Apheresis

Therapeutic plasma exchange in rheumatic diseases: a university hospital experience

INTRODUCTION

Each day, evidence accumulates related to the use of therapeutic plasma exchange (TPE) in patients with rheumatic diseases. San Ignacio University Hospital has recorded all of the TPE sessions performed by the institution's apheresis group.

OBJECTIVE

To describe the TPE experience of patients with rheumatologic diseases in a hospital setting.

METHODS

Descriptive, observational, retrospective analysis. This study included analyses of the TPE sessions that were performed in patients with rheumatic diseases from November 2009 to November 2013.

RESULTS

The apheresis group performed 136 sessions in 27 patients. The mean patient age was 43 years (SD 18.5), and 59.3% of the patients were female. Regarding the diagnosis, the most frequents ones where: ANCA-associated vasculitis followed by systemic lupus erythematosus and catastrophic antiphospholipid syndrome. The average number of sessions per patient was 5 (SD 1.8), and the average plasma exchange per patient was 1.3 plasma volume replacement units. The most used replacement solution was frozen fresh plasma (FFP; 63.2% of the sessions). Of all the sessions, 4.4% presented complications, and the majority of the complications were related to vascular access. Fifteen patients required renal replacement therapy (RRT) secondary to the same cause that created the need for TPE, 3 patients required RRT due to causes other than the TPE diagnostic intervention and 1 patient had undergone chronic dialysis.

CONCLUSIONS

TPE is a therapeutic alternative that is needed for the management of patients with rheumatic diseases with renal involvement and those who are refractory to conventional management. Our clinical results were in agreement with the global literature.

Effect of plasmapheresis on serum beta-endorphin levels

OBJECTIVES

The aim of this study was to examine the effects of plasmapheresis on serum beta-endorphin (BE) levels.

METHOD

The serum BE levels of 12 patients with various autoimmune or hematological disorders were monitored during plasmapheresis therapy.

RESULTS

BE levels increased after the initial session in 8 of 12 patients; in the remaining 4 patients no change (n = 2) or a decline (n = 2) in BE levels was found. However, no further changes were observed during subsequent therapy. During the last session, an elevation in the BE level was detected in 5 patients, with no change in 1 and a decrease in BE level in another 5 patients.

CONCLUSION

Our findings suggest that although plasmapheresis results in an elevation in serum BE levels initially, this change does not persist during subsequent sessions.

Vasculitis Following Treatment of Rheumatoid Arthritis with Extracorporeal Staphylococcal Protein A Immunoadsorption Column (Prosorba)

We report a case of vasculitis after Prosorba treatment in a patient with rheumatoid arthritis. The patient is a 66-year-old white male with long standing rheumatoid arthritis and hepatitis B. He was treated with the standard regimen for Prosorba treatment. He improved and met criteria for an American College of Rheumatology (ACR) 20% response. While on therapy he developed a nonhealing ulcer. Approximately 2 weeks after treatment was completed, he developed palpable purpura and mononeuritis multiplex. Deep dermal biopsy confirmed the presence of both small and medium vessel vasculitis. Nerve conductions studies were consistent with neuropathic conduction delays. He was treated with 1mg/kg/day of oral prednisone. Prosorba has been reported to cause leukocytoclastic vasculitis during treatment, but has not been noted to involve medium sized vessels. This patient's history and presentation are most consistent with rheumatoid arthritis associated vasculitis, though the Prosorba treatment cannot be ruled out as a cause or a contributing factor. Importantly, although Prosorba treated his synovitis, it did not prevent concomitant vasculitis.