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Saiki K, Sofue T, Higashiyama C, Shiga T, Aoki Y, Shiraishi A, Kunisho Y, Onishi K, Nakamura E, Ishida T, Minamino T. A case of hyperviscosity syndrome associated with Waldenström macroglobulinemia treated with membrane plasma exchange without predilution. CEN Case Rep 2024:10.1007/s13730-024-00912-z. [PMID: 38963601 DOI: 10.1007/s13730-024-00912-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/29/2024] [Indexed: 07/05/2024] Open
Abstract
A 75-year-old man with blurred vision and nasal bleeding was diagnosed with hyperviscosity syndrome and central retinal vein occlusion secondary to Waldenström macroglobulinemia. Serum total protein and IgM levels were undetectable. Because of the severe symptoms, we determined that immediate plasma-exchange treatment was required to decrease the blood viscosity. The initial plasma exchange was performed using the membrane isolation method with a predilution standby. A saline predilution replacement was prepared to decrease the total membrane pressure (TMP); however, the predilution protocol was not used because the planned treatment volume could be achieved without increasing the TMP. After two consecutive days of membrane plasma exchange, all serum biochemical tests were measurable, and IgM was below 4000 mg/dL. After chemotherapy, his visual symptoms improved, and he was discharged. Since it is difficult to assess the risk of elevated TMP prior to initial plasma exchange, membrane plasma exchange with a predilution standby may be a useful strategy for initial plasma exchange for hyperviscosity syndrome in terms of safety and efficiency.
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Affiliation(s)
- Koichi Saiki
- Department of CardioRenal and CerebroVascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Tadashi Sofue
- Department of CardioRenal and CerebroVascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Chikako Higashiyama
- Department of Clinical Engineering, Kagawa University Hospital, Kagawa, Japan
| | - Takafumi Shiga
- Department of CardioRenal and CerebroVascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yuhei Aoki
- Department of CardioRenal and CerebroVascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Aiko Shiraishi
- Department of CardioRenal and CerebroVascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yasushi Kunisho
- Department of CardioRenal and CerebroVascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Keisuke Onishi
- Department of CardioRenal and CerebroVascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Eisuke Nakamura
- Department of CardioRenal and CerebroVascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Tomoya Ishida
- Department of Hematology and Immunology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tetsuo Minamino
- Department of CardioRenal and CerebroVascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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Favi E, Molinari P, Alfieri C, Castellano G, Ferraresso M, Cresseri D. Case report: Eculizumab plus obinutuzumab induction in a deceased donor kidney transplant recipient with DEAP-HUS. Front Immunol 2022; 13:1073808. [PMID: 36591301 PMCID: PMC9795842 DOI: 10.3389/fimmu.2022.1073808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
The wide-spread use of the anti-complement component 5 monoclonal antibody (moAb) eculizumab has greatly reduced the incidence of relapsing atypical hemolytic uremic syndrome (aHUS) after kidney transplantation (KT). However, the optimal management of aHUS transplant candidates with anti-Complement Factor H (CFH) antibodies remains debated. In these patients, the benefits of chronic eculizumab administration should be weighed against the risk of fatal infections, repeated hospital admissions, and excessive costs. We report the case of a 45-year-old female patient with CFHR1/CFHR3 homozygous deletion-associated aHUS who underwent deceased-donor KT despite persistently elevated anti-CFH antibody titers. As induction and aHUS prophylaxis, she received a combination of eculizumab and obinutuzumab, a humanized type 2 anti-CD20 moAb. The post-operative course was uneventful. After 1-year of follow-up, she is doing well with excellent allograft function, undetectable anti-CFH antibodies, sustained B-cell depletion, and no signs of aHUS activity. A brief review summarizing current literature on the topic is also included. Although anecdotal, our experience suggests that peri-operative obinutuzumab administration can block anti-CFH antibodies production safely and effectively, thus ensuring long-lasting protection from post-transplant aHUS relapse, at a reasonable cost. For the first time, we have demonstrated in vivo that obinutuzumab B-cell depleting properties are not significantly affected by eculizumab-induced complement inhibition.
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Affiliation(s)
- Evaldo Favi
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy,*Correspondence: Evaldo Favi,
| | - Paolo Molinari
- Nephrology, Dialysis, and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Alfieri
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy,Nephrology, Dialysis, and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Castellano
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy,Nephrology, Dialysis, and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariano Ferraresso
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Donata Cresseri
- Nephrology, Dialysis, and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Lépine MS, Goua V, Debouverie OS, Giraud C, Rafat C, Thonier V, Masmouhi BE, Ndour CT, Huguet-Jacquot S, Mailloux A, Cortey A, Jouannic JM, Maisonneuve E. Multidisciplinary management of anti-PP1P k or anti-P alloimmunization during pregnancy: A new case with anti-P and a literature review. Transfusion 2021; 61:1972-1979. [PMID: 33811650 DOI: 10.1111/trf.16384] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Red blood cell alloimmunization is the first cause of fetal and neonatal anemia. Alloimmunizations with anti-PP1Pk or anti-P can cause recurrent miscarriages and hemolytic disease of the fetus and newborn in the 2nd and 3rd trimesters of pregnancy. We report on a pregnant patient immunized with anti-P and a history of recurrent miscarriages. CASE REPORT This P2 k (GLOB:-1; P1PK:-1,3) patient had a first pregnancy marked by a caesarean at 38 weeks of gestation (WG) for non-reassuring fetal heart rate. Then, she had three early spontaneous miscarriages. The fifth pregnancy began with a high titer of anti-P at 128. Early initiation of treatment with Intravenous Immunoglobulins (IVIg) and plasma exchanges (PE) starting at 5 WG permitted us to reduce the titer of anti-P below 32. A healthy infant was delivered by caesarean at 38 WG without anemia at birth and no exchange transfusion was required. DISCUSSION AND REVIEW OF THE LITERATURE The P and Pk antigens are expressed on placental, trophoblastic, and embryonic cells. This explains why P1 k (GLOB:-1; P1PK:1,3), P2 k (GLOB:-1; P1PK:-1,3), or Tj(a-)/p (GLOB:-1; P1PK:-1,-3) patients are prone to recurrent abortions in the first trimester of pregnancy. A literature review demonstrated 87% (68/78) of miscarriages in p patients. However, publication biases are possible with the most severe cases being reported. CONCLUSION Immunizations to P and PP1Pk antigens differ from others in their physiopathology and precocity. The association of PE and IVIg seems to be an effective treatment in the management of anti-PP1Pk or anti-P fetomaternal incompatibilities.
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Affiliation(s)
- Marlène Sohier Lépine
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers University, Poitiers, France
| | - Valérie Goua
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers University, Poitiers, France
| | - Odile Souchaud Debouverie
- Department of Internal Medicine, Poitiers University Hospital, Poitiers University, Poitiers, France
| | - Christine Giraud
- Department of Hematology, Poitiers University Hospital, Poitiers University, Poitiers, France.,Établissement Français du Sang (EFS), Poitiers, France
| | - Cédric Rafat
- Department of Nephrology and Kidney Transplantation, Tenon Hospital, Paris, France
| | - Vincent Thonier
- Centre National de Référence pour les Groupes Sanguins (CNRGS), Paris, France.,Institut National de la Transfusion Sanguine (INTS), Paris, France
| | | | - Cécile Toly Ndour
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
| | - Stéphanie Huguet-Jacquot
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
| | - Agnès Mailloux
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
| | - Anne Cortey
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
| | - Jean-Marie Jouannic
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
| | - Emeline Maisonneuve
- Department of Fetal Medicine, Trousseau Hospital, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP), Trousseau Hospital, Paris, France
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Maurizi-Balzan J, Jouve T, Naciri-Bennani H, Noble J, Tanoukhi K, Motte L, Malvezzi P, Rostaing L. [How to implement a complete apheresis program within a hemodialysis unit]. Nephrol Ther 2019; 15:439-447. [PMID: 31585841 DOI: 10.1016/j.nephro.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 12/13/2022]
Abstract
Many apheresis techniques can be performed in a blood-bank facility or a hemodialysis (HD) facility. However, it makes sense to perform apheresis in a hemodialysis facility as apheresis involves extra-corporeal circuits and because HD can be performed at the same time as apheresis (tandem procedure). Apheresis techniques comprise therapeutic plasma exchange, double-filtration plasmapheresis, and its derivative (rheopheresis and LDL-apheresis), and immunoadsorption (specific and semi-specific). We have setup an apheresis platform in our hospital that fulfills health recommendations. This process has involved financial investment and significant human resources, and has enabled us to network with different specialties (neurology, hematology, vascular medicine). We have setup protocols according to the type of pathology to be treated by apheresis, and to monitor clinical and biological data for each apheresis session. The main side effects of apheresis are a fall in blood pressure when a session is initiated, an increase in fluid overload, hypocalcemia, and the loss of some essential plasmatic factors. However, these side-effects are easily identified and can be properly managed in real time. Within two-years, we have performed 1845 apheresis sessions (134 patients). Of these, 66 received apheresis before and/or after kidney transplantation for ABO and/or HLA incompatibility (desensitization), for humoral rejection, or in the setting of relapsing focal-segmental glomerulosclerosis. Our patients' outcomes have been similar to those reported in the literature. The other 68 patients had various conditions. Because our program is now well-established, we are currently forming a specialist center to train physicians and nurses in the various apheresis techniques/procedures.
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Affiliation(s)
- Jocelyne Maurizi-Balzan
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France.
| | - Thomas Jouve
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Hamza Naciri-Bennani
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Johan Noble
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Khadija Tanoukhi
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Lionel Motte
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Paolo Malvezzi
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Lionel Rostaing
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
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Palma-Garcia L, Velásquez-Rimachi V, Pezo-Pezo A, Roig J, Perez-Villegas J. Therapeutic plasma exchange: Experience in a third level hospital, 2013-2016, Lima (Peru). J Clin Apher 2018. [PMID: 29536568 DOI: 10.1002/jca.21623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is an extracorporeal procedure which consists of removing the patient's plasma and replacing it with an appropriate replacement fluid. Plasma and blood cells are separated by a centrifugation process. Our department has used TPE for several years, and in 2013 we introduced an institutional apheresis protocol. The main objective of this report is to describe the TPE procedures performed between 2013 and 2016 in the Peruvian population. METHODS We analyzed the technical and clinical aspects of 864 centrifugal TPE procedures as well as the associated complications. We evaluated 230 patients treated in our institution. RESULTS The therapeutic indications included 16 different diseases: 89.5% (N = 206/230) neurological, 7.3% (N = 17/230) hematological, 1.7% (N = 4/230) rheumatologic, 0.8% (N = 2/230) dermatological and 0.4% (N = 1/230) nephrological. 70.4% (N = 142/230) of patients were diagnosed with Guillain-Barré syndrome. Albumin 5% solution was the most frequent replacement solution, used in 65.8% (N = 569/864) of the procedures. The mean plasma volume (PV) replaced was 2451.73 ml, corresponding to 1.0 PV in all procedures. Complications occurred in 10.9% (N = 95/864) of the sessions. Allergic reactions were the most common events and cardiopulmonary arrests were recorded in two patients. CONCLUSION This is the first report of TPE performed in the Peruvian population. The use of an institutional apheresis protocol was beneficial to improve registries in our service and our professional health attention. This study reports a low rate of complications, suggesting that TPE is safe. There is a need to create a multicenter Peruvian apheresis registry to assess the benefits and risks of TPE in Peru.
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Affiliation(s)
- Luis Palma-Garcia
- Hemotherapy Unit, National Hospital Dos de Mayo, Lima, Peru.,Hemotherapy Service Apheresis Group, National Dos de Mayo, Lima, Peru
| | - Victor Velásquez-Rimachi
- Hemotherapy Service Apheresis Group, National Dos de Mayo, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru.,Sociedad Científica de San Fernando, Lima, Peru
| | - Armando Pezo-Pezo
- Hemotherapy Service Apheresis Group, National Dos de Mayo, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru.,Sociedad Científica de San Fernando, Lima, Peru
| | | | - Julio Perez-Villegas
- Hemotherapy Service Apheresis Group, National Dos de Mayo, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru.,Neurological Unit, National Hospital Dos de Mayo, Lima, Peru
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