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Khodakarim N, Kalantari S, Riahi T, Moradians V, Talebi-Taher M, Yassin Z, Afshar H, Kooranifar S, Aloosh O, Ziaie S, Zamani N, Tirkan A, Ramim T. Effectiveness of Plasmapheresis Treatment in the Treatment of Patients with COVID-19 Disease. Med J Islam Repub Iran 2022; 36:83. [PMID: 36128282 PMCID: PMC9448457 DOI: 10.47176/mjiri.36.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
Abstract
Background: According to the World Health Organization, COVID-19 management focuses primarily on infection prevention, case management, case monitoring, and supportive care. However, due to the lack of evidence, no specific anti-SARS-CoV-2 treatment is recommended. This study aimed to evaluate the effectiveness of plasmapheresis treatment in COVID-19 patients with symptoms of pulmonary involvement on the computed tomography (CT) of the lung. Methods: In 2021, an experimental study in critically ill patients admitted to the COVID-19 ward in the Hazrat-e Rasool hospital diagnosed with COVID-19 was conducted in the second phase (pilot study). The diagnosis was confirmed according to clinical signs, CT scan of the lung, and the Polymerase chain reaction (PCR) test. All patients received the usual treatments for COVID-19 disease and underwent plasmapheresis at a dose of 40 cc/kg daily up to 4 doses. All patients were observed for 24 hours for complications of plasmapheresis treatment and simultaneously for symptoms of COVID-19, after which only routine care measures were performed. The next day and 2 weeks after resumption of the treatment, patients experienced COVID-19 symptoms, including shortness of breath, cough, and fever. Blood oxygen saturation, and treatment results were evaluated. Qualitative and rank variables were described using absolute and relative frequencies and quantitative parametric variables were used using mean and confidence interval. Frequencies were compared in groups using the chi-square test. All tests were performed in 2 directions and P > 0.05 was considered statistically significant. Results: Of the 120 patients studied, 79 (65.8%) were men and 41 (34.2%) were women. The mean age was 60.30 ± 15.61 years (22-95 years). The mean hospital stay was 12.89 days ± 7.25 days (2-38 days). Increased blood oxygen saturation levels in patients had an increasing trend. Inflammatory indices had a downward trend in patients. The frequency of plasmapheresis had no significant effect on reducing the downward trend of inflammatory markers. The greatest reduction occurred in the first plasmapheresis. Conclusion: Finally, according to the findings, plasmapheresis is one of the appropriate treatments to improve patients' symptoms and reduce cytokine storm. Recovered patients had lower levels of inflammatory markers than those who died.
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Affiliation(s)
- Nastaran Khodakarim
- Department of Internal Medicine, School of Medicine, Hazrat- e Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Kalantari
- Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Taghi Riahi
- Department of Internal Medicine, School of Medicine, Hazrat- e Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Vahan Moradians
- Department of Internal Medicine, School of Medicine, Hazrat- e Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshid Talebi-Taher
- Department of Infectious Disease, Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Zeynab Yassin
- Department of Infectious Disease, School of Medicine, Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hale Afshar
- Department of Pulmonary Medicine, School of Medicine, Hazrat- e Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Siavash Kooranifar
- Department of Internal Medicine, School of Medicine, Hazrat- e Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Oldooz Aloosh
- Department of Internal Medicine, School of Medicine, Hazrat- e Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Ziaie
- Department of Internal Medicine, School of Medicine, Hazrat- e Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nazanin Zamani
- Department of Internal Medicine, School of Medicine, Hazrat- e Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Atefe Tirkan
- Department of Internal Medicine, School of Medicine, Hazrat- e Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Tayeb Ramim
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran,Corresponding author: Tayeb Ramim,
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Diskin CJ, Maldonado R, Leon J, Dansby LM, Carter TB, Radcliff L, Diskin CD. How effective is rescue therapeutic plasma exchange in treatment of SARS-Coronavirus-2? Ther Apher Dial 2022; 27:170-176. [PMID: 35490343 PMCID: PMC9348252 DOI: 10.1111/1744-9987.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/13/2021] [Accepted: 04/26/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION After the FDA gave emergency approval for the use of therapeutic plasma exchange in treatment for SARS-Coronoavirus-2, we analyzed its efficacy in patients who had failed all other known therapies. METHODS This was a prospective observational study of 42 patients with SARS-Coronoavirus-2 who had failed conventional therapy and were treated with therapeutic plasma exchange. Pre- and postexchange clinical and laboratory parameters were monitored. The patients were then also compared with a group of 147 patients with SARS-Coronoavirus-2 who were referred for stage 3 acute renal failure and dialysis from SARS-Coronoavirus-2. RESULTS After therapeutic plasma exchange, there were significant improvements in some clinical parameters but mortality remained high; although better than the renal failure group (43.9% vs. 50.7%, p = 0.004). CONCLUSION SARS-CoV-2 patients who failed all other therapies had significant mortality with therapeutic plasma exchange; however, their survival was better than SARS-CoV-2 patients with stage 3 acute renal failure.
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Affiliation(s)
- Charles J. Diskin
- Hypertension, Nephrology, Dialysis & TransplantationOpelikaAlabamaUSA
| | - Ricardo Maldonado
- Department of Infectious DiseaseEast Alabama Medical CenterOpelikaAlabamaUSA
| | - Jose Leon
- East Alabama Rheumatology CenterOpelikaAlabamaUSA
| | - Linda M. Dansby
- Hypertension, Nephrology, Dialysis & TransplantationOpelikaAlabamaUSA
| | - Thomas B. Carter
- Hypertension, Nephrology, Dialysis & TransplantationOpelikaAlabamaUSA
| | - Lautrec Radcliff
- Hypertension, Nephrology, Dialysis & TransplantationOpelikaAlabamaUSA
| | - Charles D. Diskin
- Hypertension, Nephrology, Dialysis & TransplantationOpelikaAlabamaUSA
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Cegolon L, Einollahi B, Panahi Y, Imanizadeh S, Rezapour M, Javanbakht M, Nikpouraghdam M, Abolghasemi H, Mastrangelo G. On Therapeutic Plasma Exchange Against Severe COVID-19-Associated Pneumonia: An Observational Clinical Study. Front Nutr 2022; 9:809823. [PMID: 35308291 PMCID: PMC8926159 DOI: 10.3389/fnut.2022.809823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/10/2022] [Indexed: 12/17/2022] Open
Abstract
BackgroundThere is a risk of novel mutations of SARS-CoV-2 that may render COVID-19 resistant to most of the therapies, including antiviral drugs and vaccines. The evidence around the application of therapeutic plasma exchange (TPE) for the management of critically ill patients with COVID-19 is still provisional, and further investigations are needed to confirm its eventual beneficial effects.AimsTo assess the effect of TPE on the risk of mortality in patients with COVID-19-associated pneumonia, using three statistical procedures to rule out any threats to validity.MethodsWe therefore carried out a single-centered retrospective observational non-placebo-controlled trial enrolling 73 inpatients from Baqiyatallah Hospital in Tehran (Iran) with the diagnosis of COVID-19-associated pneumonia confirmed by real-time polymerase chain reaction (RT-qPCR) on nasopharyngeal swabs and high-resolution computerized tomography chest scan. These patients were broken down into two groups: Group 1 (30 patients) receiving standard care (corticosteroids, ceftriaxone, azithromycin, pantoprazole, hydroxychloroquine, lopinavir/ritonavir), and Group 2 (43 patients) receiving the above regimen plus TPE (replacing 2 l of patients' plasma by a solution, 50% of normal plasma, and 50% of albumin at 5%) administered according to various time schedules. The follow-up time was 30 days and all-cause mortality was the endpoint.ResultsDeaths were 6 (14%) in Group 2 and 14 (47%) in Group 1. However, different harmful risk factors prevailed among patients not receiving TPE rather than being equally split between the intervention and control group. We used an algorithm of structural equation modeling (of STATA) to summarize a large pool of potential confounders into a single score (called with the descriptive name “severity”). Disease severity was lower (Wilkinson rank-sum test p < 0.001) among patients with COVID-19 undergoing TPE (median: −2.82; range: −5.18; 7.96) as compared to those not receiving TPE (median: −1.35; range: −3.89; 8.84), confirming that treatment assignment involved a selection bias of patients according to the severity of COVID-19 at hospital admission. The adjustment for confounding was carried out using severity as the covariate in Cox regression models. The univariate hazard ratio (HR) of 0.68 (95%CI: 0.26; 1.80; p = 0.441) for TPE turned to 1.19 (95%CI: 0.43; 3.29; p = 0.741) after adjusting for severity.ConclusionsIn this study sample, the lower mortality observed among patients receiving TPE was due to a lower severity of COVID-19 rather than the TPE effects.
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Affiliation(s)
- Luca Cegolon
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Public Health Department, University Health Agency Giuliano-Isontina (ASUGI), Trieste, Italy
- *Correspondence: Luca Cegolon ;
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Behzad Einollahi
| | - Yunes Panahi
- Pharmacotherapy Department, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sina Imanizadeh
- Student Research Committee (SRC), Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Rezapour
- Student Research Committee (SRC), Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Nikpouraghdam
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hassan Abolghasemi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Giuseppe Mastrangelo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University, Padua, Italy
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Janikowska A, Soukup J, Pliquett RU, Abdel-Rahim R. Therapeutic Plasma Exchanges in Combination with High-Dose Steroid-Induced Immunosuppression as an Ultima Ratio Therapy in Severe Coronavirus Disease 2019 (COVID-19): A Case-Series Report. J Inflamm Res 2022; 15:715-722. [PMID: 35140501 PMCID: PMC8820755 DOI: 10.2147/jir.s344028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/07/2022] [Indexed: 12/15/2022] Open
Abstract
We present 2 cases of severe Covid-19 with comorbidities (arterial hypertension, obesity, diabetes mellitus) treated with membrane-based therapeutic plasma exchanges in combination with a short-term high-dose immunosuppressive therapy. The therapy has been initiated in an attempt to alleviate the prevalent cytokine storm and to prevent intubation and invasive mechanical ventilation, when a long-term nasal oxygen therapy with a maximum flow rate of 8L/min was insufficient to achieve an adequate oxygenation. Even though patient 2 had to be intubated after the 4th cycle of plasmapheresis due to the exhaustion of the respiratory muscles and the subsequent acquired sepsis with a microbiological evidence of a mixed bacterial-fungal infection, both patients showed a good response to treatment, including improvement of laboratory and radiological findings. To our knowledge, this combination of therapeutic plasma exchange with a high-dose steroid therapy has not been reported previously.
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Affiliation(s)
- Agata Janikowska
- Department of Nephrology and Diabetology, Carl-Thiem Hospital, Cottbus, Germany
- Correspondence: Agata Janikowska, Tel +49 355 46 79592, Fax +49 355 46 2240, Email
| | - Jens Soukup
- Clinic for Anesthesiology, Intensive Therapy and Palliative Medicine, Carl-Thiem Hospital, Cottbus, Germany
| | - Rainer U Pliquett
- Department of Nephrology and Diabetology, Carl-Thiem Hospital, Cottbus, Germany
| | - Rabah Abdel-Rahim
- Department of Nephrology and Diabetology, Carl-Thiem Hospital, Cottbus, Germany
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Laaribi I, Kachmar S, Bouayed Z, Mimouni H, Mekkaoui I, El Rhalete A, El Mouhib A, Bkiyar H, Housni B. Plasmapherisis in Covid-19 patient under ECMO: A Moroccan case report experience. Ann Med Surg (Lond) 2022; 74:103250. [PMID: 35035952 PMCID: PMC8743489 DOI: 10.1016/j.amsu.2022.103250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction Sars-CoV-2 induces an intense cytokine response called cytokine storm at the origin of acute respiratory distress syndrome, multiple organ dysfunction syndrome and death. In this context, several treatments have been proposed; and plasmapheresis appears as a promising treatment. Case presentation We report the case of a 57-year-old patient admitted for Sars-CoV-2 infection, who requiried the use of mechanical ventilation, assistance by veno-venous extracorporeal membrane oxygenation ECMO and treated by plasmapheresis plugged on the ECMO circuit. Discussion We discuss the mechanisms responsible for the Sars-CoV-2 induced cytokine storm leading to an acute respiratory distress syndrome and the main therapeutic alternatives with emphasis on plasmapheresis. Conclusion Reduction of cytokines by plasmapheresis may be very useful in the management of Covid-19 infection if it is undertaken early even on an ECMO circuit. Most patients infected with Sars Cov-2 have a mild to moderate form but some patients develop acute respiratory distress syndrome. Cytokine storm is at the origin of this acute respiratory distress syndrome. Reduction of cytokines by plasmapheresis may be very useful in the management of COVID-19 infection even on an ECMO circuit.
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Affiliation(s)
- Ilyass Laaribi
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Corresponding author. Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco.
| | - Safaa Kachmar
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Zakaria Bouayed
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Hamza Mimouni
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Ikram Mekkaoui
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Abdelilah El Rhalete
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Amine El Mouhib
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Houssam Bkiyar
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Mohammed First University Oujda, FMP Oujda, LAMCESM, Oujda, Morocco
| | - Brahim Housni
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Mohammed First University Oujda, FMP Oujda, LAMCESM, Oujda, Morocco
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6
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Cui Y, Hu C, Cheng Y, Han X, Wang W. Plasmapheresis: a feasible choice for bullous pemphigoid patients infected with SARS-CoV-2. Int J Dermatol 2021; 61:252-256. [PMID: 34520570 PMCID: PMC8653043 DOI: 10.1111/ijd.15892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 12/15/2022]
Abstract
Bullous pemphigoid (BP) patients were vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection because they have similar risk factors, so we should pay attention to patients with BP during the epidemic of coronavirus disease-19 (COVID-19). As far as treatment is concerned, many strategies for BP were changed during the epidemic. Plasmapheresis not only has been included in the guidelines for BP but also has been used successfully to rescue COVID-19 patients, especially in severe cases. Therefore, it is a feasible choice for BP patients, especially for refractory BP patients, infected with SARS-CoV-2. Apart from these, we have reviewed some points for attention during the plasmapheresis session.
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Affiliation(s)
- Yu Cui
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Caixia Hu
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Yi Cheng
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Xiaomei Han
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Wenqing Wang
- Department of Dermatology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
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Matsushita Y, Kusaoi M, Hiki M, Murayama G, Abe Y, Nozawa K, Takahashi K, Yamaji K, Tamura N, Naito T. Combination therapy with plasma exchange and glucocorticoid may be effective for severe COVID-19 infection: A retrospective observational study. Ther Apher Dial 2021; 25:390-400. [PMID: 33887110 PMCID: PMC8250198 DOI: 10.1111/1744-9987.13656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/15/2021] [Indexed: 12/15/2022]
Abstract
We retrospectively analyzed the characteristics and outcomes of five patients with COVID-19 who were received glucocorticoid (with or without pulse therapy) and therapeutic plasma exchange. The efficacy of the treatment was determined by whether the patient was able to be transferred from the COVID-19 exclusive ICU to the general ward. In comparing patients who received prednisolone pulse therapy (three cases) with those who did not (two cases), 2/3 (66%) and 0/2 (0%) patients could be discharged from the COVID-19 dedicated ICU, respectively. Among five patients who was performed plasma exchange, two elderly male patients who underwent plasma exchange as early as within 8 days of disease exacerbation survived and were able to be transferred to the general ward. This observational study indicates that plasma exchange in conjunction with methylprednisolone pulse therapy at the appropriate time may be an effective treatment for elderly patients with severe COVID-19.
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Affiliation(s)
- Yasushi Matsushita
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Makio Kusaoi
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Makoto Hiki
- Department of Emergency Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan.,Department of Cardiovascular Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Goh Murayama
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshiyuki Abe
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhisa Nozawa
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Ken Yamaji
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
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8
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Balagholi S, Dabbaghi R, Eshghi P, Mousavi SA, Heshmati F, Mohammadi S. Potential of therapeutic plasmapheresis in treatment of COVID-19 patients: Immunopathogenesis and coagulopathy. Transfus Apher Sci 2020; 59:102993. [PMID: 33162341 PMCID: PMC7605792 DOI: 10.1016/j.transci.2020.102993] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Therapeutic plasmapheresis (TP) is the process of the separation and removal of plasma from other blood components and is considered as an adjunctive treatment strategy to the discarded abnormal agent in the management of respiratory viral pandemics. This article reviews the mechanisms of immunopathogenesis and coagulopathy induced by SARS-CoV-2 and the potential benefits of TP as adjunctive treatment in critically COVID-19 patients.
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Affiliation(s)
- Sahar Balagholi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Rasul Dabbaghi
- Ophtalmic Research Center, Research Institute for Ophtalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyman Eshghi
- Pediatric Congenital Hematologic Disorders Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Seyed Asadollah Mousavi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Mohammadi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran; Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
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9
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Redant S, De Bels D, Ismaili K, Honoré PM. Membrane-Based Therapeutic Plasma Exchange in Intensive Care. Blood Purif 2020; 50:290-297. [PMID: 33091920 DOI: 10.1159/000510983] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/16/2020] [Indexed: 11/19/2022]
Abstract
The principles and use of plasmapheresis are often little understood by intensivists. We propose to review the principles, the main indications, and the methods of using this technique.
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Affiliation(s)
- Sebastien Redant
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium,
| | - David De Bels
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Khalid Ismaili
- Division of Nephrology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Patrick M Honoré
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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10
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Nasonov EL, Beketova TV, Reshetnyak TM, Lila AM, Ananieva LP, Lisitsyna TA, Soloviev SK. Coronavirus disease 2019 (COVID-19) and immune-mediated inflammatory rheumatic diseases: at the crossroads of thromboinflammation and autoimmunity. RHEUMATOLOGY SCIENCE AND PRACTICE 2020. [DOI: 10.47360/1995-4484-2020-353-367] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Inflammation and coagulation are key basic mechanism of protection against all potentially pathogenic mechanical and biological factors targeting human organism from inner and outer environment. On the other hand, uncontrolled inflammation results in hypercoagulation, inhibition of anticoagulation and alteration of mechanisms responsible for resolution of inflammation, while production of “procoagulant” mediators (thrombin, tissue factor and others), activation of platelets and of vascular endothelial cells maintains inflammation. All factors taken together serve as the basis for a pathological process called thromboinflammation or immunothrombosis. Currently thromboinflammation is considered in the broad sense as a universal pathogenetic mechanism of numerous widespread acute and chronic conditions, including immune-mediated (autoimmune) inflammatory rheumatic diseases, oftentimes complicated by severe irreversible damage to vital organs. Thromboinflammation gained specific attention during СОVID-19 (coronavirus disease 2019) pandemic, caused by SARS-Cov-2 (severe acute respiratory syndrome Coronavirus-2). COVID-19 is considered currently as systemic thromboinflammation syndrome, manifesting via generalized thrombosis of arterial and venous macro- and microvasculature, termed as COVID-19-coagulopathy. The paper discusses common pathogenetic coagulopathy mechanisms in COVID-19 and immune-mediated (autoimmune) inflammatory rheumatic diseases (IMRDs), associated with overproduction of antiphospholipid antibodies, activation of the complement system, and dis-regulated synthesis of proinflammatory cytokines, etc. Delineating the autoimmune subtype of thromboinflammation, identification of genetic (i.e., genes encoding the complement system and others) and molecular-biologic biomarkers associated with higher occurrence of COVID-19-coagulopathy are the most relevant undertakings for the current practice. Gaining insights into mechanisms of thromboinflammation and converting them into potential pharmacotherapies of IMDs would facilitate and accelerate the drafting of effective therapeutic strategies for COVID-19.
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Affiliation(s)
- E. L. Nasonov
- VA Nasonova Research Institute of Rheumatology;
I.M. Sechenov First Moscow State Medical University, MOH (Sechenov University)
| | | | - T. M. Reshetnyak
- VA Nasonova Research Institute of Rheumatology;
Russian Medical Academy of Continuing Prefessional Education, Ministry of Health of Russia
| | - A. M. Lila
- VA Nasonova Research Institute of Rheumatology
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11
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Daoud AM, Soliman KM, Ali HK. Potential limitations of plasmapheresis in treatment of COVID-19 patients: How to overcome them? Ther Apher Dial 2020; 25:350. [PMID: 32710694 DOI: 10.1111/1744-9987.13568] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Ahmed M Daoud
- Nephrology Division, Internal Medicine Department, Cairo University Medical School, Cairo, Egypt
| | - Karim M Soliman
- Nephrology Division, Internal Medicine department, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hatem K Ali
- Nephrology Division, Internal Medicine Department, University Hospitals of Birmingham, Birmingham, UK
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