Pancytopenia with mixed cryoglobulinemia: evidence for anti-percursor cell activity of cryoglobulin--effects of plasmapheresis

Extracorporeal antibody elimination in neuroimmunological diseases

Extracorporeal procedures for the elimination of autoantibodies are an important therapeutic option in various neuroimmunological diseases, especially those with neuromuscular involvement. Recent advances with the development of selective apheresis methods have given extracorporeal therapeutic procedures a new perspective. In this article, we review the therapeutic use of plasma exchange and immunoadsorption therapy in different neuroimmunological diseases.

Plasmapheresis in paraproteinemia

Indications, results, techniques, laboratory monitoring and complications of therapeutic plasmapheresis in patients with symptomatic paraproteinemia are reviewed. In paraproteinemia associated with severe complications plasma-pheresis has been used successfully as an emergency treatment, as a treatment that reduces temporarily the paraprotein level until reduction of resynthesis is reached by cytotoxic therapy, or as a longterm adjuvant therapy in cases of slowly proliferating plasmacytoma or lymphoma. Plasmapheresis has not been shown to influence the underlying malignant process. Paraprotein-related complications that can be reduced by plasmapheresis are hyperviscosity, hypervolemia, haemorrhagic diathesis, cryoglobulinemic symptoms, rapidly deteriorating renal insufficiency, visual impairment, and neurologic disturbances. Technically, large-pored plasma filters have some advantage as compared to centrifugation techniques. Paraprotein-specific complications of therapeutic plasmapheresis are rare. As an ancillary treatment, therapeutic plasmapheresis has expanded the therapeutic tools in the management of paraproteinemia.

Immunosuppressive agents and plasmapheresis in immunological disorders

Plasmapheresis (PA) was introduced in the treatment of immunologically mediated disease at the beginning of last decade and it was initially claimed to be the panacea for several diseases. It was quickly realized that PA on its own did not have a sustained therapeutic effect and it was the immunosuppressive drugs which could help in the maintenance of an established effect. In this communication we review the immunoregulatory effects of several immunosuppressive agents and discuss their role when used in conjunction with PA primarily in the treatment of rheumatological disorders.