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Sawada M, Ogino K, Hayashi T, Waki K. Therapeutic plasma exchange for refractory Kawasaki disease in children weighing less than 10 kg. Ther Apher Dial 2024; 28:424-431. [PMID: 38093652 DOI: 10.1111/1744-9987.14099] [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: 09/19/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 04/30/2024]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) is used for treating refractory Kawasaki disease (KD); however, there are few reports on its use in small children. METHODS Nine children with refractory KD who underwent TPE between January 2010 and December 2022 were retrospectively investigated. Data on patient demographics, inflammatory markers, coronary artery lesions (CALs), TPE settings and complications, and outcomes were examined. RESULTS A total of 37 TPE sessions were performed on nine patients, with 3-6 sessions per patient. The median body weight was 8.9 kg. C-reactive protein, white blood cell (WBC), and interleukin-6 levels significantly decreased (p < 0.05). Of the 33 coronary arteries with CALs before TPE, 44% and 3% had CALs at 1 month and 1 year after TPE, respectively. Minor complications, such as mild hypocalcemia and naturally recovering coagulopathy, occurred without serious complications. CONCLUSIONS TPE for refractory KD may be safe and effective in preventing CALs.
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Affiliation(s)
- Mariko Sawada
- Department of Pediatrics, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Kayo Ogino
- Department of Pediatrics, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Tomohiro Hayashi
- Department of Pediatrics, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Kenji Waki
- Department of Pediatrics, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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2
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Yadav M, Maiwal R, Kumar Br V, Tripathi G, Sharma N, Sharma N, Bindal V, Mathew B, Pandey S, Singh SP, Tevathia HV, Maras JS, Sarin SK. Comparative metabolome analysis reveals higher potential of haemoperfusion adsorption in providing favourable outcome in ACLF patients. Liver Int 2024; 44:1189-1201. [PMID: 38358068 DOI: 10.1111/liv.15858] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 01/02/2024] [Accepted: 01/21/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND AIMS Acute-on-chronic liver failure (ACLF) is a serious illness associated with altered metabolome, organ failure and high mortality. Need for therapies to improve the metabolic milieu and support liver regeneration are urgently needed. METHODS We investigated the ability of haemoperfusion adsorption (HA) and therapeutic plasma exchange (TPE) in improving the metabolic profile and survival in ACLF patients. Altogether, 45 ACLF patients were randomized into three groups: standard medical therapy (SMT), HA and TPE groups. Plasma metabolomics was performed at baseline, post-HA and TPE sessions on days 7 and 14 using high-resolution mass spectrometry. RESULTS The baseline clinical/metabolic profiles of study groups were comparable. We identified 477 metabolites. Of these, 256 metabolites were significantly altered post 7 days of HA therapy (p < .05, FC > 1.5) and significantly reduced metabolites linked to purine (12 metabolites), tryptophan (7 metabolites), primary bile acid (6 metabolites) and arginine-proline metabolism (6 metabolites) and microbial metabolism respectively (p < .05). Metabolites linked to taurine-hypotaurine and histidine metabolism were reduced and temporal increase in metabolites linked to phenylalanine and tryptophan metabolism was observed post-TPE therapy (p < .05). Finally, weighted metabolite correlation network analysis (WMCNA) along with inter/intragroup analysis confirmed significant reduction in inflammatory (tryptophan, arachidonic acid and bile acid metabolism) and secondary energy metabolic pathways post-HA therapy compared to TPE and SMT (p < .05). Higher baseline plasma level of 11-deoxycorticosterone (C03205; AUROC > 0.90, HR > 3.2) correlated with severity (r2 > 0.5, p < .05) and mortality (log-rank-p < .05). Notably, 51 of the 64 metabolite signatures (ACLF non-survivor) were reversed post-HA treatment compared to TPE and SMT(p < .05). CONCLUSION HA more potentially (~80%) improves plasma milieu compared to TPE and SMT. High baseline plasma 11-deoxycorticosterone level correlates with early mortality in ACLF patients.
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Affiliation(s)
- Manisha Yadav
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rakhi Maiwal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vinay Kumar Br
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gaurav Tripathi
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Neha Sharma
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nupur Sharma
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vasundhra Bindal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Babu Mathew
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sushmita Pandey
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Satender Pal Singh
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Jaswinder Singh Maras
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Sonoda K, Komatsu M, Ozawa Y, Yamamoto H, Kamijo Y. Investigation of the Effect of Therapeutic Plasma Exchange for TAFRO Syndrome: A Pilot Study. Biomedicines 2024; 12:849. [PMID: 38672203 PMCID: PMC11048432 DOI: 10.3390/biomedicines12040849] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
TAFRO syndrome is a rare systemic inflammatory disorder with a fatal course. Nevertheless, a definitive treatment strategy has not yet been established. Anti-inflammatory therapies, including glucocorticoid treatment and immunosuppressants, have not been satisfactory. Therefore, new treatment options are needed for patients with TAFRO syndrome. The effectiveness of therapeutic plasma exchange (TPE) has mainly been reported in several case reports. In this case series study, we investigated the effect of TPE on TAFRO syndrome. We reviewed six consecutive cases with TAFRO syndrome treated at Shinshu University Hospital. All of them underwent TPE. A significant improvement in mean blood pressure, albumin, total bilirubin, and C-reactive protein was observed after TPE. Furthermore, early TPE treatment was suggested to have an impact on the prognosis. More intensive studies are needed to emphasize the overall conclusion obtained that TPE can be an effective/acceptable treatment option for TAFRO syndrome.
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Affiliation(s)
- Kosuke Sonoda
- Department of Nephrology, Shinshu University Hospital, Matsumoto 390-8621, Japan; (K.S.); (Y.K.)
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (Y.O.); (H.Y.)
| | - Yoko Ozawa
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (Y.O.); (H.Y.)
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (Y.O.); (H.Y.)
- Department of Respiratory Medicine, Iida Municipal Hospital, Iida 395-8502, Japan
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University Hospital, Matsumoto 390-8621, Japan; (K.S.); (Y.K.)
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Mehrabyan A, Traub RE. Retrospective review of patients with myasthenia gravis switched from plasma exchange therapy to efgartigimod treatment. Muscle Nerve 2024; 69:467-471. [PMID: 38284651 DOI: 10.1002/mus.28042] [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: 03/17/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION/AIMS Therapeutic plasma exchange (TPE) is sometimes used as maintenance therapy for the treatment of myasthenia gravis (MG). Efgartigimod is a newly approved monoclonal antibody targeting the neonatal Fc receptor, effectively reducing immunoglobulin G levels in the treatment of MG. The aim of this study was to describe the clinical experience of switching patients from maintenance TPE treatment to efgartigimod infusions. METHODS A retrospective review of medical records was performed on patients previously treated with maintenance TPE for the diagnosis of MG and subsequently switched to efgartigimod infusions. Clinical characteristics and response to treatment switch were described. RESULTS Five of seven patients demonstrated improvement on Myasthenia Gravis Foundation of America-post intervention status, one was unchanged and one was in pharmacological remission. This was reflected in pre- and postswitch MG activities of daily living and MG manual muscle testing scores. All patients have continued on efgartigimod therapy. The duration of treatment with efgartigimod at the time of this review ranged from 1 to 13 months. Recurrent uncomplicated infections were noted in two patients on efgartigimod therapy. Maintenance dosing regimens of efgartigimod varied based on clinical response to treatment and side effects. DISCUSSION In this series, efgartigimod appeared effective and well tolerated in patients switched from TPE.
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Affiliation(s)
| | - Rebecca E Traub
- University of North Carolina, Chapel Hill, North Carolina, USA
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Edmonds KB, Her J, Langston C, Jennings R, Diaz S. Efficacy of therapeutic plasma exchange in a case of severe, generalised canine pemphigus foliaceus. Vet Dermatol 2024; 35:247-251. [PMID: 38044720 DOI: 10.1111/vde.13218] [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: 08/01/2023] [Revised: 09/15/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
Successful treatment of pemphigus foliaceus (PF) often requires a multimodal therapeutic approach. The dog described herein underwent four therapeutic plasma exchange treatments for severe, refractory PF, resulting in a 50% reduction of lesional body surface area. This treatment option should be considered for the management of canine PF.
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Affiliation(s)
- Kaitlyn Bello Edmonds
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Columbus, Ohio, USA
| | - Jiwoong Her
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Columbus, Ohio, USA
| | - Catherine Langston
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Columbus, Ohio, USA
| | - Ryan Jennings
- Department of Veterinary Biosciences, College of Veterinary Medicine, Columbus, Ohio, USA
| | - Sandra Diaz
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Columbus, Ohio, USA
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Aljabri B, Saber W, Alzahrani S, Dada A. Resolution of Extensive Xanthomas Associated With Severe Hypertriglyceridemia via Modified Therapeutic Plasma Exchange. JCEM Case Rep 2024; 2:luae054. [PMID: 38601066 PMCID: PMC11005844 DOI: 10.1210/jcemcr/luae054] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Indexed: 04/12/2024]
Abstract
Severe hypertriglyceridemia can be manifested by xanthomas. Therapeutic plasma exchange (TPE) is an invasive medical procedure that has been documented as a viable approach for severe hypertriglyceridemia when cases would be refractory to conventional therapies. TPE is mainly an optional therapeutic modality for cases of severe acute pancreatitis or preventing the recurrence of pancreatitis. Beyond this clinical application, data are scarce on TPE utilization in managing cutaneous lesions associated with hypertriglyceridemia. We present a case of severe hypertriglyceridemia accompanied by extensive xanthomas of various types and a history of recurrent pancreatitis. After conventional therapy failed, a modified plasmapheresis regimen was used and was able to achieve a fast and marked reduction in the patient's serum triglyceride levels with complete resolution of the extensive cutaneous lesions, providing him a newfound comfort he had not experienced in some time and suggesting the regimen potentially could be considered in the treatment of refractory severe hypertriglyceridemia with debilitating cutaneous complications.
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Affiliation(s)
- Bandari Aljabri
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah 23431, Saudi Arabia
| | - Wafa Saber
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah 23431, Saudi Arabia
| | - Saud Alzahrani
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah 23431, Saudi Arabia
| | - Ashraf Dada
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Jeddah 23431, Saudi Arabia
- College of Medicine, Al Faisal University, Riyadh 11533, Saudi Arabia
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Kim HJ, Chung Y, Kim H, Hwang SH, Oh HB, Ko DH. Trends in category and grade for therapeutic plasma exchange in the latest guideline on therapeutic apheresis by the American Society for Apheresis: Hurdles in pursuing evidence-based medicine. Vox Sang 2024. [PMID: 38357715 DOI: 10.1111/vox.13603] [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: 08/18/2023] [Revised: 01/08/2024] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND OBJECTIVES The Writing Committee of American Society for Apheresis released the ninth edition of guidelines for therapeutic apheresis in 2023. Categories have been a part of the guidelines since the first edition, and the grading system was introduced in the fifth edition, with updates in every new edition. In this study, we investigated the category and grade change trends through the latest five editions, focusing on therapeutic plasma exchange, to suggest future directions as part of evidence-based medicine. MATERIALS AND METHODS Categories and grades for therapeutic plasma exchange (TPE) were collected and analysed from the fifth through ninth editions. We aligned classification changes to the ninth edition's clinical context and compared its categories and grades with those introduced in the guideline. RESULTS Among 166 total indications in the ninth edition, 118 included TPE procedure, either as a sole treatment or as one of the therapeutic apheresis techniques. The total number of indications changed, but Category III remained predominant throughout the editions. Similarly, Grade 2C consistently emerged as the most prevalent grade. Notably, 24 cases had grade changes. Of the 16 cases with evidence quality changes, the quality weakened in six and improved in 10. Evidence levels were not improved throughout the study period for 102 clinical conditions. CONCLUSION To address gaps in evidence quality, international collaboration is imperative to establish comprehensive large-scale studies or randomized controlled trials. This will refine the use of therapeutic apheresis, including TPE, to foster evidence-based advancements in clinical practice.
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Affiliation(s)
- Han Joo Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yousun Chung
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang-Hyun Hwang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Heung-Bum Oh
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Hyun Ko
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Hakroush S, Korsten P, Ströbel P, Tampe B. Relevance of histopathological findings for predictive scoring of short-term treatment response to plasma exchange in severe ANCA-associated renal vasculitides. Front Immunol 2024; 15:1340999. [PMID: 38380320 PMCID: PMC10878170 DOI: 10.3389/fimmu.2024.1340999] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Rapidly progressive glomerulonephritis (RPGN) is characterized by a rapid loss of kidney function, affecting both renal and overall patient survival. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a small vessel vasculitis affecting multiple organ systems including the kidney, and among most frequent causes of RPGN. We here aimed to validate a recently described scoring system for short-term treatment response to therapeutic plasma exchange (PLEX) in a well-characterized and independent cohort of severe renal AAV presenting with RPGN. Furthermore, we compared this scoring with established classification systems in renal AAV including histopathological findings. Methods We here directly compare the scoring system with retrospective data about PLEX treatment in our own clinical practice and according to current recommendations in a cohort of 53 patients with severe AAV presenting with RPGN confirmed by kidney biopsy. Results We here confirm that PLEX scoring is capable to identify patients at risk for short-term poor outcome in severe AAV presenting with RPGN (p<0.0001). Furthermore, multiple stepwise regression analysis revealed that the PLEX score with renal biopsy performed best to predict poor outcome in this patient population (p<0.0001). Conclusion Our observations underscore the relevance of performing a kidney biopsy in this patient population that is often challenged in the setting of intensive care treatment, requirement of KRT with need for anticoagulation and bleeding risk. Therefore, validation of our observations and this recent scoring system for treatment response to PLEX in independent cohorts would be of great clinical relevance in the treatment of patients with severe AAV presenting with RPGN.
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Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
- SYNLAB Pathology Hannover, SYNLAB Holding Germany, Augsburg, Germany
- Institute of Pathology, Klinikum Bremen-Mitte, School of Medicine of the University of Göttingen, Bremen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
- Department of Rheumatology and Clinical Immunology, St Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
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Fjellbirkeland OW, Szpirt WM, Børresen ML. The role of plasmapheresis in severe acute disseminated encephalomyelitis with clinical findings of transverse myelitis. Ther Apher Dial 2024; 28:119-124. [PMID: 37646345 DOI: 10.1111/1744-9987.14059] [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: 06/21/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Acute disseminated encephalomyelitis is a rare acute demyelinating disease of the central nervous system (CNS). The pathogenesis remains unclear but is suspected to be autoimmune. High doses of methylprednisolone (HDMP) are currently considered standard of treatment. Plasmapheresis (PE) is typically given in steroid refractory cases. There is currently limited evidence supporting its use in ADEM. MATERIALS AND METHODS We report a 16-year-old girl with ADEM who improved rapidly after initiating PE. RESULTS The patient presented with acute onset of multifocal CNS symptoms, including encephalopathy, requiring intensive care unit management. Despite HDMP administration, her clinical condition continued to deteriorate. PE was therefore initiated on the same day as HDMP. Her clinical condition improved significantly following the first session. She was extubated and discharged from the intensive care unit the following day. CONCLUSION HDMP combined with PE may be an effective first-line treatment in patients with fulminant ADEM.
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Affiliation(s)
| | - Wladimir M Szpirt
- Department of Nephrology, Plasmapheresis Services, Copenhagen, Denmark
| | - Malene L Børresen
- Department of Pediatrics and Adolescent Medicine, Copenhagen, Denmark
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Douglas CE, House TR, Yalon L, Menon S. Therapeutic plasma exchange for mechanical red cell hemolysis: A case series. J Clin Apher 2024; 39:e22093. [PMID: 37850483 PMCID: PMC10922221 DOI: 10.1002/jca.22093] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/22/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
We present three cases of severely elevated plasma free hemoglobin (PFH) in pediatric patients on mechanical circulatory support devices at a tertiary pediatric care center. Due to severe levels of PFH in the setting of critical illness with the inability to pursue immediate mechanical device exchange, membrane filtration therapeutic plasma exchange (TPE) was performed, which resulted in a lowering of PFH levels. However, long-term outcomes were heterogeneous across the cases. This case series reviews patient presentation, organ function before and after TPE, and the overall role of TPE as an effective treatment option to decrease severely elevated PFH levels. In doing so, we hope to add to what is known about the use of TPE for mechanical red cell hemolysis and provide guidance on its use in critically ill patients.
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Affiliation(s)
- Chloe E. Douglas
- Division of Nephrology, Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Taylor R. House
- Division of Nephrology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Larissa Yalon
- Division of Nephrology, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Shina Menon
- Division of Nephrology, Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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Jung Y, Nelson HA, Lin DMH. Use of therapeutic plasma exchange to remove lipoprotein X in a patient with vanishing bile duct syndrome presenting with cholestasis, pseudohyponatremia, and hypercholesterolemia: A case report and review of literature. J Clin Apher 2024; 39:e22105. [PMID: 38334173 DOI: 10.1002/jca.22105] [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: 04/22/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Lipoprotein X (Lp-X) is an abnormal lipoprotein found in multiple disease conditions, including liver dysfunction and cholestasis. High Lp-X concentrations can interfere with some laboratory testing that may result in spurious results. The detection of Lp-X can be challenging, and there is currently a lack of consensus regarding the management of Lp-X other than treating the underlying disease. CASE PRESENTATION A 42-year-old female with Hodgkin's lymphoma treated with dexamethasone, high dose cytarabine and cisplatin and vanishing bile duct syndrome confirmed by liver biopsy presented with cholestasis, pseudohyponatremia (sodium, 113 mmol/L; reference range 136-146 mmL/L; serum osmolality, 303 mOsm/kg), and hypercholesterolemia (> 2800 mg/dL, reference range < 200 mg/dL). Lp-X was confirmed by lipoprotein electrophoresis (EP). Although she did not manifest any specific signs or symptoms, therapeutic plasma exchange (TPE) was initiated based on laboratory findings of extreme hypercholesterolemia, spuriously abnormal serum sodium, and HDL values, and the potential for short- and long-term sequelae such as hyperviscosity syndrome, xanthoma, and neuropathy. During the hospitalization, she was treated with four 1.0 plasma volume TPE over 6 days using 5% albumin for replacement fluid. After the first TPE, total cholesterol (TC) decreased to 383 mg/dL and sodium was measured at 131 mmol/L. The patient was transitioned into outpatient maintenance TPE to eliminate the potential of Lp-X reappearance while the underlying disease was treated. Serial follow-up laboratory testing with lipoprotein EP showed the disappearance of Lp-X after nine TPEs over a 10-week period. LITERATURE REVIEW There are seven and four case reports of Lp-X treated with TPE and lipoprotein apheresis (LA), respectively. While all previous case reports showed a reduction in TC levels, none had monitored the disappearance of Lp-X after completing a course of therapeutic apheresis. CONCLUSION Clinicians should have a heightened suspicion for the presence of abnormal Lp-X in patients with cholestasis, hypercholesterolemia, and pseudohyponatremia. Once Lp-X is confirmed by lipoprotein EP, TPE should be initiated to reduce TC level and remove abnormal Lp-X. Most LA techniques are not expected to be beneficial since Lp-X lacks apolipoprotein B. Therefore, we suggest that inpatient course of TPE be performed every other day until serum sodium, TC and HDL levels become normalized. Outpatient maintenance TPE may also be considered to keep Lp-X levels low while the underlying disease is treated. Serum sodium, TC, and HDL levels should be monitored while on maintenance TPE.
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Affiliation(s)
- Yujung Jung
- Bloodworks Northwest, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Heather A Nelson
- Department of Pathology, University of Utah Health, Salt Lake City, Utah, USA
- ARUP Institute for Clinical and Experimental Pathology®, Salt Lake City, Utah, USA
| | - David Ming-Hung Lin
- Bloodworks Northwest, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Aljezani MA, Althubaiti F, Alhamed L, Alharthi A, Alamoodi A, Bakheet Y, Badawi M, Hindawi S. Plasma Exchange in Pediatric Neurology Patients: A Single-Center Experience. Cureus 2024; 16:e52691. [PMID: 38384617 PMCID: PMC10879651 DOI: 10.7759/cureus.52691] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is a procedure involving the filtration of a patient's plasma to eliminate pathogenic components or address deficiencies. This technique finds varied indications in the pediatric age group, particularly in neuroinflammatory diseases. OBJECTIVES The objective of this study is to delve into our local experience with TPE, focusing on indications, outcomes, and complications among children with neurological diseases at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. RESULTS Conducted at the pediatric department of KAUH in Jeddah from November 2008 to July 2023, this retrospective cohort study examined 15 patients, revealing a notable male predominance with 12 male patients (80%) and three female patients (20%). About two-thirds of patients exhibited an average illness severity, with a Glasgow Coma Scale (GCS) score of 10.7 and an Expanded Disability Status Scale (EDSS) score of 4.8. The median length of hospital stay was 23 days, and in the pediatric intensive care unit (PICU), it was 8.5 days. Presenting symptoms included limb weakness (n = 6), loss of consciousness (n = 3), dysphagia (n = 3), photophobia (n = 1), and ascending paralysis (n = 1). The TPE was performed for Guillain-Barré syndrome (GBS) (n = 7), myasthenia gravis (MG) (n = 3), transverse myelitis (TM) (n = 2), neuromyelitis optica (NMO) (n = 2), and systemic lupus erythematosus (SLE) cerebritis (n = 1). Twelve patients were admitted to the PICU, and mechanical ventilation was required for 10 patients. In magnetic resonance imaging (MRI) findings, abnormalities were observed in 10 cases, while the remaining five either had normal results or did not undergo MRI. Most patients required five sessions of TPE (n = 7). The median age at the initiation of TPE was 13 years. Twelve patients improved with TPE treatment, while three did not. Complications observed during and following TPE included fever (n = 5), electrolyte disturbance (n = 5), hypotension (n = 3), hypocalcemia (n = 2), bradycardia (n = 2), vomiting (n = 1), tachycardia (n = 1), eye rash (n = 1), infection (n = 1), and bleeding originating from the TPE procedure site (n = 1). CONCLUSION In conclusion, our study underscores the significance of TPE as a therapeutic modality, emphasizing the imperative for ongoing research to fully exploit its potential across diverse medical contexts for enhancing patient care. Our findings, consistent with prior research, reveal plasma exchange's (PLEX's) wide-ranging applications and complications in neurological disorders.
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Affiliation(s)
- Maram A Aljezani
- Pediatric Neurology, King Abdulaziz University Hospital (KAUH), Jeddah, SAU
- Pediatric Neurology, King Fahad Medical City (KFMC), Riyadh, SAU
| | | | | | | | | | | | - Maha Badawi
- Hematology, King Abdulaziz University, Jeddah, SAU
| | - Salwa Hindawi
- Hematology/Blood Transfusion Services, King Abdulaziz University, Jeddah, SAU
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Maejima N, Matsumoto S, Hayakawa I, Koike K, Abe Y. A Case of Acute Necrotizing Encephalopathy With Multiple Organ Failure Following COVID-19. Cureus 2024; 16:e51665. [PMID: 38313914 PMCID: PMC10838156 DOI: 10.7759/cureus.51665] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Neurological complications are frequent non-respiratory complications associated with coronavirus disease 2019 (COVID-19), and acute encephalopathy (AE) has been reported to occur in 2.2% of patients. Among many phenotypes of AEs, acute necrotizing encephalopathy (ANE) is associated with multiple organ failure (MOF), leading to severe neurological morbidity and mortality. A previously healthy seven-year-old girl presented with a one-day history of fever followed by 12 hours of vomiting and altered consciousness. On arrival, the patient was in shock. Blood tests revealed severe acute liver failure and kidney injury, accompanied by coagulopathy. The serum interleukin-6 levels were also elevated. PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. A head CT scan showed heterogeneous low-density areas in the bilateral thalamus, without brainstem involvement. She was diagnosed as ANE complicated with MOF (ANE severity score = 6). Intravenous methylprednisolone and therapeutic plasma exchange (TPE) were initiated with neurocritical care. After the introduction of TPE, hemodynamics improved rapidly, followed by gradual improvement in neurological manifestations. Upon follow-up after two months, no neurological or systemic sequelae were noted. Although further studies are needed, our case suggests that early immunomodulatory therapy and TPE may have contributed to the improvement in ANE and MOF associated with COVID-19.
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Affiliation(s)
- Naohiko Maejima
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, JPN
| | - Shotaro Matsumoto
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, JPN
| | - Itaru Hayakawa
- Division of Neurology, National Center for Child Health and Development, Tokyo, JPN
| | - Kentaro Koike
- Division of Neurology, National Center for Child Health and Development, Tokyo, JPN
| | - Yuichi Abe
- Division of Neurology, National Center for Child Health and Development, Tokyo, JPN
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Tonev D, Momchilova A. Oxidative Stress and the Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) Pathway in Multiple Sclerosis: Focus on Certain Exogenous and Endogenous Nrf2 Activators and Therapeutic Plasma Exchange Modulation. Int J Mol Sci 2023; 24:17223. [PMID: 38139050 PMCID: PMC10743556 DOI: 10.3390/ijms242417223] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/18/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
The pathogenesis of multiple sclerosis (MS) suggests that, in genetically susceptible subjects, T lymphocytes undergo activation in the peripheral compartment, pass through the BBB, and cause damage in the CNS. They produce pro-inflammatory cytokines; induce cytotoxic activities in microglia and astrocytes with the accumulation of reactive oxygen species, reactive nitrogen species, and other highly reactive radicals; activate B cells and macrophages and stimulate the complement system. Inflammation and neurodegeneration are involved from the very beginning of the disease. They can both be affected by oxidative stress (OS) with different emphases depending on the time course of MS. Thus, OS initiates and supports inflammatory processes in the active phase, while in the chronic phase it supports neurodegenerative processes. A still unresolved issue in overcoming OS-induced lesions in MS is the insufficient endogenous activation of the Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) pathway, which under normal conditions plays an essential role in mitochondria protection, OS, neuroinflammation, and degeneration. Thus, the search for approaches aiming to elevate endogenous Nrf2 activation is capable of protecting the brain against oxidative damage. However, exogenous Nrf2 activators themselves are not without drawbacks, necessitating the search for new non-pharmacological therapeutic approaches to modulate OS. The purpose of the present review is to provide some relevant preclinical and clinical examples, focusing on certain exogenous and endogenous Nrf2 activators and the modulation of therapeutic plasma exchange (TPE). The increased plasma levels of nerve growth factor (NGF) in response to TPE treatment of MS patients suggest their antioxidant potential for endogenous Nrf2 enhancement via NGF/TrkA/PI3K/Akt and NGF/p75NTR/ceramide-PKCζ/CK2 signaling pathways.
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Affiliation(s)
- Dimitar Tonev
- Department of Anesthesiology and Intensive Care, University Hospital “Tzaritza Yoanna—ISUL”, Medical University of Sofia, 1527 Sofia, Bulgaria
| | - Albena Momchilova
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Science, 1113 Sofia, Bulgaria;
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Liu X, Xia M, Liu D, Liu H, Tang C, Chen G, Liu Y, Yuan F, Liu H. Efficacy of protein A immunoadsorption and therapeutic plasma exchange in ANCA-associated vasculitis with severe renal involvement: a retrospective study. Ann Med 2023; 55:2230875. [PMID: 37452682 PMCID: PMC10351471 DOI: 10.1080/07853890.2023.2230875] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 03/25/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Severe renal impairment is a common complication of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and is associated with poor prognosis and shorter survival. It is urgent to find effective treatments to improve the prognosis of AAV patients. This study was designed to assess the efficacy and safety of protein A immunoadsorption (PAIA) and therapeutic plasma exchange (TPE) for AAV with severe renal involvement. METHODS A total of 48 AAV patients with renal involvement admitted to the Second Xiangya Hospital from January 2018 to February 2021 were selected. Clinical data, myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA), remission at 6 months, and outcomes were evaluated. The primary outcomes of interest were death and renal survival as defined by the occurrence of end-stage renal disease (ESRD). RESULTS PAIA was effective in the removal of MPO-ANCA and IgG, and showed superior over TPE in the clearance of MPO-ANCA within 1 month after treatment. After a median follow-up of 14.5 months, PAIA therapy showed an advantage in reducing mortality over TPE. There was no difference in the development of ESRD between the two groups. Multivariate Cox regression analysis indicated that higher serum creatinine (SCr) and lower haemoglobin level were independent risks of ESRD. Age > 60, lower serum albumin (ALB), and failure to achieve remission at 6 months were independent risks of death. CONCLUSIONS PAIA treatment reduces MPO-ANCA and IgG as well as mortality in AAV patients, and may be beneficial for severe AAV in clinical practice. Higher SCr, lower serum ALB or haemoglobin levels, age > 60, and failure to achieve remission at 6 months independently predict the ESRD or death of AAV patients with severe renal involvement.KEY MESSAGESCompared with therapeutic plasma exchange, protein A immunoadsorption treatment eliminates myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) and IgG better and reduces mortality in ANCA-associated vasculitis (AAV) patients with severe renal involvement.Higher serum creatinine, lower serum albumin or haemoglobin levels, age > 60, and failure to achieve remission at 6 months independently predict the end-stage renal disease (ESRD) or death of AAV patients with severe renal involvement.
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Affiliation(s)
- Xiaojuan Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China
| | - Ming Xia
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China
| | - Di Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China
| | - Haiyang Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China
| | - Chengyuan Tang
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China
| | - Guochun Chen
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China
| | - Yu Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China
| | - Fang Yuan
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China
| | - Hong Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China
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Cone Sullivan J, Conklin SE, Conrad S, Horowitz C, Diethelm M, Comenzo R. Therapeutic plasma exchange decreases plasma anti-SARS-CoV-2 spike IgG without increasing the proximate incidence of COVID-19. J Clin Apher 2023; 38:721-726. [PMID: 37706521 DOI: 10.1002/jca.22087] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) removes both pathologic and protective immunoglobulins (Ig). SARS-CoV-2 immunity is partially mediated by anti-SARS-CoV-2 spike antibodies (SAb), which impair viral host-cell invasion. Nonetheless, the systematic effect of TPE on SAb concentration and SARS-CoV-2 immunity is unknown. METHODS Paired plasma waste specimens from the first (first-TPE) and last (last-TPE) TPE treatment were collected from 9 patients between July 21, 2021 and March 1, 2022. The effects of TPE on Ig levels were assessed by quantitatively comparing the SAb, total IgG, and total IgM levels first-/last-TPE treatment. Complementary qualitative assessment for these changes was achieved via protein electrophoresis (PEP) and immunofixation (IFE). A retrospective review was performed to investigate the incidence of new SARS-CoV-2 infections following TPE v. other treatment at the same outpatient apheresis/infusion center during the same time frame. RESULTS Median SAb levels between the first- and last-TPE waste specimens decreased significantly from 424.6 AU/mL to 17.0 AU/mL (P = 0.004). Concordantly, PEP and IFE analysis demonstrated broad Ig decreases. Cumulative incidence of subsequent COVID-19 diagnosis at 30, 90, and 180 days post-procedure did not differ between the TPE v. other treatment groups (n = 709 total patients). CONCLUSIONS TPE significantly reduced SAb levels, a marker of SARS-CoV-2 immunity, but did not appear to provoke increased incidence of COVID-19 infections. Further investigation of the kinetics of TPE-mediated SAb decrease and post-TPE recovery are warranted.
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Affiliation(s)
- Jensyn Cone Sullivan
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Steven E Conklin
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Anatomic & Clinical Pathology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Stephanie Conrad
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Coby Horowitz
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mark Diethelm
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Raymond Comenzo
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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Odish MF, Garimella PS, Crisostomo H, Yi C, Owens RL, Pollema T. Using Cardiohelp, Quadrox, and Nautilus Extracorporeal Membrane Oxygenators as Vascular Access for Hemodialysis, Continuous Renal Replacement Therapy, and Plasmapheresis: A Brief Technical Report. ASAIO J 2023; 69:e455-e459. [PMID: 37399278 PMCID: PMC10602218 DOI: 10.1097/mat.0000000000002005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 07/05/2023] Open
Abstract
The use of intermittent hemodialysis (iHD), and continuous renal replacement therapy (CRRT), along with extracorporeal membrane oxygenation (ECMO) in patients with acute kidney injury (AKI) and end-stage renal disease (ESRD) is very common. In this technical report, we describe the methods to perform these dialytic therapies safely and effectively using the ECMO circuit in lieu of a separate dialysis catheter. Specifically, we describe in detail how to connect these kidney replacement therapy modalities to a Quadrox, Nautilus, and Cardiohelp HLS (combined oxygenator and pump) oxygenator. The dialysis (iHD or CRRT) inlet is attached to the post-oxygenators Luer-Lock, whereas the return is attached to the pre-oxygenator Luer-Lock, both with a dual lumen pigtail. We also discuss the technical aspects of performing plasmapheresis in conjunction with ECMO and iHD or CRRT. Finally, we highlight the fact that the reported technique does not require modifying the ECMO cannulas/tubing which helps maximize safety.
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Affiliation(s)
- Mazen F. Odish
- From the Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, UC San Diego Department of Medicine, La Jolla, California
| | - Pranav S. Garimella
- Division of Nephrology-Hypertension, UC San Diego Department of Medicine, La Jolla, California
| | | | - Cassia Yi
- UC San Diego Health Department of Nursing, La Jolla, California
| | - Robert L. Owens
- From the Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, UC San Diego Department of Medicine, La Jolla, California
| | - Travis Pollema
- Division of Cardiovascular and Thoracic Surgery, UC San Diego Department of Surgery, La Jolla, California
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Vo LT, Do VC, Trinh TH, Vu T, Nguyen TT. Combined Therapeutic Plasma Exchange and Continuous Renal Replacement Therapy in Children With Dengue-Associated Acute Liver Failure and Shock Syndrome: Single-Center Cohort From Vietnam. Pediatr Crit Care Med 2023; 24:818-828. [PMID: 37310173 PMCID: PMC10540756 DOI: 10.1097/pcc.0000000000003304] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Pediatric acute liver failure (PALF) is a fatal complication in patients with severe dengue. To date, clinical data on the combination of therapeutic plasma exchange (TPE) and continuous renal replacement therapy (CRRT) for managing dengue-associated PALF concomitant with shock syndrome are limited. DESIGN Retrospective cohort study (January 2013 to June 2022). PATIENTS Thirty-four children. SETTING PICU of tertiary Children's Hospital No. 2 in Vietnam. INTERVENTIONS We assessed a before-versus-after practice change at our center of using combined TPE and CRRT (2018 to 2022) versus CRRT alone (2013 to 2017) in managing children with dengue-associated acute liver failure and shock syndrome. Clinical and laboratory data were reviewed from PICU admission, before and 24 h after CRRT and TPE treatments. The main study outcomes were 28-day in-hospital mortality, hemodynamics, clinical hepatoencephalopathy, and liver function normalization. MEASUREMENTS AND MAIN RESULTS A total of 34 children with a median age of 10 years (interquartile range: 7-11 yr) underwent standard-volume TPE and/or CRRT treatments. Combined TPE and CRRT ( n = 19), versus CRRT alone ( n = 15), was associated with lower proportion of mortality 7 of 19 (37%) versus 13 of 15 (87%), difference 50% (95% CI, 22-78; p < 0.01). Use of combined TPE and CRRT was associated with substantial advancements in clinical hepatoencephalopathy, liver transaminases, coagulation profiles, and blood lactate and ammonia levels (all p values < 0.001). CONCLUSIONS In our experience of children with dengue-associated PALF and shock syndrome, combined use of TPE and CRRT, versus CRRT alone, is associated with better outcomes. Such combination intervention was associated with normalization of liver function, neurological status, and biochemistry. In our center we continue to use combined TPE and CRRT rather than CRRT alone.
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Affiliation(s)
- Luan Thanh Vo
- Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam
| | - Viet Chau Do
- Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam
| | - Tung Huu Trinh
- Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam
| | - Thien Vu
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga, Japan
- AI Nutrition Project, National Institutes of Biomedical Innovation, Health and Nutrition, (NIBIOHN), Ibaraki, Osaka, Japan
| | - Thanh Tat Nguyen
- Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
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Davies E, Khan S, Mo YD, Jacquot C, Dham N, Sinha P, Webb J. Modifications to therapeutic plasma exchange to achieve rapid exchange on cardiopulmonary bypass prior to pediatric cardiac transplant. J Clin Apher 2023; 38:514-521. [PMID: 37042579 PMCID: PMC10567986 DOI: 10.1002/jca.22053] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/08/2023] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Cardiac transplants increasingly occur following placement of ventricular assist devices (VADs). A strong association exists between human leukocyte antigen (HLA) sensitization and VAD placement; however, desensitization protocols that utilize therapeutic plasma exchange (TPE) are fraught with technical challenges and are at increased risk of adverse events. In response to increased VAD utilization in our pre-transplant population, we developed a new institutional standard for TPE in the operating room. METHODS Through a multidisciplinary effort, we developed an institutional protocol for intraoperative TPE immediately prior to cardiac transplantation after cannulation onto cardiopulmonary bypass (CPB). All procedures used the standard TPE protocol on the Terumo Optia (Terumo BCT, Lakewood, CO, USA), but incorporated multiple modifications to limit patients' bypass times, and to coordinate with the surgical teams. These modifications included deliberate misidentification of replacement fluid and maximization of the citrate infusion rate. RESULTS These adjustments allowed the machine to run at maximal inlet speeds, minimizing duration of TPE. To date, 11 patients have been treated with this protocol. All survived their cardiac transplantation operation. Hypocalcemia and hypotension were noted; however, none of these adverse events appeared to have clinical impact. Technical complications included unexpected fibrin deposition in the TPE circuit and air in the inlet line due to surgical manipulation of the CPB cannula. No thromboembolic complications occurred in any patient. CONCLUSION We feel that this procedure can be rapidly and safely performed in HLA sensitized pediatric patients on CPB to limit the risk of antibody mediated rejection of their heart transplant.
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Affiliation(s)
- Emily Davies
- Division of Pediatric Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Sairah Khan
- Division of Cardiology and Cardiac Transplant, Children's National Hospital, Children's National Heart Institute, Washington, District of Columbia, USA
| | - Yunchuan D Mo
- Division of Laboratory and Transfusion Medicine, Children's National Hospital, Washington, District of Columbia, USA
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, District of Columbia, USA
| | - Cyril Jacquot
- Division of Laboratory and Transfusion Medicine, Children's National Hospital, Washington, District of Columbia, USA
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, District of Columbia, USA
| | - Niti Dham
- Division of Cardiology and Cardiac Transplant, Children's National Hospital, Children's National Heart Institute, Washington, District of Columbia, USA
| | - Pranava Sinha
- Division of Pediatric Cardiac Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jennifer Webb
- Division of Laboratory and Transfusion Medicine, Children's National Hospital, Washington, District of Columbia, USA
- Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, District of Columbia, USA
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Tonev D, Momchilova A. Therapeutic Plasma Exchange and Multiple Sclerosis Dysregulations: Focus on the Removal of Pathogenic Circulatory Factors and Altering Nerve Growth Factor and Sphingosine-1-Phosphate Plasma Levels. Curr Issues Mol Biol 2023; 45:7749-7774. [PMID: 37886933 PMCID: PMC10605592 DOI: 10.3390/cimb45100489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023] Open
Abstract
Multiple sclerosis (MS) is predominantly an immune-mediated disease of the central nervous system (CNS) of unknown etiology with a possible genetic predisposition and effect of certain environmental factors. It is generally accepted that the disease begins with an autoimmune inflammatory reaction targeting oligodendrocytes followed by a rapid depletion of their regenerative capacity with subsequent permanent neurodegenerative changes and disability. Recent research highlights the central role of B lymphocytes and the corresponding IgG and IgM autoantibodies in newly forming MS lesions. Thus, their removal along with the modulation of certain bioactive molecules to improve neuroprotection using therapeutic plasma exchange (TPE) becomes of utmost importance. Recently, it has been proposed to determine the levels and precise effects of both beneficial and harmful components in the serum of MS patients undergoing TPE to serve as markers for appropriate TPE protocols. In this review we discuss some relevant examples, focusing on the removal of pathogenic circulating factors and altering the plasma levels of nerve growth factor and sphingosine-1-phosphate by TPE. Altered plasma levels of the reviewed molecular compounds in response to TPE reflect a successful reduction of the pro-inflammatory burden at the expense of an increase in anti-inflammatory potential in the circulatory and CNS compartments.
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Affiliation(s)
- Dimitar Tonev
- Department of Anesthesiology and Intensive Care, University Hospital “Tzaritza Yoanna—ISUL”, Medical University of Sofia, 1527 Sofia, Bulgaria
| | - Albena Momchilova
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Science, 1113 Sofia, Bulgaria;
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Yu F, Wang L, Yuan H, Gao Z, He L, Hu F. Wasp venom-induced acute kidney injury: current progress and prospects. Ren Fail 2023; 45:2259230. [PMID: 38376456 PMCID: PMC10512847 DOI: 10.1080/0886022x.2023.2259230] [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: 07/04/2023] [Accepted: 09/11/2023] [Indexed: 02/21/2024] Open
Abstract
Wasp venom can trigger local and systemic reactions, with the kidneys being commonly affected, potentially causing acute kidney injury (AKI). Despite of the recent advances, our knowledge on the underlying mechanisms of toxicity and targeted therapies remain poor. AKI can result from direct nephrotoxic effects of the wasp venom or secondary rhabdomyolysis and intravascular hemolysis, which will release myoglobin and free hemoglobin. Inflammatory responses play a central role in these pathological mechanisms. Noteworthily, the successful establishment of a suitable experimental model can assist in basic research and clinical advancements related to wasp venom-induced AKI. The combination of therapeutic plasma exchange and continuous renal replacement therapy appears to be the preferred treatment for wasp venom-induced AKI. In addition, studies on cilastatin and varespladib for wasp venom-induced AKI treatment have shown their potential as therapeutic agents. This review summarizes the available evidence on the mechanisms and treatment of wasp venom-induced AKI, with a particular focus on the role of inflammatory responses and potential targets for therapeutic drugs, and, therefore, aiming to support the development of clinical treatment against wasp venom-induced AKI.
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Affiliation(s)
- Fanglin Yu
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Ling Wang
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Hai Yuan
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Zhao Gao
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Li He
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Fengqi Hu
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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Yeom GE, Lim SH, Kim JH, Ahn YH, Kim H, Ha J, Kim HY, Kang HG. Gastrointestinal involvement of passenger lymphocyte syndrome followed by minor ABO-incompatible renal transplantation: A case report. Pediatr Transplant 2023; 27:e14556. [PMID: 37300335 DOI: 10.1111/petr.14556] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/02/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND People with group O blood are considered universal organ donors compatible with any other blood group. However, in the case of minor ABO-incompatible transplantation, immune-mediated hemolysis may occur due to concomitant transfer of donor B lymphocytes together with the allograft. These passenger lymphocytes can produce antibodies in the recipients erythrocytes, causing hemolytic anemia known as passenger lymphocyte syndrome (PLS). METHODS A retrospective chart review was performed. RESULTS A 6-year-old boy (A+) underwent transplantation of a kidney from his father (O+). On postoperative day (POD) 6, the patient developed fever with no explainable causes. On POD 11, he presented with abdominal pain, hematochezia, and severe diarrhea, with sudden hemolytic anemia. Since then, GI symptoms have continued. On POD 20, direct antiglobulin test (DAT) was positive, and the anti-A IgM/G titer was 2/32. The results of the anti-A antibody elution test were strongly positive (3+). These findings highly suggested PLS. On the same day, the GI symptoms suddenly worsened, and laboratory findings showed hemolysis and thrombocytopenia with disseminated intravascular coagulation (DIC). Abdominal computed tomography (CT) scans suggested ischemic colitis of venous origin, and the patient underwent segmental colectomy with ileostomy formation on POD 23. To remove the anti-A antibodies, the patient underwent therapeutic plasma exchange (TPE) five times until the DAT and anti-A elution test were negative. CONCLUSIONS We report a case of gastrointestinal involvement of PLS that occurred after minor ABO-incompatible kidney transplantation. This is the first report of ischemic colitis as an atypical manifestation of PLS.
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Affiliation(s)
- Gyeong Eun Yeom
- Departments of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Seon Hee Lim
- Department of Pediatrics, Pusan National University Children's Hospital and School of Medicine, Yangsan, Republic of Korea
| | - Ji Hyun Kim
- Departments of Pediatrics, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Yo Han Ahn
- Departments of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jongwon Ha
- The Transplantation Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hee Gyung Kang
- Departments of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
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23
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LiKamWa A, Kobaitri K, Totapally BR. A Neonate With Cytokine Storm Managed With Steroids, Therapeutic Plasma Exchange, and Tocilizumab. Cureus 2023; 15:e45138. [PMID: 37842348 PMCID: PMC10569940 DOI: 10.7759/cureus.45138] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Neonatal cytokine storms, though rare, can induce hyperinflammation due to elevated interleukin-6 (IL-6), triggering multiorgan failure. We present the case of a term male neonate necessitating extracorporeal membrane oxygenation (ECMO) post-birth for persistent pulmonary hypertension due to meconium aspiration syndrome. Three days after weaning from ECMO support, steroids and therapeutic plasma exchange were initiated due to deteriorating thrombocytopenia, oxygenation, hemodynamic instability, and increased C-reactive protein (CRP) and ferritin levels. Elevated IL-6 prompted tocilizumab administration after four days of daily plasmapheresis. Post-tocilizumab infusion, notable enhancements in platelet counts, oxygenation indices, and CRP were observed, resulting in stable discharge of the child. Comprehensive evaluations for infections, including coronavirus disease 2019, as well as genetic and metabolic disorders, yielded negative results.
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Affiliation(s)
- Amy LiKamWa
- Pediatrics, Herbert Wertheim College of Medicine, Miami, USA
| | - Kaitlin Kobaitri
- Critical Care Medicine, Nicklaus Children's Hospital, Miami, USA
| | - Balagangadhar R Totapally
- Critical Care Medicine, Nicklaus Children's Hospital, Miami, USA
- Pediatrics, Herbert Wertheim College of Medicine, Miami, USA
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24
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Rduch T, Arn N, Kinkel J, Fischer T, Binet I, Hornung R, Herrmann IK. Magnetic blood purification-based soluble fms-like tyrosine kinase-1 removal in comparison with dextran sulfate apheresis and therapeutic plasma exchange. Artif Organs 2023; 47:1309-1318. [PMID: 36995348 DOI: 10.1111/aor.14531] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Preeclampsia remains one of the most serious complications of pregnancy. Effective therapies are yet to be developed. Recent research has identified an imbalance of angiogenic and antiangiogenic factors as a root cause of preeclampsia. In particular, soluble fms-like tyrosine kinase-1 (sFlt-1) has been shown to bind the angiogenic factors vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), reducing blood vessel growth. Increasing preclinical and clinical evidence suggests that removal of the sFlt-1 protein may benefit patients with early onset preeclampsia. sFlt-1 may be removed by conventional blood purification techniques, such as therapeutic plasma exchange (TPE) and dextran sulfate apheresis (DSA), or emerging technologies, including extracorporeal magnetic blood purification (MBP). METHODS We compare the performance and selectivity of TPE, DSA, and MBP for the therapeutic removal of sFlt-1. For MPB, we employ magnetic nanoparticles functionalized with either sFlt-1 antibodies or the sFlt-1-binding partner, vascular endothelial growth factor (VEGF). RESULTS We demonstrate that sFlt-1 removal by MBP is feasible and significantly more selective than TPE and DSA at comparable sFlt-1 removal efficiencies (MBP 96%, TPE 92%, DSA 78%). During both TPE and DSA, complement factors (incl. C3c and C4) are depleted to a considerable extent (-90% for TPE, -55% for DSA), while in MBP, complement factor concentrations remain unaltered. We further demonstrate that the removal efficacy of sFlt-1 in the MBP approach is strongly dependent on the nanoparticle type and dose and can be optimized to reach clinically feasible throughputs. CONCLUSIONS Taken together, the highly selective removal of sFlt-1 and potential other disease-causing factors by extracorporeal magnetic blood purification may offer new prospects for preeclamptic patients.
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Affiliation(s)
- Thomas Rduch
- Department of Gynaecology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, St. Gallen, Switzerland
- Laboratory for Particles-Biology Interactions, Department of Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, St. Gallen, Switzerland
| | - Norbert Arn
- Clinic for Nephrology and Transplant Medicine, Cantonal Hospital St.Gallen, Rorschacherstrasse 95, St.Gallen, Switzerland
| | - Janis Kinkel
- Department of Gynaecology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, St. Gallen, Switzerland
| | - Tina Fischer
- Department of Gynaecology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, St. Gallen, Switzerland
| | - Isabelle Binet
- Clinic for Nephrology and Transplant Medicine, Cantonal Hospital St.Gallen, Rorschacherstrasse 95, St.Gallen, Switzerland
| | - René Hornung
- Department of Gynaecology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, St. Gallen, Switzerland
| | - Inge K Herrmann
- Laboratory for Particles-Biology Interactions, Department of Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, St. Gallen, Switzerland
- Department of Mechanical and Process Engineering, ETH Zurich, Nanoparticle Systems Engineering Laboratory, Institute of Energy and Process Engineering, Sonneggstrasse 3, Zurich, Switzerland
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Coppo P, Joly BS. Caplacizumab: A game changer also in pregnancy-associated immune-mediated thrombotic thrombocytopenic purpura? Br J Haematol 2023; 202:725-727. [PMID: 37291806 DOI: 10.1111/bjh.18915] [Citation(s) in RCA: 2] [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: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Therapeutic options in immune-mediated thrombotic thrombocytopenic purpura (iTTP) during pregnancy are limited besides therapeutic plasma exchange (TPE) and corticosteroids. The report by Odetola et al. suggests that caplacizumab represents a reasonable option in iTTP during pregnancy, especially when the disease is not rapidly controlled with the standard TPE-corticosteroid association. Commentary on: Odetola et al. Safe and effective use of caplacizumab in pregnancy-related acquired thrombotic thrombocytopenic purpura. Br J Haematol 2023;202:879-882.
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Affiliation(s)
- Paul Coppo
- Service d'hématologie, AP-HP. 6 and Sorbonne - Université, Paris, France
- Centre National de Référence des Microangiopathies thrombotiques (CNR-MAT), AP-HP. 6 and Sorbonne - Université, Paris, France
- Centre de Recherche des Cordeliers, INSERM UMRS1138, Paris, France
| | - Bérangère S Joly
- Centre National de Référence des Microangiopathies thrombotiques (CNR-MAT), AP-HP. 6 and Sorbonne - Université, Paris, France
- Service d'Hématologie Biologique, Hôpital Lariboisière, AP-HP.Nord, Université Paris Cité, Paris, France
- EA3518, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
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26
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Mercure-Corriveau N, Roy S, Hu C, Crowe EP, Zhu X, Obando D, Patel EU, Tobian AAR, Wang Y, Bloch EM, Newsome SD. Therapeutic plasma exchange in the management of stiff person syndrome spectrum disorders: a case series and review of the literature. Ther Adv Neurol Disord 2023; 16:17562864231180736. [PMID: 37529719 PMCID: PMC10387686 DOI: 10.1177/17562864231180736] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/11/2023] [Indexed: 08/03/2023] Open
Abstract
Background Stiff person syndrome spectrum disorders (SPSD) are a rare group of disabling neuroimmunological disorders. SPSD often requires immune therapies, especially in the setting of inadequate response to symptomatic treatments. The safety and efficacy of therapeutic plasma exchange (TPE) in SPSD remains uncertain. Objectives To describe the safety, tolerability, and efficacy of TPE in patients with SPSD. Design A retrospective observational study. Methods A retrospective review of SPSD patients seen at Johns Hopkins Hospital (JHH) from 1997 to 2021 was performed. Patient demographics/history, examination/diagnostic findings, treatment response, and TPE-related complications were recorded. Assessment for any associations between clinical characteristics, including age, sex, clinical phenotype, and time on immunotherapy, and response to TPE 3 months after treatment was performed. A subgroup of 18 patients treated with TPE at JHH and 6 patients treated with TPE at outside institutions were evaluated for any change in usage of symptomatic medications 3 months after the TPE treatment. Literature review of SPSD and TPE was also conducted. Results Thirty-nine SPSD patients were treated with TPE (21 at JHH and 18 at outside institutions); median age 48 years, 77% female, median modified Rankin Scale 3; mean initial anti-GAD65 antibody titer was 23,508 U/mL. Twenty-four patients (62%) had classic SPS, 10 (26%) had SPS-plus, 2 (5%) had progressive encephalomyelitis with rigidity and myoclonus, and 3 (8%) had pure cerebellar ataxia. All patients were on symptomatic treatments, 30 (77%) previously received IVIg, and 3 (8%) previously received rituximab. Four patients (10%) had a TPE-related adverse event. One developed asymptomatic hypotension, another had both line thrombosis and infection, and two had non-life-threatening bleeding events. Twenty-three (59%) patients reported improvement in symptoms after TPE. Of the subgroup of 24 patients evaluated for any change in usage of symptomatic medications 3 months after the TPE treatment, 14 (58%) required fewer GABAergic symptomatic medications. Literature review identified 57 additional patients with SPSD; 43 (75%) reported temporary improvement after TPE. Conclusion The majority of patients treated with TPE had improvement. Moreover, most patients evaluated for any change in usage of symptomatic medications after the TPE treatment no longer required as much symptomatic medications months after TPE. TPE appears safe and well-tolerated in SPSD. Further studies are needed to assess the long-term efficacy of TPE in SPSD and identify which patients may benefit the most from TPE.
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Affiliation(s)
- Nicolas Mercure-Corriveau
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shuvro Roy
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Chen Hu
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Elizabeth P. Crowe
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Xianming Zhu
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle Obando
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Eshan U. Patel
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aaron A. R. Tobian
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Yujie Wang
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Scott D. Newsome
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
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27
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Göth D, Mahler CF, Kälble F, Speer C, Benning L, Schmitt FCF, Dietrich M, Krautkrämer E, Zeier M, Merle U, Morath C, Fiedler MO, Weigand MA, Nusshag C. Liver-Support Therapies in Critical Illness-A Comparative Analysis of Procedural Characteristics and Safety. J Clin Med 2023; 12:4669. [PMID: 37510784 PMCID: PMC10380554 DOI: 10.3390/jcm12144669] [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: 04/17/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Extracorporeal liver-support therapies remain controversial in critically ill patients, as most studies have failed to show an improvement in outcomes. However, heterogeneous timing and inclusion criteria, an insufficient number of treatments, and the lack of a situation-dependent selection of available liver-support modalities may have contributed to negative study results. We retrospectively investigated the procedural characteristics and safety of the three liver-support therapies CytoSorb, Molecular Adsorbent Recirculating System (MARS) and therapeutic plasma exchange (TPE). Whereas TPE had its strengths in a shorter treatment duration, in clearing larger molecules, affecting platelet numbers less, and improving systemic coagulation and hemodynamics, CytoSorb and MARS were associated with a superior reduction in particularly small protein-bound and water-soluble substances. The clearance magnitude was concentration-dependent for all three therapies, but additionally related to the molecular weight for CytoSorb and MARS therapy. Severe complications did not appear. In conclusion, a better characterization of disease-driving as well as beneficial molecules in critically ill patients with acute liver dysfunction is crucial to improve the use of liver-support therapy in critically ill patients. TPE may be beneficial in patients at high risk for bleeding complications and impaired liver synthesis and hemodynamics, while CytoSorb and MARS may be considered for patients in whom the elimination of smaller toxic compounds is a primary objective.
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Affiliation(s)
- Daniel Göth
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Christoph F Mahler
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Florian Kälble
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Claudius Speer
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Louise Benning
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Felix C F Schmitt
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Maximilian Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Ellen Krautkrämer
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Mascha O Fiedler
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Christian Nusshag
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany
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28
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Abdelhay A, Mahmoud AA, Ammari O, Dalbah R, Reghis M, Hashem A, Alkasem M, Mostafa M. Outcomes of therapeutic plasma exchange in severe autoimmune hemolytic anemia hospitalizations: An analysis of the National Inpatient Sample. Transfusion 2023. [PMID: 37395043 DOI: 10.1111/trf.17445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/12/2023] [Accepted: 05/09/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Autoimmune hemolytic anemia (AIHA) is characterized by humoral and/or cellular immune-mediated hemolysis of red blood cells. The role of therapeutic plasma exchange (TPE) in AIHA is unclear. STUDY DESIGN AND METHODS We queried the National Inpatient Sample (NIS) for 2002-2019 to identify hospitalizations with the primary diagnosis of AIHA. We included hospitalizations with the highest severity subclass identified by All Patient Refined Disease Related Group (APR-DRG). We used multivariate regression analysis to compare in-hospital mortality and other relevant in-hospital outcomes between hospitalizations that received TPE and those that did not. RESULTS We identified 255 weighted hospitalizations in the TPE group and 4973 in the control group. Those in the control group were older (median age 67 vs. 48 years, p < .001) and had a higher prevalence of most comorbidities. The TPE group had higher odds of all-cause in-hospital mortality (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.11). They also had higher rates of many secondary outcomes, including requiring mechanical ventilation, developing circulatory shock, acute stroke, urinary tract infections, intracranial hemorrhage, acute kidney injury, and requiring new hemodialysis. No significant differences were noted in the rates of acute myocardial infarctions, bacterial pneumonia, sepsis/septicemia, thromboembolic events, and other bleeding events. Furthermore, the TPE group had a higher median length of hospital stay (19 vs. 9 days, p < .001). CONCLUSION Hospitalizations with severe AIHA that received TPE had higher rates of adverse in-hospital outcomes.
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Affiliation(s)
- Ali Abdelhay
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Amir A Mahmoud
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Omar Ammari
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Rami Dalbah
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Mouna Reghis
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Anas Hashem
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Mouaz Alkasem
- School of Medicine, University of Jordan, Amman, Jordan
| | - Mariam Mostafa
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
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29
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Mohan PB, Chittoria RK, Koliyath S, Pathan I, Thomas N, Kerakada N, Kedareswar M, Koirala D, R A, Ahmed FM. Therapeutic Plasma exchange therapy in Burns. J Cutan Aesthet Surg 2023; 16:259-261. [PMID: 38189078 PMCID: PMC10768955 DOI: 10.4103/jcas.jcas_173_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Severe burn injury affects the body in many devastating ways, the most severe being systemic inflammatory response syndrome. This results in a myriad of effects like increasing capillary permeability, thereby fluid loss. It also causes a surge in inflammatory mediators like interleukin (IL)-6, which further increases the capillary leak and fluid loss. This results in refractory hypotension in patients despite adequate fluid resuscitation. Plasma exchange has been used in the management of a number of illnesses with a significant inflammatory component, and, therefore can be considered to have a role in burn injury. In our article, we would like to share our experience of using therapeutic plasma exchange therapy in burn patient.
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Affiliation(s)
- Padmalakshmi Bharathi Mohan
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Ravi Kumar Chittoria
- Department of Plastic Surgery & Telemedicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Shijina Koliyath
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Imran Pathan
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Neljo Thomas
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Nishad Kerakada
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Maramreddy Kedareswar
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Diwash Koirala
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Aishwarya R
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Furqan Mohammed Ahmed
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Bereanu AS, Pisaltu T, Bereanu R, Vintila B, Codru I, Chicea L, Crisan O, Căinap C, Cainap S, Sava M. Therapeutic Plasma Exchange in Catastrophic Antiphospholipid Syndrome (CAPS): A Rare Case Report and Literature Review. In Vivo 2023; 37:1914-1919. [PMID: 37369472 DOI: 10.21873/invivo.13286] [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: 05/02/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND/AIM Catastrophic antiphospholipid syndrome (CAPS) may be the first manifestation ("de novo") of antiphospholipid syndrome (APS) or a complication in the clinical course of patients known to have this syndrome. Approximately 40% of patients had an associated autoimmune disease, mainly, systemic lupus erythematosus (SLE). The trigger can be one of the following: infections, surgical interventions, neoplasms, pregnancy, discontinuation of anticoagulant treatment, and others. CAPS is a medical emergency in which early identification and prompt initiation of aggressive therapy is extremely important. According to the Guidelines for the use of Therapeutic Apheresis in Clinical Practice developed by the American Society for Apheresis (ASFA), last updated in April 2023, in CAPS, the indication for therapeutic plasma exchange (TPE) is category I, grade 2C. CASE REPORT We present a case of probable CAPS secondary to systemic lupus erythematosus (SLE) in an elderly patient in whom clinical and biological improvement was achieved through a multidisciplinary approach and prompt initiation of TPE. Because TPE is considered first-line therapy in CAPS, we initiated the procedure as soon as the attending rheumatologist raised this suspicion. Four plasmapheresis sessions were performed in the Intensive Care Unit. We used TPE by membrane filtration. Following the therapeutic intervention with TPE, corticotherapy (Solumedrol in puls-therapy), cyclophosphamide and anticoagulant treatment, the evolution was favourable, with clinical and biological improvement. CONCLUSION The prompt initiation of TPE, because of the suspicion of CAPS, increases the chances of a favourable evolution.
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Affiliation(s)
- Alina-Simona Bereanu
- Faculty of Medicine, "Lucian Blaga" University of Sibiu, Sibiu, Romania;
- County Clinical Emergency Hospital of Sibiu, Sibiu, Romania
| | - Teofil Pisaltu
- County Clinical Emergency Hospital of Sibiu, Sibiu, Romania
| | - Rareș Bereanu
- Faculty of Medicine, "Lucian Blaga" University of Sibiu, Sibiu, Romania
| | - Bogdan Vintila
- Faculty of Medicine, "Lucian Blaga" University of Sibiu, Sibiu, Romania
- County Clinical Emergency Hospital of Sibiu, Sibiu, Romania
| | - Ioana Codru
- Faculty of Medicine, "Lucian Blaga" University of Sibiu, Sibiu, Romania
- County Clinical Emergency Hospital of Sibiu, Sibiu, Romania
| | - Liana Chicea
- Faculty of Medicine, "Lucian Blaga" University of Sibiu, Sibiu, Romania
- County Clinical Emergency Hospital of Sibiu, Sibiu, Romania
| | - Ovidiu Crisan
- Faculty of Pharmacy, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Calin Căinap
- Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Cainap
- Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Sava
- Faculty of Medicine, "Lucian Blaga" University of Sibiu, Sibiu, Romania
- County Clinical Emergency Hospital of Sibiu, Sibiu, Romania
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31
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Iannaccone A, Reisch B, Kimmig R, Schmidt B, Mavarani L, Darkwah Oppong M, Tyczynski B, Dzietko M, Jahn M, Gellhaus A, Köninger A. Therapeutic Plasma Exchange in Early-Onset Preeclampsia: A 7-Year Monocentric Experience. J Clin Med 2023; 12:4289. [PMID: 37445324 DOI: 10.3390/jcm12134289] [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: 05/12/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Different therapeutic apheresis techniques have been clinically tested to delay preterm delivery in the case of eoPE (early-onset preeclampsia). Our study evaluated the feasibility of TPE (therapeutic plasma exchange) compared to standard-of-care treatment. Twenty patients treated with 95 TPE sessions were included in the final analysis and retrospectively matched with 21 patients with comparable placental dysfunction. Gestational age at admission was 23.75 ± 2.26 versus 27.57 ± 2.68 weeks of gestation (WoG) in the control group (p = < 0.001), mean sFlt-1/PlGF ratio was 1946.26 ± 2301.63 versus 2146.70 ± 3273.63 (p = 0.821) and mean sEng was 87.63 ± 108.2 ng/mL versus 114.48 ± 88.78 ng/mL (p = 0.445). Pregnancy was prolonged for 8.25 ± 5.97 days when TPE was started, compared to 3.14 ± 4.57 days (p = 0.004). The median sFlt-1/PlGF Ratio was 1430 before and 1153 after TPE (-18.02%). Median sEng fell from 55.96 ng/mL to 47.62 mg/mL (-27.73%). The fetal survival rate was higher in TPE-treated cases. NICU (Neonatal Intensive Center Unit) stay was in the median of 63 days in the TPE group versus 48 days in the standard-of-care group (p = 0.248). To date, this monocentric retrospective study, reports the largest experience with extracorporeal treatments in eoPE worldwide. TPE could improve pregnancy duration and reduce sFlt-1 and sEng in maternal serum without impairing neonatal outcomes.
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Affiliation(s)
- Antonella Iannaccone
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Beatrix Reisch
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany
| | - Laven Mavarani
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Mark Dzietko
- Department of Pediatrics I, Division of Neonatology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Alexandra Gellhaus
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Angela Köninger
- Department of Gynecology and Obstetrics, St. Hedwig's Clinic of the Order of St. John, University Regensburg, 93053 Regensburg, Germany
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Noutsos T, Isbister GK. Snakebite-associated thrombotic microangiopathy: a spotlight on pharmaceutical interventions. Expert Rev Clin Pharmacol 2023. [PMID: 37259708 DOI: 10.1080/17512433.2023.2220963] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Snakebite is a neglected public health issue causing death and disability, disproportionately affecting tropical and subtropical resource poor countries globally. Snakebite-associated thrombotic microangiopathy (TMA) occurs in a subset of snakebites and is associated with acute kidney injury (sometimes requiring renal replacement therapy), and a risk of chronic kidney disease. AREAS COVERED This expert review synthesizes current evidence on therapeutic interventions in snakebite-associated TMA, via PubMed search for cohort studies and randomized controlled trials (RCT) in snakebite-associated TMA from 1970 to October 2022. EXPERT OPINION There are no interventional RCTs in snakebite-associated TMA. Recent cohort studies from Sri Lanka, India and Australia report clinical and laboratory endpoint outcomes for intervention with antivenom and therapeutic plasma-exchange (TPE). TPE is a resource intense and costly treatment using large volumes of blood donor plasma. There is no consistent evidence supporting TPE in snakebite-associated TMA with respect to patient survival, dialysis free survival, or hospital length of stay. Antivenom is the standard of care for patients with snake envenoming, but there is no specific evidence of benefit in snakebite-associated TMA. Emerging new therapies in snakebite more broadly are untested in snakebite-associated TMA. RCTs are needed to improve the evidence for treatment of snakebite-associated TMA.
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Affiliation(s)
- Tina Noutsos
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia
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Ebermeyer T, Hequet O, Berard F, Prier A, Eyraud MA, Arthaud CA, Heestermans M, Duchez AC, Guironnet-Paquet A, Berthelot P, Cognasse F, Hamzeh-Cognasse H. The efficacy of therapeutic plasma exchange in COVID-19 patients on endothelial tightness in vitro is hindered by platelet activation. Front Cardiovasc Med 2023; 10:1094786. [PMID: 37215546 PMCID: PMC10192624 DOI: 10.3389/fcvm.2023.1094786] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Coronavirus disease (COVID)-19 is characterised in particular by vascular inflammation with platelet activation and endothelial dysfunction. During the pandemic, therapeutic plasma exchange (TPE) was used to reduce the cytokine storm in the circulation and delay or prevent ICU admissions. This procedure consists in replacing the inflammatory plasma by fresh frozen plasma from healthy donors and is often used to remove pathogenic molecules from plasma (autoantibodies, immune complexes, toxins, etc.). This study uses an in vitro model of platelet-endothelial cell interactions to assess changes in these interactions by plasma from COVID-19 patients and to determine the extent to which TPE reduces such changes. We noted that exposure of an endothelial monolayer to plasmas from COVID-19 patients post-TPE induced less endothelial permeability compared to COVID-19 control plasmas. Yet, when endothelial cells were co-cultured with healthy platelets and exposed to the plasma, the beneficial effect of TPE on endothelial permeability was somewhat reduced. This was linked to platelet and endothelial phenotypical activation but not with inflammatory molecule secretion. Our work shows that, in parallel to the beneficial removal of inflammatory factors from the circulation, TPE triggers cellular activation which may partly explain the reduction in efficacy in terms of endothelial dysfunction. These findings provide new insights for improving the efficacy of TPE using supporting treatments targeting platelet activation, for instance.
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Affiliation(s)
- Theo Ebermeyer
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
| | - Olivier Hequet
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Université Jean Monnet de Saint-Etienne, Lyon, France
| | - Frederic Berard
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Université Jean Monnet de Saint-Etienne, Lyon, France
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, Hospices Civils de Lyon, Lyon, France
| | - Amelie Prier
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Marie-Ange Eyraud
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Charles-Antoine Arthaud
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Marco Heestermans
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Anne-Claire Duchez
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Aurelie Guironnet-Paquet
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Université Jean Monnet de Saint-Etienne, Lyon, France
| | - Philippe Berthelot
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Université Jean Monnet de Saint-Etienne, Lyon, France
- University Hospital of Saint-Etienne, Infectious Diseases Department, F-42023, Saint-Etienne, France
| | - Fabrice Cognasse
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Hind Hamzeh-Cognasse
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
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Boparai S, Lakra R, Dhaliwal L, Hansra RS, Bhuiyan MAN, Conrad SA, Krishnan P. Therapeutic Plasma Exchange in Severe Rhabdomyolysis: A Case-Control Study. Cureus 2023; 15:e39748. [PMID: 37398832 PMCID: PMC10310893 DOI: 10.7759/cureus.39748] [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] [Accepted: 03/30/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Rhabdomyolysis is a serious condition that can cause acute kidney injury (AKI), compartment syndrome, severe metabolic and electrolyte derangement leading to arrhythmias, and even death. Total plasma exchange (TPE) has been used as a treatment modality to clear myoglobin, but the evidence is limited. In this study, we aim to investigate the use of TPE in critically ill rhabdomyolysis patients. METHODS We retrospectively chart reviewed adult patients admitted to the intensive care unit (ICU) with a diagnosis of rhabdomyolysis between 2012 and 2021. We dichotomized patients into two groups based on whether TPE was used or not in addition to standard care. PRISMA machines with TPE2000 filters and either 5% albumin or fresh frozen plasma were used in the TPE group. RESULTS The patients' age ranged from 23 years to 87 years (mean 49.4, SD 18.1), and 51% were male. Initial creatinine ranged from 0.6 to 16mg/dL (mean 3.4, SD 2.7), creatinine phosphokinase (CPK) from 403-93,232 U/L, and myoglobin from 934 to >20,000. The Sequential Organ Failure Assessment (SOFA)scores on admission ranged from 6 to 17 (mean 7.23, SD 3.40). Overall, 28.78% (N=19) of the patients received therapeutic plasma exchange. The overall mortality in our study was 31.9%, with the length of ICU stay ranging from 1-25 days (mean 7.10, SD 5.91) among survivors. Older age and the presence of shock were predictive of mortality in univariate and multivariate analyses. There was no statistically significant association in mortality between the TPE and non-TPE groups (36.84% in TPE vs. 36.17% in the non-TPE group, OR 0.7209, p=0.959). Only two patients in the non-TPE group developed CKD/ESRD on long-term follow-up. CONCLUSION Our study showed that TPE administration in critically ill patients with rhabdomyolysis did not improve mortality or length of ICU stay. Further studies are required to elucidate its indication and effect on long-term renal outcomes.
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Affiliation(s)
- Sukhmani Boparai
- Internal Medicine, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Rachaita Lakra
- Internal Medicine, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Lovekirat Dhaliwal
- Internal Medicine, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Rajkamal S Hansra
- Pulmonary and Critical Care Medicine, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | | | - Steven A Conrad
- Pulmonary and Critical Care Medicine, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Prathik Krishnan
- Pulmonary and Critical Care Medicine, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
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Porosnicu TM, Sirbu IO, Oancea C, Sandesc D, Bratosin F, Rosca O, Jipa D, Boeriu E, Bandi SSS, Pricop M. The Impact of Therapeutic Plasma Exchange on Inflammatory Markers and Acute Phase Reactants in Patients with Severe SARS-CoV-2 Infection. Medicina (Kaunas) 2023; 59:medicina59050867. [PMID: 37241099 DOI: 10.3390/medicina59050867] [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: 01/19/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Due to the poor prognosis and the very high mortality rate associated with severe SARS-CoV-2 infections, various regimens have been tried to stop the evolution of the inflammatory cascade, such as immunomodulatory therapy and plasma clearance of the acute phase reactants involved. Therefore, the objective of this review was to analyze the effects of using therapeutic plasma exchange (TPE), also known as plasmapheresis, on the inflammatory markers of critically ill COVID-19 patients admitted to the intensive care unit (ICU). Materials and Methods: A thorough scientific database search was performed, and it included a review of articles published on PubMed, Cochrane Database, Scopus, and Web of Science from the beginning of the COVID-19 pandemic in March 2020 until September 2022 that focused on the treatment of SARS-CoV-2 infections using plasma exchange for patients admitted to the ICU. The current study included original articles, reviews, editorials, and short or special communications regarding the topic of interest. Results: A total of 13 articles were selected after satisfying the inclusion criterion of three or more patients enrolled with clinically severe COVID-19 that were eligible for TPE. From the included articles, it was observed that TPE was used as a last-resort salvage therapy that can be regarded as an alternative treatment method when the standard management for these patients fails. TPE significantly decreased the inflammatory status as measured by Interleukin-6 (IL-6), C-reactive protein (CRP), lymphocyte count, and D-dimers, as well as improving the clinical status measured with PaO2/FiO2 and duration of hospitalization. The pooled mortality risk reduction after TPE was 20%. Conclusions: There are sufficient studies and evidence to show that TPE reduces inflammatory mediators and improves coagulation function and the clinical/paraclinical status. Nevertheless, although it was shown that TPE decreases the severe inflammatory status without significant complications, the improvement of survival rate remains unclear.
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Affiliation(s)
- Tamara Mirela Porosnicu
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Intensive Care Unit, "Pius Brinzeu" Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Ioan Ovidiu Sirbu
- Center for Complex Network Sciences, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Disease, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Dorel Sandesc
- Department of Anesthesia and Intensive Care, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Department XIII, Discipline of Infectious Disease, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Rosca
- Department XIII, Discipline of Infectious Disease, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniel Jipa
- Intensive Care Unit, "Pius Brinzeu" Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Estera Boeriu
- Department of Pediatrics, Discipline of Pediatric Oncology and Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Satya Sai Sri Bandi
- Malla Reddy Institute of Medical Sciences, Suraram Main Road 138, Hyderabad 500055, India
| | - Marius Pricop
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Lee OPE, Kanesan N, Leow EH, Sultana R, Chor YK, Gan CS, Lee JH. Survival Benefits of Therapeutic Plasma Exchane in Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis. J Intensive Care Med 2023:8850666231170775. [PMID: 37097910 DOI: 10.1177/08850666231170775] [Citation(s) in RCA: 3] [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] [Indexed: 04/26/2023]
Abstract
OBJECTIVES To summarize the role of therapeutic plasma exchange (TPE) in critically ill adults and children with severe sepsis. DATA COLLECTION A systematic search was performed using the following databases: Medline, EMBASE, CINAHL, and Cochrane from January 1990 till December 2022. Comparative studies of TPE in severe sepsis were selected. Adult and pediatric data were analyzed separately. DATA SYNTHESIS Eight randomized control trials and 6 observational studies (n = 50,142 patients) were included. Centrifugal TPE was the most common modality (209/280, 74.6% adults and 952/1026, 92.7% children). Every TPE study utilized different volume exchanges. Most TPE sessions (1173/1306, 89.8%) employed fresh frozen plasma (FFP) as replacement fluid and heparin as anticoagulant. Adults with severe sepsis supported with TPE using FFP had lower mortality (risk ratio, RR: 0.64 [95% confidence interval, CI: 0.49, 0.84]) compared to those who did not. In contrast, TPE was associated with increased mortality in septic children without thrombocytopenia-associated multiorgan failure (RR: 2.23, 95% CI: 1.93, 2.57). There was no difference in outcomes in patients supported with centrifugal and membrane TPE. In both populations, patients supported on TPE as a continuous regime had poorer outcome. CONCLUSION Current evidence indicates that TPE is a potential adjunct therapy in adults with severe sepsis but not in children.
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Affiliation(s)
- Olive P E Lee
- Sarawak General Hospital, Kuching, Malaysia
- Birmingham Children's Hospital, Birmingham, UK
| | | | - Esther H Leow
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Yek K Chor
- Birmingham Children's Hospital, Birmingham, UK
| | - Chin S Gan
- Pediatric Intensive Care Unit, University Malaya Medical Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jan H Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
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Ciorpac M, Caratașu CC, Szilagyi A, Mihai CT, Nistor I, Iliescu R, Tamba BI. A novel device and system concept for therapeutic plasma exchange in rats. Ther Apher Dial 2023. [PMID: 37039771 DOI: 10.1111/1744-9987.13989] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) has been developed more than 100 years ago in an animal model and adapted to humans 30 years later. Since then, the TPE research on animal models is lacking, mainly due to difficulties raised by the scaling of the plasmapheresis unit so that the animal's cardiovascular parameters are not considerably affected. METHODS The system concept of a novel TPE device with continuous hemodynamic monitoring in small rodent models has been used. RESULTS A continuum TPE unit for rats has been developed, able to produce up to 95% plasma exchange rate without any TPE-related hemodynamic impairment, monitored up to 35 days after the procedure. CONCLUSION The TPE unit for rats was able to produce 95% plasma exchange rate in non-anesthetized animals, enabling a full translation of the human TPE into an animal model. The newly developed plasmapheresis unit enable a wide range of more accurate preclinical evaluation, with cardiac parameters monitoring, using small rodents in awaken state.
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Affiliation(s)
- Mitică Ciorpac
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy of Iasi, Iasi, Romania
| | - Cezar-Cătălin Caratașu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy of Iasi, Iasi, Romania
| | - Andrei Szilagyi
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy of Iasi, Iasi, Romania
| | - Cosmin-Teodor Mihai
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy of Iasi, Iasi, Romania
| | - Ionut Nistor
- Innovation and Technological Transfer Center for the Management of the Elderly and Healthy Aging (CITT MAVIS), Grigore T. Popa University of Medicine and Pharmacy of Iasi, Iasi, Romania
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, Iasi, Romania
| | - Radu Iliescu
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, Iasi, Romania
| | - Bogdan Ionel Tamba
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy of Iasi, Iasi, Romania
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Pandey P, Setya D, Marik A, Ranjan S, Kumari S, Mandal S, Kumar P. Single center experience of therapeutic plasma exchange in a resource-constrained setting: A study of trends in scope and complications. J Clin Apher 2023. [PMID: 37029628 DOI: 10.1002/jca.22052] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/03/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Therapeutic apheresis procedures are becoming an increasingly integral part of modern medical practice, be it as a part of therapy or pre-conditioning regimes for solid organ transplants. In our center, we follow the American Society for Apheresis (ASFA) guidelines for categorizing these procedures. However, lack of a centralized registry for therapeutic apheresis in India, lack of consolidated data as well as a resource-constrained setting prevent it from being utilized to its full potential. STUDY DESIGN AND METHODS This study was a retrospective analysis of therapeutic plasma exchange (TPE) procedures performed from January 2015 to October 2022 in the Department of Transfusion Medicine at a large tertiary care hospital in North India. All consecutive TPE procedures were included. Overall and specialty-wise scoring for all patients was performed. Mean scores were calculated. RESULTS A total of 1434 procedures were performed during the study duration of 7 years. These procedures were performed for 284 different patients. Majority of the procedures were referred from nephrology (895 of 1434, 62.4%), followed by neurology, gastroenterology, and liver transplant teams, hematology, critical care, rheumatology, pediatrics, and internal medicine. Complete response, partial response, and no-response were observed in 1077 (75.1%), 201 (14%), and 156 (10.9%) procedures respectively. Only 14 procedures reported adverse effects. DISCUSSION Increasing effectiveness of TPE in a number of procedures and a variety of indications has broadened its scope, while the small number of adverse events, when supervised by trained Transfusion Medicine physicians has made TPE a more viable and safer alternative to other treatment modalities.
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Affiliation(s)
- Prashant Pandey
- Department of Transfusion Medicine & Transplant Immunology, Jaypee hospital, Sector-128, Noida, 201304, India
| | - Divya Setya
- Department of Immunohematology & Transfusion Medicine, Manipal Hospital, Sector-5, Jaipur, 302013, India
| | - Arghyadeep Marik
- Department of Transfusion Medicine & Transplant Immunology, Jaypee hospital, Sector-128, Noida, 201304, India
| | - Shweta Ranjan
- Department of Transfusion Medicine & Transplant Immunology, Jaypee hospital, Sector-128, Noida, 201304, India
| | - Supriya Kumari
- Department of Transfusion Medicine & Transplant Immunology, Jaypee hospital, Sector-128, Noida, 201304, India
| | - Saikat Mandal
- Department of Transfusion Medicine & Transplant Immunology, Jaypee hospital, Sector-128, Noida, 201304, India
| | - Praveen Kumar
- Department of Transfusion Medicine & Transplant Immunology, Jaypee hospital, Sector-128, Noida, 201304, India
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Zhang Y, Cheng YK, Yang CF, Jin LM, Li YM. Therapeutic plasma exchange in anti-N-methyl-D-aspartate receptor encephalitis. Ther Apher Dial 2023; 27:197-206. [PMID: 36165337 DOI: 10.1111/1744-9987.13934] [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: 06/09/2022] [Revised: 09/05/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022]
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most commonly identified cause of autoimmune encephalitis. Therapeutic plasma exchange has been increasingly employed to treat this disease. This expansion is a consequence of improved techniques and apheresis instruments, as well as the recognition of its applicability in neurological diseases. However, several aspects of treatment remain incompletely clarified, and treatment strategies are still heterogeneous, especially with regard to therapeutic plasma exchange in anti-NMDAR encephalitis. This review provides an overview of the use of therapeutic plasma exchange including the principle and mechanisms, the evidence, initial time, efficiency and complications in anti-NMDAR encephalitis.
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Affiliation(s)
- Yuan Zhang
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Jilin, China
| | - Yong-Kang Cheng
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Jilin, China
| | - Chun-Feng Yang
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Jilin, China
| | - Lin-Mei Jin
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Jilin, China
| | - Yu-Mei Li
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Jilin, China
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Abdelwahab OA, Diab RA, Elsaeidy KS, Albakri K, El-Samahy M, Ramadan O, Negida A, Seif AM, Al-Alfy MN. Efficacy of therapeutic plasma exchange in patients with severe COVID-19: A systematic review and meta-analysis. Rev Med Virol 2023; 33:e2435. [PMID: 36905184 DOI: 10.1002/rmv.2435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/12/2023]
Abstract
We conducted this systematic review and meta-analysis to evaluate the existing evidence and to quantitatively synthesise evidence on the impact of therapeutic plasma exchange (TPE) on severe COVID-19 patients. This systematic review and meta-analysis protocol was prospectively registered on PROSPERO (CRD42022316331). We systemically searched six electronic databases (PubMed, Scopus, Web of Science, ScienceDirect, clinicaltrial.gov, and Cochrane Central Register of Controlled Trials) from inception until 1 June 2022. We included studies comparing patients who received TPE versus those who received the standard treatment. For risk of bias assessment, we used the Cochrane risk of bias assessment tool, the ROBINS1 tool, and the Newcastle Ottawa scale for RCTs, non-RCTs, and observational studies, respectively. Continuous data were pooled as standardized mean difference (SMD), and dichotomous data were pooled as risk ratio in the random effect model with the corresponding 95% confidence intervals (CI). Thirteen studies (one randomized controlled trials (RCT) and 12 non-RCTs) were included in the meta-analysis, with a total of 829 patients. There is a moderate-quality evidence from one RCT that TPE reduces the lactic dehydrogenase (LDH) levels (SMD -1.09, 95% CI [-1.59 to -0.60]), D-dimer (SMD -0.86, 95% CI [-1.34 to -0.37]), and ferritin (SMD -0.70, 95% CI [-1.18 to -0.23]), and increases the absolute lymphocyte count (SMD 0.54, 95% CI [0.07-1.01]), There is low-quality evidence from mixed-design studies that TPE was associated with lower mortality (relative risk 0.51, 95% CI [0.35-0.74]), lower IL-6 (SMD -0.91, 95% CI [-1.19 to -0.63]), and lower ferritin (SMD -0.51, 95% CI [-0.80 to -0.22]) compared to the standard control. Among severely affected COVID-19 patients, TPE might provide benefits such as decreasing the mortality rate, LDH, D-dimer, IL-6, and ferritin, in addition to increasing the higher absolute lymphocyte count. Further well-designed RCTs are needed.
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Affiliation(s)
- Omar Ahmed Abdelwahab
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Rehab Adel Diab
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, Al-Azhar University for Girls, Cairo, Egypt
| | - Khaled Saad Elsaeidy
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khaled Albakri
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Mohamed El-Samahy
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Omar Ramadan
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Negida
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mohamed N Al-Alfy
- Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Rattanathamsakul N, Siritho S, Viswanathan S, Hiew FL, Apiwattanakul M, Tan K, Thirugnanam UN, Yeo T, Quek AML, Estiasari R, Remli R, Aye SMM, Ohnmar O, Hoang NTT, Pasco PM. Facilities, selection, outcome measurement, and limitations of therapeutic plasma exchange for neuroimmunological disorders: The South East Asian survey study. J Clin Apher 2023. [PMID: 36896493 DOI: 10.1002/jca.22047] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) for neuroimmunological disorders has played an important role in the Southeast Asian region. This study investigates the challenges of performing TPE within the region. METHOD A questionnaire-based survey was conducted and launched to 15 South East Asian Therapeutic Plasma Exchange Consortium (SEATPEC) members from seven countries in January 2021. It included demographics, TPE techniques, indications, challenges, timing, outcome measurement, and access to laboratory testing in each local center. RESULTS A total of 15 neurologists from 12 participating centers were included. They usually perform five sessions of TPE (100.0%), with 1 to 1.5 plasma volume (93.3%), and exchanges via the central catheter (100.0%). Acute relapses of neuromyelitis optica spectrum disorder and myasthenia gravis are the most common indications. They used a combination of normal saline and 5% albumin (60.0%) as replacement fluid. Most (66.7%) used TPE as an add-on treatment in steroid-refractory cases or as first-line treatment for severe attacks. They suggested assessing the TPE efficacy of TPE by the interval to the next attack, post-TPE relapse rates, and TPE-related complications. The major challenges within our region are expense, reimbursibility, and access to TPE. CONCLUSION Although countrywise differences exist, all share similarities regarding methods, indications, timing, obstacles, and challenges of TPE for neuroimmunological conditions. Regional collaboration will be essential to identify strategies to reduce these barriers to access to TPE in the future.
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Affiliation(s)
- Natthapon Rattanathamsakul
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasitorn Siritho
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Department of Neurology, Bumrungrad International Hospital, Bangkok, Thailand
| | | | - Fu Liong Hiew
- Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Metha Apiwattanakul
- Department of Neurology, Neurological Institute of Thailand, Bangkok, Thailand
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Amy M L Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Riwanti Estiasari
- Department of Neurology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rabani Remli
- Department of Neurology, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Seinn Mya Mya Aye
- Department of Neurology, Aryu International Hospital, Yangon, Myanmar
| | - Ohnmar Ohnmar
- Department of Neurology, Yangon General Hospital, Yangon, Myanmar
| | - Nghia T T Hoang
- Department of Neurology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Paul M Pasco
- Department of Neurosciences, Philippine General Hospital, Manila, Philippines
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Routray SS, Tripathy S, Das P, Ray GK. Minor Cross-Matching in the Diagnosis of Pneumococcal Hemolytic Uremic Syndrome in an 18-Month-Old Boy. Lab Med 2023; 54:215-219. [PMID: 36124770 DOI: 10.1093/labmed/lmac092] [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: 11/13/2022] Open
Abstract
In developing nations, limitations in diagnostic facilities act as a barrier for differentiation of hemolytic uremic syndrome (HUS) based on the etiology. A sick-looking 18-month-old boy presented to our hospital in Bhubaneswar, India, with clinical signs and symptoms of left lobar pneumonia, abnormal hematological and renal parameters, no growth in blood culture, a negative direct antiglobulin test (DAT) result, and low complement levels. A rapid deterioration in his clinical condition necessitated intensive care support, blood transfusion, and renal replacement therapy (peritoneal dialysis and hemodialysis). Because his health care team suspected atypical HUS, therapeutic plasma exchange (TPE) was initiated as soon as possible. In the absence of a lectin panel, minor cross-matching confirmed T-antigen exposure. With a diagnosis of HUS induced by Streptococcus pneumoniae (sp-HUS), TPE was stopped immediately, and washed blood components were administered. Despite the aforementioned measures, the boy died of HUS on day 20 after presentation. This case emphasized the role of minor cross-matching in the detecting of polyagglutination in resolving the diagnostic dilemma of sp-HUS.
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Affiliation(s)
- Suman Sudha Routray
- Department of Transfusion Medicine and Blood Centre, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Sukanta Tripathy
- Department of Transfusion Medicine and Blood Centre, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Palash Das
- Department of Transfusion Medicine and Blood Centre, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Gopal Krushna Ray
- Department of Transfusion Medicine and Blood Centre, Kalinga Institute of Medical Sciences, Bhubaneswar, India
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Cain S, Plapp FV, Dasgupta A, Ye Z. Severe complications in a 25-year-old male after brown recluse spider bite treated by therapeutic plasma exchange: A case report and review of other case studies. J Clin Apher 2023. [PMID: 36876877 DOI: 10.1002/jca.22045] [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: 09/20/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
Although in the majority of patients (90%), the bite wound of brown recluse spider resolves spontaneously, some patients may experience a severe reaction requiring hospitalization. A 25-year-old male developed severe hemolytic anemia, jaundice, and other complications following a brown recluse spider bite on his posterior right thigh. He was treated with methylprednisolone, antibiotics, and red blood cells (RBCs) transfusion without response. Therapeutic plasma exchange (TPE) was added to the treatment regimen, and his hemoglobin (Hb) was eventually stabilized, leading to significant clinical improvement. The beneficial effect of TPE in the current case was compared to three other reported cases. We recommend close monitoring of Hb levels in patients with systemic loxoscelism during the first week after brown recluse spider bite and early implementation of TPE in the management of severe acute hemolysis when patients do not respond to usual treatment modalities and RBC transfusion.
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Affiliation(s)
- Sarah Cain
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Frederick V Plapp
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Zhan Ye
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Gulati K, Pusey CD. Plasma exchange as an adjunctive therapy in anti-neutrophil cytoplasm antibody-associated vasculitis. Expert Rev Clin Immunol 2023; 19:417-430. [PMID: 36860127 DOI: 10.1080/1744666x.2023.2184354] [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: 03/03/2023]
Abstract
INTRODUCTION We summarize evidence for the role of therapeutic plasma exchange (TPE) in the treatment of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). TPE rapidly removes ANCA IgG, complement and coagulation factors important in the pathogenesis of AAV. TPE has been used in patients with rapidly deteriorating renal function to achieve early disease control, allowing time for immunosuppressive agents to prevent resynthesis of ANCA. The PEXIVAS trial challenged the utility of TPE in AAV, as it did not show benefit of adjunctive TPE on a combined end point of end stage kidney disease (ESKD) and death. AREAS COVERED We analyze data from PEXIVAS and other trials of TPE in AAV, an up-to-date meta-analysis, and recently published large cohort studies. EXPERT OPINION There remains a role for the use of TPE in AAV in certain groups of patients, in particular those with severe renal involvement (Cr >500 μmol/L or dialysis-dependent). It should be considered in patients with Cr >300 μmol/L and rapidly deteriorating function, or with life-threatening pulmonary hemorrhage. A separate indication is patients double positive for anti-GBM antibodies and ANCA. TPE may have the greatest benefit as part of steroid-sparing immunosuppressive treatment strategies.
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Affiliation(s)
- Kavita Gulati
- Vasculitis Clinic, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.,Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Charles D Pusey
- Vasculitis Clinic, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.,Centre for Inflammatory Disease, Imperial College London, London, UK
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Porosnicu TM, Sandesc D, Jipa D, Gindac C, Oancea C, Bratosin F, Fericean RM, Kodimala SC, Pilut CN, Nussbaum LA, Sirbu IO. Assessing the Outcomes of Patients with Severe SARS-CoV-2 Infection after Therapeutic Plasma Exchange by Number of TPE Sessions. J Clin Med 2023; 12:jcm12051743. [PMID: 36902537 PMCID: PMC10003394 DOI: 10.3390/jcm12051743] [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: 01/31/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
The high mortality risk in severe SARS-CoV-2 infections is tightly correlated to the extreme elevation of inflammatory markers. This acute accumulation of inflammatory proteins can be cleared using plasma exchange (TPE), commonly known as plasmapheresis, although the available data on performing TPE in COVID-19 patients is limited regarding the optimal treatment protocol. The purpose for this study was to examine the efficacy and outcomes of TPE based on different treatment methods. A thorough database search was performed to identify patients from the Intensive Care Unit (ICU) of the Clinical Hospital of Infectious Diseases and Pneumology between March 2020 and March 2022 with severe COVID-19 that underwent at least one session of TPE. A total of 65 patients satisfied the inclusion criteria and were eligible for TPE as a last resort therapy. Of these, 41 patients received 1 TPE session, 13 received 2 TPE sessions, and the remaining 11 received more than 2 TPE sessions. It was observed that IL-6, CRP, and ESR decreased significantly after all sessions were performed in all three groups, with the highest decrease of IL-6 in those who received >2 TPE sessions (from 305.5 pg/mL to 156.0 pg/mL). Interestingly, there was a significant increase in leucocyte levels after TPE, but there was no significant difference in MAP changes, SOFA score, APACHE 2 score, or the PaO2/FiO2 ratio. The ROX index was significantly higher among the patients who underwent more than two TPE sessions, with an average of 11.4, compared to 6.5 in group 1 and 7.4 in group 2, which increased significantly after TPE. Nevertheless, the mortality rate was very high (72.3%), and the Kaplan-Meier analysis identified no significant difference in survival according to the number of TPE sessions. TPE can be used as last resort salvage therapy that can be regarded as an alternative treatment method when the standard management of these patients fails. It significantly decreases the inflammatory status measured via IL-6, CRP, and WBC, as well as demonstrating an improvement of the clinical status measured via PaO2/FiO2, and duration of hospitalization. However, the survival rate does not seem to change with the number of TPE sessions. Based on the survival analysis, one session of TPE as last resort treatment in patients with severe COVID-19 proved to have the same effect as repeated TPE sessions of 2 or more.
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Affiliation(s)
- Tamara Mirela Porosnicu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Intensive Care Unit, “Victor Babes” Clinical Hospital for Infectious Diseases and Pneumology, 300041 Timisoara, Romania
| | - Dorel Sandesc
- Department of Anesthesia and Intensive Care, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Intensive Care Unit, “Pius Brinzeu” Emergency Clinical Hospital, 300041 Timisoara, Romania
| | - Daniel Jipa
- Intensive Care Unit, “Pius Brinzeu” Emergency Clinical Hospital, 300041 Timisoara, Romania
| | - Ciprian Gindac
- Intensive Care Unit, “Pius Brinzeu” Emergency Clinical Hospital, 300041 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Felix Bratosin
- Department XIII, Discipline of Infectious Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Roxana Manuela Fericean
- Department XIII, Discipline of Infectious Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Shiva Charana Kodimala
- MediCiti Institute of Medical Sciences, NTR University of Health Sciences, Hyderabad 501401, India
| | - Ciprian Nicolae Pilut
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Correspondence:
| | - Laura Alexandra Nussbaum
- Department of Neurosciences, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Ioan Ovidiu Sirbu
- Center for Complex Network Sciences, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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Luo X, Li X, Lai X, Ke L, Zhou J, Liu M, Cao L, Fu L. Therapeutic plasma exchange in patients with sepsis: Secondary analysis of a cluster-randomized controlled trial. J Clin Apher 2023; 38:55-62. [PMID: 36314372 PMCID: PMC10092885 DOI: 10.1002/jca.22027] [Citation(s) in RCA: 3] [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: 06/19/2022] [Revised: 09/28/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Sepsis is life-threatening organ dysfunction caused by infection-related inflammatory response. Therapeutic plasma exchange (TPE) can remove inflammatory mediators and benefit patients in different disease settings. However, no solid evidence showed the efficacy and safety of TPE in sepsis. METHODS This study was a secondary analysis of a randomized controlled trial. Critically ill patients with sepsis were divided into two groups according to whether treated with TPE. The primary outcome was the delta Sequential Organ Failure Assessment (SOFA) score from days 1 to 7. Secondary outcomes included new-onset organ failure, intensive care unit (ICU)-free and alive days to day 28, and 28-day mortality. Propensity score-matched (PSM) analysis was applied to control confounders. Analysis of covariance (ANCOVA) and logistic regression were used to assess the association between TPE and selected outcomes. RESULTS Among the 2772 critically ill patients enrolled in the trial, 742 patients with sepsis were selected and 22 patients received TPE were matched with 22 control patients. No significant difference was found in the delta SOFA score and 28-day mortality between TPE group and control group. The ICU-free and alive days in the TPE group were significantly shorter than the control group. CONCLUSIONS TPE may be not associated with improvement of organ failure and mortality in critically ill patients with sepsis and may be associated with a prolonged ICU stay.
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Affiliation(s)
- Xiang Luo
- Department of Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Xiaoling Li
- Department of Anesthesiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Xiaoyan Lai
- Department of Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Lu Ke
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.,Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Man Liu
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Longxiang Cao
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lingyan Fu
- Department of Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
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Vivero A, Peedin AR, Gao Y, Karp JK. Successful treatment of pure red cell aplasia using therapeutic plasma exchange after ABO-incompatible hematopoietic stem cell transplant. J Clin Apher 2023. [PMID: 36703597 DOI: 10.1002/jca.22041] [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: 09/30/2021] [Revised: 12/05/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023]
Abstract
Hematopoietic stem cell transplants (HSCTs) are widely used in the treatment of hematologic malignancies and bone marrow failure syndromes. ABO compatibility is typically of secondary importance, and up to 50% of HSCT are performed in ABO-incompatible pairings. In the literature, pure red cell aplasia (PRCA) occurs in 1% to 50% of all major/bidirectional ABO-incompatible stem cell transplants, but treatment of PRCA remains heterogeneous. Here, we report two cases in which patients with transfusion-dependent PRCA following HSCT were successfully treated with therapeutic plasma exchange (TPE). Case 1: A 52-year-old type O-positive male with acute myeloid leukemia underwent HSCT using apheresis-derived HSCs from a fully human leukocyte antigen (HLA)-matched, related type A-positive male donor. He developed PRCA that was refractory to multiple therapies, so a series of 10 TPE was performed over 3 weeks. Case 2: A 21-year-old type A-positive male with aplastic anemia underwent HSCT using bone marrow-derived HSCs from a fully HLA-matched related type B-positive female donor. He developed PRCA that was refractory to multiple therapies, so a series of 5 TPE was performed over 2 weeks. Case 1: The patient has been transfusion independent since TPE #7, and type A red blood cells (RBCs) were seen on the ABO type after TPE #9. Case 2: The patient has been transfusion independent since after TPE #1, and type B RBCs were seen on the ABO type after TPE #5. TPE was successful in treating two patients with PRCA after ABO-incompatible HSCT transplants. Isoagglutinin titers decreased below the level of detection for both our patients. Ultimately both patients became transfusion independent and showed evidence of erythroid cell recovery.
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Affiliation(s)
- Angelica Vivero
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexis R Peedin
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Yuanzheng Gao
- Department of Pathology, Cooper University Health Care, Camden, New Jersey, USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Tonev DG, Momchilova AB. Therapeutic Plasma Exchange in Certain Immune-Mediated Neurological Disorders: Focus on a Novel Nanomembrane-Based Technology. Biomedicines 2023; 11:biomedicines11020328. [PMID: 36830870 PMCID: PMC9953422 DOI: 10.3390/biomedicines11020328] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
Therapeutic plasma exchange (TPE) is an efficient extracorporeal blood purification technique to remove circulating autoantibodies and other pathogenic substances. Its mechanism of action in immune-mediated neurological disorders includes immediate intravascular reduction of autoantibody concentration, pulsed induction of antibody redistribution, and subsequent immunomodulatory changes. Conventional TPE with 1 to 1.5 total plasma volume (TPV) exchange is a well-established treatment in Guillain-Barre Syndrome, Chronic Inflammatory Demyelinating Polyradiculoneuropathy, Neuromyelitis Optica Spectrum Disorder, Myasthenia Gravis and Multiple Sclerosis. There is insufficient evidence for the efficacy of so-called low volume plasma exchange (LVPE) (<1 TPV exchange) implemented either by the conventional or by a novel nanomembrane-based TPE in these neurological conditions, including their impact on conductivity and neuroregenerative recovery. In this narrative review, we focus on the role of nanomembrane-based technology as an alternative LVPE treatment option in these neurological conditions. Nanomembrane-based technology is a promising type of TPE, which seems to share the basic advantages of the conventional one, but probably with fewer adverse effects. It could play a valuable role in patient management by ameliorating neurological symptoms, improving disability, and reducing oxidative stress in a cost-effective way. Further research is needed to identify which patients benefit most from this novel TPE technology.
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Affiliation(s)
- Dimitar G. Tonev
- Department of Anesthesiology and Intensive Care, Medical University of Sofia, University Hospital “Tzaritza Yoanna—ISUL”, 1527 Sofia, Bulgaria
- Correspondence:
| | - Albena B. Momchilova
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Science, 1113 Sofia, Bulgaria
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Duong-Quy S, Huynh-Truong-Anh D, Tran-Xuan Q, Nguyen-Quang T, Nguyen-Thi-Kim T, Nguyen-Chi T, Tran-Ngoc-Anh T, Nguyen-Van-Hoai N, Do-Thi-Thu M, Tang-Thi-Thao T, Bui-Diem K, Hoang-Anh T, Nguyen-Ngoc-Phuong T, Nguyen-Nhu V. Bradycardia unresponded to atropin testing was successfully treated with therapeutic plasma exchange in a patient with severe COVID-19 complicated by Guillain-Barré syndrome: A case report. Front Cardiovasc Med 2023; 9:1035896. [PMID: 36741850 PMCID: PMC9892716 DOI: 10.3389/fcvm.2022.1035896] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been an alarming situation worldwide for the past 2 years. The symptoms of coronavirus disease 2019 (COVID-19) are not only confined to the respiratory system but also affect a multitude of organ systems. Bradycardia associated with Guillain-Barré syndrome (GBS) is a rare autonomic and peripheral neurological complication of COVID-19. In this case report, we present the case of a 26-year-old man diagnosed with bradycardia associated with GBS after contracting COVID-19. Initially, this patient had the classical symptoms of COVID-19 and was hospitalized in the intensive care unit (ICU) for acute respiratory distress syndrome (ARDS). Then, he developed weakness in the lower extremities, diminished tendon reflexes, a loss of sensation without sphincter muscle disorders, and bradycardia. His bradycardia did not respond to atropine. The patient was treated concurrently with a high-flow nasal cannula, systemic corticosteroids, anticoagulation, and therapeutic plasma exchange (TPE) for COVID-19-induced ARDS, bradycardia, and GBS. His ARDS and bradycardia improved after the first cycle of TPE and medical treatment. After three cycles of TPE, the patient progressively recovered his muscle strength in the lower limbs and regained peripheral sensation. He was discharged from the hospital in stable condition after 4 weeks of hospitalization and was followed up after 6 months for cardiorespiratory and neurological complications. This case report elucidates the potential difficulties and challenges that physicians may encounter in diagnosing and treating COVID-19-induced bradycardia and GBS during the pandemic outbreak. However, the patient outcomes with the treatment combining the conventional treatment with therapeutic plasma exchange seem to be optimistic.
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Affiliation(s)
- Sy Duong-Quy
- Biomedical Research Center, Lam Dong Medical College, Da Lat, Vietnam,COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam,Division of Pulmonary, Allergy, and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, United States,Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam,*Correspondence: Sy Duong-Quy ✉
| | - Duc Huynh-Truong-Anh
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Quynh Tran-Xuan
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Tien Nguyen-Quang
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Thanh Nguyen-Thi-Kim
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Thanh Nguyen-Chi
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Thuy Tran-Ngoc-Anh
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Nam Nguyen-Van-Hoai
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Mai Do-Thi-Thu
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | | | - Khue Bui-Diem
- Department of Physiology and Pathophysiology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tien Hoang-Anh
- Department of Cardiology. Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | | | - Vinh Nguyen-Nhu
- Department of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam,Department of Respiratory Functional Exploration, University Medical Center, Ho Chi Minh City, Vietnam,Vinh Nguyen-Nhu ✉
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Nakip ÖS, Kesici S, Terzi K, Orhan D, Bayrakcı B. Fatal thrombotic microangiopathy in an infant with COVID-19: a case report. Turk J Pediatr 2023; 65:667-671. [PMID: 37661682 DOI: 10.24953/turkjped.2022.1150] [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] [Indexed: 09/05/2023]
Abstract
BACKGROUND While macrovascular thrombosis is common in adult COVID-19 patients, thrombotic microangiopathy as a part of endothelitis might play an important role in severe organ dysfunction. Thrombocytopenia-associated multiple organ failure (TAMOF) is a thrombotic microangiopathy syndrome that is associated with endothelial damage. Herein, we aim to report a pediatric TAMOF case related to SARS-CoV-2 infection which has been scarcely reported to date. CASE A 7-month-old boy who became severely ill after being infected with SARS-CoV-2 required advanced critical care treatments such as continuous renal replacement therapy, therapeutic plasma exchange, and extracorporeal membrane oxygenation. A heart and lung biopsy obtained during sternotomy showed thrombotic microangiopathy. Despite early plasma exchange, mortality was inevitable because of severe liver failure. CONCLUSIONS This case report implies that SARS-CoV-2 infection could cause TAMOF in children. To the best of our knowledge, this is the second SARS-CoV-2-induced pediatric TAMOF case. More studies are needed to determine alternative treatments for patients with TAMOF who are resistant to conventional therapies.
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Affiliation(s)
- Özlem Sarıtaş Nakip
- Department of Pediatric Critical Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara
| | - Selman Kesici
- Department of Pediatric Critical Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara
| | - Kıvanç Terzi
- Department of Pediatric Critical Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara
| | - Diclehan Orhan
- Department of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Benan Bayrakcı
- Department of Pediatric Critical Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara
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