, and biologics have been used with mixed results. The profound "cytokine storm" induced endotheliopathy and microthrombotic disease in patients with COVID-19 may lead to acute respiratory distress syndrome, sepsis, and multi-organ failure. We present a case of SARS-COV2 pneumonia with septic shock and multi-organ failure that demonstrated significant clinical improvement after therapeutic plasma exchange. A 65-year-old female with multiple comorbidities presented with progressive dyspnea and dry cough. She was found to be COVID-19 positive with pneumonia, and developed progressive hypoxemia and shock requiring vasopressors, cardioversion, and non-invasive positive pressure ventilation. Given her worsening sepsis with multi-organ failure, she underwent therapeutic plasma exchange with rapid clinical improvement. Her case supports the theory that plasma exchange may help abate the "cytokine storm" induced endotheliopathy and microthrombosis associated with COVID-19. Further studies are needed to identify markers of this pathway and the potential role of plasma exchange in these critically ill patients.
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Affiliation(s)
- Philip Keith
- Critical Care Medicine, Lexington
Medical Center, West Columbia, SC, USA
| | - Matthew Day
- Critical Care Medicine, Lexington
Medical Center, West Columbia, SC, USA
| | - Carol Choe
- Critical Care Medicine, Lexington
Medical Center, West Columbia, SC, USA
| | - Linda Perkins
- Critical Care Medicine, Lexington
Medical Center, West Columbia, SC, USA
| | - Lou Moyer
- Critical Care Medicine, Lexington
Medical Center, West Columbia, SC, USA
| | - Erin Hays
- Critical Care Medicine, Lexington
Medical Center, West Columbia, SC, USA
| | - Marshall French
- Critical Care Medicine, Lexington
Medical Center, West Columbia, SC, USA
| | - Kristi Hewitt
- Critical Care Medicine, Lexington
Medical Center, West Columbia, SC, USA
| | - Gretchen Gravel
- Critical Care Medicine, Lexington
Medical Center, West Columbia, SC, USA
| | - Amanda Guffey
- Critical Care Medicine, Lexington
Medical Center, West Columbia, SC, USA
| | - L Keith Scott
- Division of Trauma and Surgical Critical
Care, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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145
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Affiliation(s)
- Li Zhang
- Department of Infectious Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Hui Zhai
- Department of Infectious Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Shasha Ma
- Department of Infectious Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Jiasheng Chen
- Department of Infectious Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yu Gao
- School of Life Science, Bengbu Medical College, Bengbu, China
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146
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Dhakal B, Miller S, Rein L, Pathak LK, Gloria L, Szabo A, Giri S, Chhabra S, Hamadani M, Paner A, Padmanabhan A, Janz S, D'Souza A, Hari P. Trends in the use of therapeutic plasma exchange in multiple myeloma. J Clin Apher 2020; 35:307-315. [PMID: 32516865 DOI: 10.1002/jca.21798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/29/2020] [Accepted: 05/15/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) is traditionally performed for hyperviscosity, neuropathy and to mitigate renal injury in the setting of high clonal free light chain burden in patients with multiple myeloma (MM) with unknown clinical benefit. MATERIALS AND METHODS Retrospective study of adults ≥18 years with MM who received TPE in the in-patient setting in the United States from 1993 to 2015. We examined the temporal trends of TPE utilization in MM hospitalizations, hospital charges, in-hospital mortality, and length of hospitalization and the predictors of in-hospital mortality and length of hospitalizations. RESULTS The number of MM-hospitalizations for TPE in adults increased significantly from 1993 to 2015 (1% in 1993-1999 to 2.1% in 2008-2015 of all MM discharges, P for trend <.0001). About 70% of TPE recipients had acute kidney injury (AKI). The median hospital charges increased 5-fold during the time period ($ 24 407 to $ 113 496; P for trend <.0001). In-hospital mortality decreased (17.5% (SE 2.66) in 1993-1997 to 8.7% (1.39) in 2007 to 2013) P for trend <.005) while the length of stay remained unchanged (11.2 days vs 11.9 days, P for trend 0.17). On adjusted analysis, significant predictors of in-hospital mortality among MM TPE recipients include, Charlson Comorbidity Index (CCI) (3 vs 2 adjusted odds ratio, aOR 2.16, 95% CI 1.26-3.71; P = .005), year (continuous) (aOR 0.93, 95% CI 0.90-0.96; P < .001) and race (other vs white; aOR 0.44, 95% CI 0.25-0.78; P = 0.004). CONCLUSIONS There has been a substantial increase in the use and associated cost of TPE in hospitalized MM patients.
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Affiliation(s)
- Binod Dhakal
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sophie Miller
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lisa Rein
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Lin Gloria
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Smith Giri
- Division of Hematology/Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Agne Paner
- Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, Illinois, USA
| | | | - Siegfried Janz
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Parameswaran Hari
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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147
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Mehdipour M, Skinner C, Wong N, Lieb M, Liu C, Etienne J, Kato C, Kiprov D, Conboy MJ, Conboy IM. Rejuvenation of three germ layers tissues by exchanging old blood plasma with saline-albumin. Aging (Albany NY) 2020; 12:8790-8819. [PMID: 32474458 PMCID: PMC7288913 DOI: 10.18632/aging.103418] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022]
Abstract
Heterochronic blood sharing rejuvenates old tissues, and most of the studies on how this works focus on young plasma, its fractions, and a few youthful systemic candidates. However, it was not formally established that young blood is necessary for this multi-tissue rejuvenation. Here, using our recently developed small animal blood exchange process, we replaced half of the plasma in mice with saline containing 5% albumin (terming it a "neutral" age blood exchange, NBE) thus diluting the plasma factors and replenishing the albumin that would be diminished if only saline was used. Our data demonstrate that a single NBE suffices to meet or exceed the rejuvenative effects of enhancing muscle repair, reducing liver adiposity and fibrosis, and increasing hippocampal neurogenesis in old mice, all the key outcomes seen after blood heterochronicity. Comparative proteomic analysis on serum from NBE, and from a similar human clinical procedure of therapeutic plasma exchange (TPE), revealed a molecular re-setting of the systemic signaling milieu, interestingly, elevating the levels of some proteins, which broadly coordinate tissue maintenance and repair and promote immune responses. Moreover, a single TPE yielded functional blood rejuvenation, abrogating the typical old serum inhibition of progenitor cell proliferation. Ectopically added albumin does not seem to be the sole determinant of such rejuvenation, and levels of albumin do not decrease with age nor are increased by NBE/TPE. A model of action (supported by a large body of published data) is that significant dilution of autoregulatory proteins that crosstalk to multiple signaling pathways (with their own feedback loops) would, through changes in gene expression, have long-lasting molecular and functional effects that are consistent with our observations. This work improves our understanding of the systemic paradigms of multi-tissue rejuvenation and suggest a novel and immediate use of the FDA approved TPE for improving the health and resilience of older people.
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Affiliation(s)
- Melod Mehdipour
- Department of Bioengineering and QB3, UC Berkeley, Berkeley, CA 94720, USA
| | - Colin Skinner
- Department of Bioengineering and QB3, UC Berkeley, Berkeley, CA 94720, USA
| | - Nathan Wong
- Department of Bioengineering and QB3, UC Berkeley, Berkeley, CA 94720, USA
| | - Michael Lieb
- Department of Bioengineering and QB3, UC Berkeley, Berkeley, CA 94720, USA
| | - Chao Liu
- Department of Bioengineering and QB3, UC Berkeley, Berkeley, CA 94720, USA
| | - Jessy Etienne
- Department of Bioengineering and QB3, UC Berkeley, Berkeley, CA 94720, USA
| | - Cameron Kato
- Department of Bioengineering and QB3, UC Berkeley, Berkeley, CA 94720, USA
| | - Dobri Kiprov
- California Pacific Medical Center, Apheresis Care Group, San-Francisco, CA 94115, USA
| | - Michael J. Conboy
- Department of Bioengineering and QB3, UC Berkeley, Berkeley, CA 94720, USA
| | - Irina M. Conboy
- Department of Bioengineering and QB3, UC Berkeley, Berkeley, CA 94720, USA
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148
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Gui RY, Huang QS, Cai X, Wu J, Liu HX, Liu Y, Yang LH, Zhang JY, Cheng YF, Jiang M, Mao M, Fang MY, Liu H, Wang LR, Wang Z, Zhou HB, Lan H, Jiang ZX, Shen XL, Zhang L, Fan SJ, Li Y, Wang QF, Huang XJ, Zhang XH. Development and validation of a prediction model (AHC) for early identification of refractory thrombotic thrombocytopenic purpura using nationally representative data. Br J Haematol 2020; 191:269-281. [PMID: 32452543 DOI: 10.1111/bjh.16767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023]
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare and life-threatening haematological emergency. Although therapeutic plasma exchange together with corticosteroids achieve successful outcomes, a considerable number of patients remain refractory to this treatment and require early initiation of intensive therapy. However, a method for the early identification of refractory iTTP is not available. To develop and validate a model for predicting the probability of refractory iTTP, a cohort of 265 consecutive iTTP patients from 17 large medical centres was retrospectively identified. The derivation cohort included 94 patients from 11 medical centres. For the validation cohort, we included 40 patients from the other six medical centres using geographical validation. An easy-to-use risk score system was generated, and its performance was assessed using internal and external validation cohorts. In the multivariable logistic analysis of the derivation cohort, three candidate predictors were entered into the final prediction model: age, haemoglobin and creatinine. The prediction model had an area under the curve of 0.886 (95% CI: 0.679-0.974) in the internal validation cohort and 0.862 (95% CI: 0.625-0.999) in the external validation cohort. The calibration plots showed a high agreement between the predicted and observed outcomes. In conclusion, we developed and validated a highly accurate prediction model for the early identification of refractory iTTP. It has the potential to guide tailored therapy and is a step towards more personalized medicine.
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Affiliation(s)
- Ruo-Yun Gui
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.,National Clinical Research Center for Hematologic Disease, Beijing, China.,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.,Collaborative Innovation Center of Hematology, Peking University, Beijing, China
| | - Qiu-Sha Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.,National Clinical Research Center for Hematologic Disease, Beijing, China.,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.,Collaborative Innovation Center of Hematology, Peking University, Beijing, China
| | - Xuan Cai
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.,National Clinical Research Center for Hematologic Disease, Beijing, China.,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.,Collaborative Innovation Center of Hematology, Peking University, Beijing, China
| | - Jin Wu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.,National Clinical Research Center for Hematologic Disease, Beijing, China.,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.,Collaborative Innovation Center of Hematology, Peking University, Beijing, China
| | - Hui-Xin Liu
- Department of Clinical Epidemiology, Peking University People's Hospital, Beijing, China
| | - Yi Liu
- Department of Hematology, Navy General Hospital, Beijing, China
| | - Lin-Hua Yang
- Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing-Yu Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yun-Feng Cheng
- Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Min Mao
- Department of Hematology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, China
| | - Mei-Yun Fang
- Zhongshan Hospital Affiliated to Dalian University, Dalian, China
| | - Hui Liu
- Department of Hematology, Beijing Hospital, Beijing, China
| | - Li-Ru Wang
- Department of Hematology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Zhao Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - He-Bing Zhou
- Department of Hematology, Beijing LuHe Hospital, Capital Medical University, Beijing, China
| | - Hai Lan
- Department of Hematology, ShunDe Hospital of GuangZhou University of Chinese Medicine, GuangZhou, China
| | - Zhong-Xing Jiang
- Department of Hematology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xu-Liang Shen
- Department of Hematology, He Ping Central Hospital of the Changzhi Medical College, Changzhi, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Sheng-Jin Fan
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yueying Li
- CAS Key Laboratory of Genomic and Precision Medicine, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China.,China National Center for Bioinformation, Beijing, China
| | - Qian-Fei Wang
- CAS Key Laboratory of Genomic and Precision Medicine, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China.,China National Center for Bioinformation, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.,National Clinical Research Center for Hematologic Disease, Beijing, China.,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.,Collaborative Innovation Center of Hematology, Peking University, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.,National Clinical Research Center for Hematologic Disease, Beijing, China.,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.,Collaborative Innovation Center of Hematology, Peking University, Beijing, China
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149
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Simenson V, Burton J, Del Toro A, Alquist CR. Acute thrombotic thrombocytopenic purpura in Louisiana: Seasonal distribution and evaluation of an ADAMTS13 order screening protocol. J Clin Apher 2020; 35:264-270. [PMID: 32408376 DOI: 10.1002/jca.21786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder caused by inactivation of ADAMTS13. It is characterized by thrombocytopenia and microangiopathic hemolytic anemia. Previous studies have produced conflicting data regarding seasonal association of TTP diagnoses. This study evaluated the seasonal distribution of acute TTP in southern Louisiana. Additionally, this study timeline overlapped with the initiation of a new screening protocol for ADAMTS13 testing. STUDY DESIGN AND METHODS A retrospective analysis of patients receiving ADAMTS13 testing at Ochsner Medical Center from January 2010 to December 2017 was performed. TTP patient episodes were defined by ADAMTS13 activity <10%. Episodes were plotted according to season of presentation and a chi-square analysis was performed. Data of identified TTP patients was analyzed to evaluate for confounding variables. ADAMTS13 order volumes and results before and after screening protocol implementation were compared. RESULTS Two hundred and fifty-two ADAMTS13 tests were ordered on 245 unique patients. Twenty-five patients had ADAMTS13 activity <10%. No significant differences in seasonal TTP case distribution were identified. Patients with confirmed TTP were younger and more likely to be Black or African American. A screening protocol did not decrease the number of annual ADAMTS13 test orders in our time frame, but was associated with a nonsignificant increase in the percentage of positive results. CONCLUSION No significant seasonal distribution of TTP was identified in our population. This analysis provides previously unexamined regional information regarding this diagnosis. The number of tests ordered after the implementation of the screening protocol increased, corresponding with our facility's expanding reach.
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Affiliation(s)
- Victoria Simenson
- Department of Internal Medicine, Ochsner Health System, New Orleans, Louisiana, USA
| | - Jeffrey Burton
- Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, Louisiana, USA
| | - Alejandra Del Toro
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Caroline Raasch Alquist
- Department of Pathology & Laboratory Medicine, Ochsner Health System, New Orleans, Louisiana, USA
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA
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150
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Beydoun HA, Beydoun MA, Hossain S, Zonderman AB, Eid SM. Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain-Barré syndrome. Muscle Nerve 2020; 61:608-615. [PMID: 32052454 PMCID: PMC11008558 DOI: 10.1002/mus.26831] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND We compared outcomes of therapeutic plasma exchange (TPE) vs intravenous immunoglobulin (IVIG) among hospitalized patients diagnosed with Guillain-Barré syndrome (GBS). METHODS In a retrospective cohort study of 6642 records (2637 TPE and 4005 IVIG) from the 2002-2014 Nationwide Inpatient Sample, treatment type was examined as predictor of length of stay, total charges, and in-hospital death, with regression modeling using risk adjustment and propensity scoring to control for confounders. RESULTS Compared with those receiving IVIG, patients who underwent TPE experienced prolonged hospitalization by approximately 7.5 days, greater hospitalization costs by approximately $46,000, and increased in-hospital death with an odds ratio of 2.78. Results did not change after controlling for confounders through risk adjustment, propensity score adjustment, or matching. CONCLUSIONS TPE may be associated with poorer healthcare utilization outcomes vs IVIG, although confounding by indication could not be ascertained.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Virginia
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, Maryland
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, Maryland
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, Maryland
| | - Shaker M Eid
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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