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Ito K, Kawasaki T, Hirano K, Sekiguchi N. Efficacy and safety of therapeutic procedure for Waldenström's macroglobulinemia with hyperviscosity syndrome. Ther Apher Dial 2024; 28:417-423. [PMID: 38069574 DOI: 10.1111/1744-9987.14094] [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: 09/07/2023] [Revised: 11/10/2023] [Accepted: 11/24/2023] [Indexed: 04/30/2024]
Abstract
INTRODUCTION Hyperviscosity syndrome (HVS) is a significant complication in Waldenström's macroglobulinemia (WM), although the significance of plasmapheresis in clinical practice has not been clarified. To confirm the efficacy and safety of plasmapheresis followed by primary therapy for WM with HVS, we retrospectively conducted this study. METHODS Untreated WM with HVS, or serum immunoglobulin M (IgM) levels ≥4000 mg/dL, were analyzed. The basic therapeutic flow was conducted as follows: (1) performing plasmapheresis, (2) followed by primary therapy without rituximab, and (3) performing the second cycle. The serum IgM reduction rate and adverse events (AEs) were evaluated. RESULTS Ten patients were enrolled. The median serum IgM levels at diagnosis, post-plasmapheresis, after the first cycle of primary therapy, and after the second cycle were 5174, 2900, 3286, and 2657 mg/dL, respectively. No patients experienced IgM flare or bleeding AEs. CONCLUSION The therapeutic flow offers sufficient efficacy and safety in WM with HVS.
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Affiliation(s)
- Kenichi Ito
- Hematology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Tomoki Kawasaki
- Nephrology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Kazuhiko Hirano
- Laboratory and Pathology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Naohiro Sekiguchi
- Hematology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
- Clinical Research Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
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2
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Gaulier A, Hardouin JB, Wiertlewski S, Lebranchu P. Efficacy and comparison of corticosteroids only and corticosteroids with plasmapheresis or intravenous immunoglobulin for the treatment of optic neuritis in demyelinating disease: A systematic review and network meta-analysis. Mult Scler Relat Disord 2024; 85:105521. [PMID: 38457882 DOI: 10.1016/j.msard.2024.105521] [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: 11/29/2023] [Revised: 01/27/2024] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE To compare the efficacy of treatment of optic neuritis (ON) with corticosteroids (CTC) alone, CTC+plasmapheresis (PLP), and CTC+intravenous immunoglobulin (IVIG). DESIGN After an episode of ON, although visual recovery is usually good, some patients may have significant visual sequelae. While the efficacy of first-line CTC is now indisputable, there is no consensus on the nature of second-line treatment. To date, no systematic review has compared the efficacy of treatment of ON with CTC alone, CTC+plasmapheresis (PLP), and CTC+intravenous immunoglobulin (IVIG). A meta-analysis is needed to compare the efficacy of PLP and IVIG in steroid-resistant ON. METHODS This systematic review included all studies comparing at least two of the three treatments for steroid-resistant ON (CTC alone, CTC+PLP, and CTC+IVIG). From all articles published on PubMed between January 2000 and June 2022, two independent ophthalmologists selected studies of interest using the PRISMA method. Methodology, patient characteristics, and outcomes were identified. A network metaanalysis was then performed to compare the efficacy of the three treatments. RESULTS Six comparative studies were included, representing 209 patients. The percentage of significant visual recovery after CTC alone, CTC+PLP, and CTC+IVIG in the acute treatment of steroid-resistant ON was 30 %, 45 %, and 77 %, respectively. Comparison of CTC+IVIG vs CTC alone, CTC+PLP vs CTC only, and CTC+PLP vs CTC+IVIG yielded odds ratios of 12.81, 2.47, and 0.19 respectively. CONCLUSION Treatment of steroid-resistant ON with CTC+PLP or CTC+IVIG is more effective than treatment with CTC alone. Although no study has directly compared the two treatments, IVIG may be more effective than PLP.
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Affiliation(s)
- Arnaud Gaulier
- Department of Ophthalmology, University Hospital of Nantes, Nantes, France.
| | - Jean-Benoit Hardouin
- PhD-HDR, University Hospital of Nantes, UMR INSERM U1246-SPHERE, Institut de Recherche en Santé 2, France
| | | | - Pierre Lebranchu
- Department of Ophthalmology, University Hospital of Nantes, Nantes, France; École Centrale Nantes, LS2N, UMR6004, F-44000 Nantes, France
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Yan D, Yao R, Xie X, Fu X, Pei S, Wang Y, Xu D, Li N. THE THERAPEUTIC EFFICACY OF PLASMAPHERESIS FOR SEPSIS WITH MULTIPLE ORGAN FAILURE: A PROPENSITY SCORE-MATCHED ANALYSIS BASED ON THE MIMIC-IV DATABASE. Shock 2024; 61:685-694. [PMID: 37988068 DOI: 10.1097/shk.0000000000002254] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
ABSTRACT Background: Despite advancements in sepsis treatment, mortality remains high. Plasmapheresis (PE) targeting multiple pathways simultaneously seems to be a potential treatment option, but evidence is insufficient. We aimed to investigate the efficacy of PE for sepsis with multiple organ failure (MOF). Method: Septic patients with MOF were identified from the Medical Information Mart for Intensive Care IV database. Patients who received PE were matched with those receiving conventional therapy via propensity score matching. Regression analyses evaluated the association between PE and outcomes. The Kaplan-Meier (KM) method was used to analyze the survival probability. The generalized additive mixed model investigated early indexes changes' association with treatment modalities and 28-day mortality. Results: Nine hundred six septic patients with MOF were enrolled. After propensity score matching, PE and conventional groups consisted of 60 cases each. Plasmapheresis was associated with a reduced risk of 28-day mortality (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.27-0.94), 1-year mortality (HR, 0.44; 95% CI, 0.26-0.74), and in-hospital mortality (HR, 0.38; 95% CI, 0.20-0.71). The KM curves demonstrated significant differences in survival probability between groups. Compared with the conventional group, the sequential organ failure assessment, norepinephrine dosage, prothrombin time, actate dehydrogenase, total bilirubin, white blood cells, and immature granulocytes in the PE group significantly decreased over time, while platelets, red blood cells, and hemoglobin significantly increased over time. Conclusions: Plasmapheresis demonstrated an association with reduced risks of 28-day, in-hospital and 1-year mortality in septic patients with MOF. Moreover, plasmapheresis might exhibit the potential to improve outcomes by improving organ function, hemodynamics, and restoring several indicators, such as coagulation, anemia, and inflammation.
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Affiliation(s)
- Danyang Yan
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Run Yao
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Xi Xie
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Xiangjie Fu
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Siya Pei
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Yanjie Wang
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Daomiao Xu
- General ICU/Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Ning Li
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
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Khan U, Sharma S, Prasad P, Agarwal A, Jain A, Jain A, Verma H. Enhancing Plasmapheresis Efficacy in Waldenstrom Macroglobulinemia: Overcoming Circuit Clotting Challenges. Semin Dial 2024; 37:282-283. [PMID: 38506146 DOI: 10.1111/sdi.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/18/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Urvashi Khan
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sourabh Sharma
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Pallavi Prasad
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anupam Agarwal
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ankur Jain
- Department of Haematology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Aditi Jain
- Department of Haematology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Himanshu Verma
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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5
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Haugen M, Magnussen K, Aarsland TE, Nissen-Meyer LSH, Strand TA. The effect of donation frequency on donor health in blood donors donating plasma by plasmapheresis: study protocol for a randomized controlled trial. Trials 2024; 25:175. [PMID: 38468338 PMCID: PMC10926559 DOI: 10.1186/s13063-024-08035-7] [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: 07/19/2023] [Accepted: 03/05/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The demand for plasma products is growing, necessitating an increase in plasma collection by plasmapheresis. While the 20th edition of the European Guidelines permits plasma donors in Europe to donate with 96-h donation intervals, the potential short- and long-term consequences of high-frequency plasma donations on donor health remain unknown. This study aims to measure the effect of plasma donation frequency on plasma protein composition, including total serum protein (TSP) and immunoglobulin G (IgG), in Norwegian male blood donors. METHODS This randomized controlled trial (RCT) included 120 male blood donors who were randomized into two intervention groups and one control group: high-frequency plasma donors (HFPDs) who donated 650 mL of plasma 3 times every 2 weeks, whereas regular-frequency plasma donors (RFPDs) who donated 650 mL of plasma 1 time every 2 weeks. The control group consisted of whole blood donors. The primary outcomes are the concentrations of TSP and IgG. DISCUSSION The findings from this study may have implications for recommendations related to donor health and plasma donation frequencies and may contribute to supporting the strategic independence of plasma products in Norway and Europe without compromising donor health. TRIAL REGISTRATION ClinicalTrials.gov: NCT05179200 . Registered December 20th, 2021.
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Affiliation(s)
- Morten Haugen
- Department of Immunology and Transfusion Medicine, Innlandet Hospital Trust, Anders Sandvigs Gate 17, 2609, Lillehammer, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Karin Magnussen
- Department of Immunology and Transfusion Medicine, Innlandet Hospital Trust, Anders Sandvigs Gate 17, 2609, Lillehammer, Norway
| | - Tonje Eiane Aarsland
- Women's Clinic, Innlandet Hospital Trust, Lillehammer, Norway
- Department of Global Public Health and Primary Care, Center of International Health, University of Bergen, Bergen, Norway
| | | | - Tor A Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
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6
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Ghimire A, Kunwar B, Aryal B, Gaire A, Bist A, Shah B, Mainali A, Ghimire B, Gajurel BP. Assessing the comparative efficacy of plasmapheresis and Intravenous immunoglobulin in myasthenia gravis treatment: A systematic review and meta-analysis. J Clin Neurosci 2024; 121:1-10. [PMID: 38306763 DOI: 10.1016/j.jocn.2024.01.025] [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: 10/07/2023] [Revised: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by muscle weakness, posing significant challenges to patients' daily lives. Intravenous immunoglobulin (IVIG) and plasmapheresis are two prominent immunomodulatory therapies used in MG management, but the choice between them remains a clinical dilemma. This systematic review and meta-analysis aim to evaluate the comparative efficacy of IVIG versus plasmapheresis in MG management. METHODS We adhered to PRISMA guidelines and prospectively registered the review protocol in PROSPERO. Systematic search across electronic databases identified 14 studies meeting inclusion criteria. Data from these studies were extracted, and assessed risk of bias. Primary outcomes included clinical efficacy, while secondary outcomes encompassed hospitalization, ventilation, antibody titers, and treatment-related complications. Statistical analysis was conducted using R software. RESULTS The pooled results indicated that patients receiving plasmapheresis had higher odds of any improvement in MG symptoms compared to IVIG. However, change in severity scores did not significantly differ between the two treatments. Hospitalization durations were similar, but IVIG-treated patients tended to have shorter stays. Antibody titers, particularly anti-MUSK antibodies, favored plasmapheresis treatment. Complication rates were comparable between two groups. However, severe complications were more common in plasmapheresis. CONCLUSION This comprehensive analysis suggests that plasmapheresis may offer superior short-term symptom improvement in MG compared to IVIG, while IVIG may lead to shorter hospital stays and lower complication rates. The choice between these treatments should be tailored to individual patient needs and disease characteristics. Further research is needed to explore long-term outcomes and mortality rates in MG management.
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Affiliation(s)
- Anup Ghimire
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.
| | - Bijay Kunwar
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Binay Aryal
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Arjun Gaire
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Anil Bist
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Bilash Shah
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Atul Mainali
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Bikal Ghimire
- Kantipur Dental College Teaching Hospital &, Research Center, Basundhara, Kathmandu, Nepal
| | - Bikram Prasad Gajurel
- Department of Neurology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
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7
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de Pascale E, Marinelli G, Iulianiello P, Matrisciano R, Viggiano D, Pluvio C. [Apheresis Techniques for the Treatment of Hyperbilirubinemia in the Nephrology Unit]. G Ital Nefrol 2024; 41:2024-vol1. [PMID: 38426683] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Therapeutic apheresis is an important hematological and nephrological method for conditions with altered plasma composition. It is also indicated for the removal of protein-bound molecules, such as bilirubin. Several techniques can remove these compounds, such as the extracorporeal circulation molecular adsorption system (MARS), plasma exchange (PEX), and plasma adsorption and perfusion (PAP). Here we report our experience in the comparison between MARS, PEX and PAP, since current guidelines do not specify which method is the most appropriate and under which circumstances it should be used. The choice of technique cannot be based on the desired plasma bilirubin concentration, since these three techniques show similar results with a similar final outcome (exitus). In fact, PAP, PEX and MARS significantly reduce bilirubin levels, but the degree of reduction is not different among the three. Furthermore, the three techniques do not differ in the rate of cholinesterase change, while less reduction of liver transaminases was found by using PAP. MARS should be preferred in the case of renal involvement (hepatorenal syndrome with hyperbilirubinemia). PAP has the advantage of being simple and inexpensive. PEX remains an option when emergency PAP is not available, but the risk of using blood products (plasma and albumin) must be considered.
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Affiliation(s)
- Emanuela de Pascale
- AORN dei Colli, "D. Cotugno" Hospital, Department of Dialysis with Hepatic-Infective Complications, via L. Bianchi, 80131, Naples, Italy
| | - Gaia Marinelli
- AORN dei Colli, "D. Cotugno" Hospital, Department of Dialysis with Hepatic-Infective Complications, via L. Bianchi, 80131, Naples, Italy
| | - Pietro Iulianiello
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples
| | - Rossana Matrisciano
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples
| | - Davide Viggiano
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples
| | - Corrado Pluvio
- AORN dei Colli, "D. Cotugno" Hospital, Department of Dialysis with Hepatic-Infective Complications, via L. Bianchi, 80131, Naples, Italy
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8
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Mantilla J, Peña D, Molano-Triviño A, Zúñiga E, Castellanos-De La Hoz JC. Divide et Vinces, Therapeutic Apheresis in Nephrological Clinical Practice. Blood Purif 2023; 53:162-169. [PMID: 38113864 DOI: 10.1159/000534455] [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: 10/17/2022] [Accepted: 09/21/2023] [Indexed: 12/21/2023]
Abstract
Therapeutic plasma exchange (TPE) or plasmapheresis has been used in various life-threatening diseases as a primary treatment or in combination with other therapies. It was first successfully employed in the 1960s for diseases like Waldenström's disease and myeloma. Since then, TPE techniques using apheresis membranes have been introduced. Apheresis therapies separate plasma components from blood using membrane screening or centrifugation methods. TPE aims to remove substances involved in the pathophysiology of diseases. It selectively removes high-molecular-weight molecules, substances with prolonged half-life, and those associated with disease pathogenesis. TPE can be performed using membranes or centrifugation, with replacement of extracted plasma volume using albumin or fresh frozen plasma. TPE requires specific competencies in nephrology and can be prescribed and monitored by nephrologists and performed by dialysis nursing staff. TPE can be combined with adsorption-based therapies to enhance its effect, and this approach is called plasma filtration adsorption. Another variation is double plasma filtration, which selectively removes substances based on molecular size. TPE can also be combined with lipoprotein removal strategies for managing familial hypercholesterolemia. TPE is an affordable extracorporeal therapy that benefits patients with life-threatening diseases. It requires collaboration between nephrologists and other specialists, and our results demonstrate successful TPE without anticoagulation in general hospitalization or outpatient settings.
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Affiliation(s)
- Juliana Mantilla
- Nephrology, School of Medicine and Health Sciences/Universidad Del Rosario/, Bogotá, Colombia
| | - Danna Peña
- Nephrology, School of Medicine and Health Sciences/Universidad Del Rosario/, Bogotá, Colombia
| | - Alejandra Molano-Triviño
- Nephrology, School of Medicine and Health Sciences/Universidad Del Rosario/, Bogotá, Colombia
- Nephrology/La Cardio - Fundación Cardioinfantil, Bogotá, Colombia
- International Renal Research Institute Vicenza, Vicenza, Italy
| | - Eduardo Zúñiga
- Nephrology, School of Medicine and Health Sciences/Universidad Del Rosario/, Bogotá, Colombia
- Nephrology/La Cardio - Fundación Cardioinfantil, Bogotá, Colombia
| | - Juan Camilo Castellanos-De La Hoz
- Nephrology, School of Medicine and Health Sciences/Universidad Del Rosario/, Bogotá, Colombia
- Nephrology/La Cardio - Fundación Cardioinfantil, Bogotá, Colombia
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Hussein G, Liu B, Yadav SK, Warsame M, Jamil R, Surani SR, Khan SA. Plasmapheresis in the ICU. Medicina (Kaunas) 2023; 59:2152. [PMID: 38138254 PMCID: PMC10744423 DOI: 10.3390/medicina59122152] [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] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
Therapeutic plasma exchange (TPE) is a treatment paradigm used to remove harmful molecules from the body. In short, it is a technique that employs a process that functions partially outside the body and involves the replacement of the patient's plasma. It has been used in the ICU for a number of different disease states, for some as a first-line treatment modality and for others as a type of salvage therapy. This paper provides a brief review of the principles, current applications, and potential future directions of TPE in critical care settings.
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Affiliation(s)
- Guleid Hussein
- Mayo Clinic Health System, Mankato, MN 56001, USA; (B.L.); (S.K.Y.); (M.W.)
| | - Bolun Liu
- Mayo Clinic Health System, Mankato, MN 56001, USA; (B.L.); (S.K.Y.); (M.W.)
| | - Sumeet K. Yadav
- Mayo Clinic Health System, Mankato, MN 56001, USA; (B.L.); (S.K.Y.); (M.W.)
| | - Mohamed Warsame
- Mayo Clinic Health System, Mankato, MN 56001, USA; (B.L.); (S.K.Y.); (M.W.)
| | - Ramsha Jamil
- Sindh Medical College, Jinnah Sindh Medical University, Karachi 75510, Pakistan;
| | - Salim R. Surani
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Medicine and Pharmacology, Texas A&M University, College Station, TX 77843, USA
| | - Syed A. Khan
- Mayo Clinic Health System, Mankato, MN 56001, USA; (B.L.); (S.K.Y.); (M.W.)
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10
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Agarwal S, Maheshwari A, Bajpai M. Large volume plasmapheresis using a single-use immunoadsorption column: A cost-effective approach for desensitization in ABO-incompatible liver transplant. J Clin Apher 2023; 38:548-554. [PMID: 37194407 DOI: 10.1002/jca.22058] [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: 12/23/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Liver transplant is a life-saving treatment, but due to the limited availability of suitable liver donors, ABO-incompatible liver transplants (ABOi-LT) are conducted to increase the availability of liver donors. Perioperative desensitization for ABOi-LT is an established strategy to circumvent the risk of graft rejection. A single prolonged session can be performed to achieve the desired titers to avoid using multiple immunoadsorption (IA) columns or off-label reuse of single-use columns. This study retrospectively assessed the effectiveness of a single prolonged plasmapheresis session using IA as a desensitization strategy in live donor liver transplant (LDLT). MATERIALS AND METHODS This retrospective observational study conducted at a center for liver diseases in North India on six ABOi-LDLT patients who underwent single prolonged IA sessions in the perioperative period from January 2018 to June 2021. RESULTS Median baseline titer in patients was 320 (64, 1024). The median plasma volume adsorbed was 7.5 volumes (4, 8) per procedure, with a mean procedure time of 600 min (310-753). The reduction in titer ranged from 4 log to 7 log reduction per procedure. Two patients developed transient hypotension during the procedure, which was managed successfully. The median duration of pre-transplant hospital stay was 1.5 days (1, 3). CONCLUSION Desensitization therapy helps overcome the ABO barrier and decreases the waiting period before a transplant when ABO identical donors are unavailable. A single prolonged IA session reduces the cost of additional IA columns and hospital stay, thus making it a cost-effective approach to desensitization.
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Affiliation(s)
- Sarika Agarwal
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ashish Maheshwari
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Meenu Bajpai
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
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11
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Jain VS, Li H, Lee KP, Rose WN. Therapy plans for therapeutic apheresis in Epic HealthLink. J Clin Apher 2023; 38:611-614. [PMID: 37376707 DOI: 10.1002/jca.22072] [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: 11/16/2022] [Revised: 05/16/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND A common required duty of pathology resident physicians while rotating on transfusion medicine is the medical oversight of the therapeutic apheresis service. A task often performed on this clinical medicine service is formulating and writing orders for therapeutic apheresis procedures. The EpicCare tool called the therapy plan provides unique advantages over a standard electronic order set for therapeutic apheresis. MATERIALS AND METHODS Transfusion medicine physicians, apheresis nurses, pharmacists, and information technology professionals collaborated to create therapy plans for three therapeutic apheresis procedures: plasmapheresis, red cell exchange, and photopheresis. RESULTS Therapy plans were implemented and have been well-received for several years. Over a six-year time period, a total of 613 therapy plans were created and signed. We speculate that this implementation may have increased both physician efficiency and patient safety. CONCLUSION This article reports our experience using therapy plans in EpicCare in order to raise awareness of this tool and to serve as an encouragement for wider adoption.
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Affiliation(s)
- Vansh S Jain
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Huihua Li
- Department of Pathology, University of Wisconsin Hospital, Madison, Wisconsin, USA
| | - Kristin P Lee
- Center for Clinical Knowledge Management, University of Wisconsin Hospital, Madison, Wisconsin, USA
| | - William Nicholas Rose
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Pathology, University of Wisconsin Hospital, Madison, Wisconsin, USA
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12
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Cardinale A, Pambrun E, Prelipcean C, Messikh Z, Moranne O. Feasibility, Efficacy, and Safety of Peripheral Venous Access for Chronic Double-Filtration Plasmapheresis with Regional Citrate Anticoagulation. Blood Purif 2023; 52:621-630. [PMID: 37536292 DOI: 10.1159/000531688] [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: 03/03/2023] [Accepted: 06/09/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Peripheral venous access (PVA) is recommended as a first-line vascular approach for therapeutic plasmapheresis with centrifugation methods but not filtration, which usually requires high blood flow. We evaluated the feasibility, efficacy, and safety of double-filtration plasmapheresis (DFPP) with PVA, using ultrasound guidance and regional citrate anticoagulation (RCA), i.e., PVA-RCA-DFPP in patients undergoing chronic DFPP. Secondly, we assessed the number of central venous catheters (CVCs) avoided. METHODS A single-center retrospective study evaluated 22 adult patients on chronic DFPP to perform PVA-RCA-DFPP. They were classified into 3 groups: successful (i.e., completion of sessions with PVA), primary failure (i.e., no sessions completed), secondary failure (i.e., ≥1 session with PVA completed but secondary return with CVC or arteriovenous fistula). RESULTS Among the 22 patients included (64% men), 7 patients (32%) were classified as primary failures (2 patient refusals, 5 inadequate PVAs), 1 patient (5%) as a secondary failure (due to uncomfortable venipunctures), and 14 patients (64%) as successful. In the successful group including 12 patients treated for chronic inflammatory demyelinating polyneuropathy (CIDP) and 2 patients for familial hypercholesterolemia (FH) (2 patients), 116 sessions were performed, with a median treated plasma volume of 4.3 L [IQR 3.6-4.6] (45 mL/kg) for a median duration of 134 min [IQR 122-144], and a median blood flow of 94 mL/min [IQR 87-103]. For the CIDP group, 90% of sessions achieved a plasma volume >1 TPV, and for the FH group 91% of sessions achieved an LDLc reduction >60%. Eleven sessions out of 116 (9%) were interrupted, mostly due to PVA dysfunction (5/11) and circuit clotting (4/11). Session interruptions decreased significantly between each patient's first and following sessions (29% to 7%, p = 0.009). CONCLUSION Chronic PVA-RCA-DFPP can be performed safely and efficiently, avoiding the use of CVCs.
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Affiliation(s)
| | - Emilie Pambrun
- Service Néphrologie-Dialyse-Aphérèse, CHU Nîmes, Nîmes, France
| | | | - Ziyad Messikh
- Service Néphrologie-Dialyse-Aphérèse, CHU Nîmes, Nîmes, France
| | - Olivier Moranne
- Service Néphrologie-Dialyse-Aphérèse, CHU Nîmes, Nîmes, France
- IDESP UMR, Montpellier, France
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13
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Altobelli C, Anastasio P, Cerrone A, Signoriello E, Lus G, Pluvio C, Perna AF, Capasso G, Simeoni M, Capolongo G. Therapeutic Plasmapheresis: A Revision of Literature. Kidney Blood Press Res 2022; 48:66-78. [PMID: 36481657 PMCID: PMC9932846 DOI: 10.1159/000528556] [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: 05/02/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Therapeutic plasmapheresis (TP) is an extracorporeal therapy that allows the removal of pathogens from plasma. The role of TP in immuno-mediated diseases and toxic conditions has been of interest for decades. SUMMARY We reviewed the recent literature on the application and the optimal choice of TP technique ranging from plasma exchange, double filtration plasmapheresis, rheopheresis, immunoadsorptions, plasma adsorption perfusion and lipidoapheresis. In addition, we report our experience in the application of TP for various diseases ranging in different medical specialties, following the American Society for Apheresis (ASFA) recommendations. KEY MESSAGES Overall patients receiving TP showed an improvement in clinical and laboratory parameters. Our review and single-center experience suggest a benefit of the application of TP in multiple clinical disciplines.
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Affiliation(s)
- Claudia Altobelli
- Division of Nephrology and Dialysis, Department of Critical Area, Cotugno Hospital, Naples, Italy
| | - Pietro Anastasio
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessandro Cerrone
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Elisabetta Signoriello
- Second Division of Neurology, Department of Advanced Medical and Surgery Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giacomo Lus
- Second Division of Neurology, Department of Advanced Medical and Surgery Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Corrado Pluvio
- Division of Nephrology and Dialysis, Department of Critical Area, Cotugno Hospital, Naples, Italy
| | - Alessandra F Perna
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mariadelina Simeoni
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanna Capolongo
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy,
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Gál K, Asbóth G, Vass M, Bíró A, Markovich A, Homoki J, Fidler G, Paholcsek M, Cziáky Z, Németh N, Remenyik J, Soltész P. Monitoring and recovery of hyperglycaemia-induced endothelial dysfunction with rheopheresis in diabetic lower extremity ulceration with hyperviscosity. Diab Vasc Dis Res 2022; 19:14791641221131788. [PMID: 36357361 PMCID: PMC9661626 DOI: 10.1177/14791641221131788] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Rheopheresis is an extracorporeal haematotherapy that improves haemorheological status by filtering proteins that enhance blood viscosity. It also has anti-inflammatory effects by removing inflammatory cytokines. Our study aims to examine the effects of rheopheresis on the endothelial status in diabetic lower extremity ulceration. METHODS In vitro experiments were performed in a HUVEC model to mimic hyperglycaemic stress. We determined the changes in gene expression levels of IL-6, IL-8, TNF-alpha, endothelin convertase enzyme, ET-1, and NO synthase, as well as the ROS and intracellular GSH levels upon hyperglycaemia. In in vivo studies, two rheopheresis procedures were performed on seven patients with diabetic lower extremity ulceration with hyperviscosity, and we measured the changes in plasma concentrations of ET-1, TXB2, SOD enzyme activity, and extracellular components of the glutathione pool depending on treatments. RESULTS Our results showed that hyperglycaemia increases endothelial expression of inflammatory cytokines, ET-1, and endothelin convertase enzyme, while NO synthase was decreased. As a result of rheopheresis, we observed decreased ET-1 and TXB2 concentrations in the plasma and beneficial changes in the parameters of the glutathione pool. CONCLUSION To summarize our results, hyperglycaemia-induced oxidative stress and endothelial inflammation can be moderated by rheopheresis in diabetic lower extremity ulceration with hyperviscosity.
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Affiliation(s)
- Kristóf Gál
- Division of Angiology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Georgina Asbóth
- Department of Food Technology, Faculty of Agricultural and Food Sciences and Environmental Management University of Debrecen, Debrecen, Hungary
| | - Melinda Vass
- Division of Angiology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Bíró
- Department of Food Technology, Faculty of Agricultural and Food Sciences and Environmental Management University of Debrecen, Debrecen, Hungary
| | - Arnold Markovich
- Department of Food Technology, Faculty of Agricultural and Food Sciences and Environmental Management University of Debrecen, Debrecen, Hungary
| | - Judit Homoki
- Department of Food Technology, Faculty of Agricultural and Food Sciences and Environmental Management University of Debrecen, Debrecen, Hungary
| | - Gábor Fidler
- Department of Food Technology, Faculty of Agricultural and Food Sciences and Environmental Management University of Debrecen, Debrecen, Hungary
| | - Melinda Paholcsek
- Department of Food Technology, Faculty of Agricultural and Food Sciences and Environmental Management University of Debrecen, Debrecen, Hungary
| | - Zoltán Cziáky
- Agricultural and Molecular Research and Service Group, University of Nyíregyháza, Nyíregyháza, Hungary
| | - Norbert Németh
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Remenyik
- Department of Food Technology, Faculty of Agricultural and Food Sciences and Environmental Management University of Debrecen, Debrecen, Hungary
| | - Pál Soltész
- Division of Angiology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Pál Soltész, Division of Angiology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Móricz Zsigmond krt. 22, Debrecen 4032, Hungary.
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Abstract
Toxic epidermal necrosis (TEN) is rare and can be life-threatening for patients. Appropriate management of TEN patients could give optimal results and prevent complications. One treatment modality for TEN is plasmapheresis, which is rarely available in most cases with severe TEN. Here we reported a successful treatment of severe TEN with plasmapheresis. A 40-year-old woman under tuberculosis therapy complained of shortness of breath that began four days prior to hospital admission and worsened ever since. The patient's skin was peeling with red spots and rashes all over the body for a week. During the examination, the patient was compos mentis, and the SCORTEN score was 2 with 12.1% risk of mortality rate. Dermatological examination of the face, trunk and extremities found extensive erosions, loose bullae filled with clear fluid, brown crusts, and generalized distribution with more than 30% epidermolysis. The patient was diagnosed with toxic epidermal necrolysis caused by antituberculosis therapy. We treated the patient by discontinuing the suspected drugs and administering the corticosteroids, but no improvement was observed. The patient underwent two cycle plasmaphereses with 5% albumin, resulting in 1.2 liter of plasma exchange. Re-epithelialization was observed after three days, and the patient was discharged on day 8. This case-report highlights the important role of plasmapheresis in treating the TEN patients. However, a study with larger sample sizes is warranted to validate the efficacy of plasmapheresis in TEN.
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Affiliation(s)
- Wahyu Lestari
- Department of Dermato-Venereology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Dermato-Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | - Vella Vella
- Department of Dermato-Venereology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Dermato-Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | - Teuku Yasir
- Department of Anesthesiology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Anesthesiology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | - Teuku Zulfikar
- Department of Pulmonology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Pulmonology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
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Scholkmann F, Tsenkova R. Changes in Water Properties in Human Tissue after Double Filtration Plasmapheresis-A Case Study. Molecules 2022; 27:molecules27123947. [PMID: 35745071 PMCID: PMC9230951 DOI: 10.3390/molecules27123947] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
Double-filtration plasmapheresis (DFPP) is a blood cleaning technique that enables the removal of unwanted substances from the blood. In our case study, we performed near-infrared (NIR) spectroscopy measurements on the human hand tissue before and after a specific DFPP treatment (INUSpheresis with a TKM58 filter), along with NIR measurements of the substances extracted via DFPP (eluate). The spectral data were analyzed using the aquaphotomics approach. The analysis showed that the water properties in the tissue change after DFPP treatment, i.e., an increase in small water clusters, free water molecules and a decrease in hydroxylated water as well as superoxide in hydration shells was noted. The opposite effect was observed in the eluates of both DFPP treatments. Our study is the first that documents changes in water spectral properties after DFPP treatments in human tissue. The changes in tissue water demonstrated by our case study suggest that the positive physiological effects of DFPP in general, and of INUSpheresis with the TKM58 filter in particular, may be associated with improvements in water quality in blood and tissues.
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Affiliation(s)
- Felix Scholkmann
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-255-93-26
| | - Roumiana Tsenkova
- Aquaphotomics Research Department, Graduate School of Agricultural Science, Kobe University, Kobe 657-8501, Japan;
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Faria R, Bucur A, Gordinho A, Falcão L, Carrão A, Fernandes S, Colaço J, Meneses-Oliveira C, Messias A. Therapeutic Plasmapheresis: Seven Year Experience of an Intensive Care Unit in Portugal. ACTA MEDICA PORT 2022; 35:176-183. [PMID: 34416929 DOI: 10.20344/amp.14266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/04/2020] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Therapeutic plasmapheresis is a therapeutic procedure in which the patient's blood is passed through a medical device which separates out plasma from other components of blood. The plasma is removed and replaced with a replacement solution. Studies on the use of plasmapheresis in critically ill patients are scarce. The aim of this study was to review all therapeutic plasmapheresis sessions carried out in the Hospital Beatriz Ângelo intensive care unit. MATERIAL AND METHODS An observational retrospective study was conducted between April 2012 and March 2019. All patients who underwent therapeutic plasmapheresis in the intensive care unit were included, and plasmapheresis sessions held outside the intensive care unit were excluded. RESULTS Of 46 patients, 63% were men (n = 29), with a median age of 53 years. The most frequent diagnoses were hypertriglyceridemia-induced pancreatitis, vasculitis, autoimmune haemolytic anaemia, and atypical haemolytic-uremic syndrome. A total of 198 plasmapheresis sessions were carried out in the intensive care unit. Most of the used replacement solutions were fresh frozen plasma (34.4%), albumin/crystalloid (24.2%), and albumin/fresh frozen plasma (19.2%). The most common complications were hydroelectrolytic changes (84; 42.4%) and coagulation disorders/thrombocytopenia (65; 32.8%). There was no need to interrupt any plasmapheresis session due to complications related to the patient. DISCUSSION Therapeutic plasmapheresis is an urgent procedure that can reduce morbidity and mortality in critically ill patients. This justifies that 37% of patients started the technique before the diagnostic confirmation. The indications for plasmapheresis and the choice of replacement solution were in agreement with the guidelines. Despite the risk of bleeding, no haemorrhagic complications were recorded. CONCLUSION Therapeutic plasmapheresis is a complex technique that requires specific training. The indications are diverse, and some are not consensual. Complications were frequent, but they did not increase morbidity.
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Affiliation(s)
- Rita Faria
- Intensive Care Department. Hospital Beatriz Ângelo. Loures. Portugal
| | - Alexei Bucur
- Intensive Care Department. Hospital Beatriz Ângelo. Loures. Portugal
| | - André Gordinho
- Intensive Care Department. Hospital Beatriz Ângelo. Loures. Portugal
| | - Luis Falcão
- Nephrology Department. Hospital Beatriz Ângelo. Loures. Portugal
| | - André Carrão
- Anaesthesiology Department. Hospital Beatriz Ângelo. Loures. Portugal
| | - Sara Fernandes
- Nephrology Department. Hospital Beatriz Ângelo. Loures. Portugal
| | - João Colaço
- Intensive Care Department. Hospital da Luz. Lisboa. Portugal
| | | | - António Messias
- Intensive Care Department. Hospital da Luz. Lisboa. Portugal
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18
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Vinh DC, Abel L, Bastard P, Cheng MP, Condino-Neto A, Gregersen PK, Haerynck F, Cicalese MP, Hagin D, Soler-Palacín P, Planas AM, Pujol A, Notarangelo LD, Zhang Q, Su HC, Casanova JL, Meyts I. Harnessing Type I IFN Immunity Against SARS-CoV-2 with Early Administration of IFN-β. J Clin Immunol 2021; 41:1425-1442. [PMID: 34101091 PMCID: PMC8186356 DOI: 10.1007/s10875-021-01068-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023]
Affiliation(s)
| | - Laurent Abel
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Hospital for Sick Children, 75015, Paris, France
- University of Paris, Imagine Institute, 75015, Paris, France
| | - Paul Bastard
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Hospital for Sick Children, 75015, Paris, France
- University of Paris, Imagine Institute, 75015, Paris, France
| | | | | | - Peter K Gregersen
- Feinstein Institute for Medical Research, Northwell Health USA, Manhasset, NY, USA
| | - Filomeen Haerynck
- Department of Paediatric Immunology and Pulmonology, Centre for Primary Immunodeficiency Ghent (CPIG), PID Research Lab, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Maria-Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - David Hagin
- Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | | | - Aurora Pujol
- Neurometabolic Diseases Laboratory, IDIBELL-Hospital Duran I Reynals; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Catalonia, Spain
- CIBERER U759, ISCiii, Madrid, Spain
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, MD, USA
| | - Qian Zhang
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
| | - Helen C Su
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, MD, USA
| | - Jean-Laurent Casanova
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Hospital for Sick Children, 75015, Paris, France
- University of Paris, Imagine Institute, 75015, Paris, France
- Howard Hughes Medical Institute, New York, NY, USA
| | - Isabelle Meyts
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
- Laboratory for Inborn Errors of Immunity, KU Leuven, Leuven, Belgium.
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19
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Jain A, Xu R, Venkataramanan R, Farooq U, Butt F, Ghahramani N, Kadry Z. Plasmapheresis Decreases Belatacept Exposure: Requires Consideration for Dose and Frequency Adjustments. Transplantation 2021; 105:e152-e153. [PMID: 34591818 DOI: 10.1097/tp.0000000000003840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ashokkumar Jain
- Department of General Surgery, Division of Transplant Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Ruichao Xu
- Pharmaceutical Sciences and Pathology, University of Pittsburgh, Pittsburgh, PA
| | | | - Umar Farooq
- Department of Medicine, Division of Nephrology, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Fauzia Butt
- Department of General Surgery, Division of Transplant Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Nasrollah Ghahramani
- Department of Medicine, Division of Nephrology, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Zakiyah Kadry
- Department of General Surgery, Division of Transplant Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
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20
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Goudarzi S, Esmaeeli S, Valencia JD, Lu ME, Hales RR, Fehnel CR, Conley CM, Quraishi SA, Nozari A. Treatment Options for COVID-19-Related Guillain-Barré Syndrome: A Systematic Review of Literature. Neurologist 2021; 26:196-224. [PMID: 34491938 PMCID: PMC8423032 DOI: 10.1097/nrl.0000000000000342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Central nervous system complications are reported in an increasing number of patients with Coronavirus Disease 2019 (COVID-19). COVID-19-related Guillain-Barré syndrome (GBS) is of particular importance given its association with higher mortality rates and prolonged respiratory failure. REVIEW SUMMARY We conducted a systematic review of published cases for COVID-19-related GBS, and provide a summary of clinical management strategies for these cases. Sixty-three studies, including 86 patients, were included. Seventy-six cases with reported outcome data were eligible for the outcome analysis. Ninety-nine percent of patients were diagnosed with COVID-19 before diagnosis of GBS (median: 14 d prior, interquartile range: 7 to 20). Intravenous immunotherapy (intravenous immunoglobulin: 0.4 g/kg/d for 5 d) was the most frequently used treatment approach. The review indicated that the outcome was not favorable in 26% of cases (persistent neurological deficits). A mortality rate of 3.5% was observed in patients with COVID-19-related GBS. CONCLUSIONS Although evidence to support specific treatments is lacking, clinicians should consider the benefits of immunotherapy and plasma exchange in addition to the standard antimicrobial and supportive therapies for patients who meet the diagnostic criteria for acute sensory and motor polyradiculoneuritis. Intravenous immunoglobulin treatment alone is not shown to result in improved outcomes or mortality. More extensive studies aimed at exploring the neurological manifestations and complications of COVID-19 and distinctive treatment options for COVID-19-related GBS are warranted.
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Affiliation(s)
| | - Shooka Esmaeeli
- Departments of Anesthesiology, Critical Care, and Pain Medicine
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | | | - Maegan E. Lu
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | - Riley R. Hales
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | - Corey R. Fehnel
- Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Christopher M. Conley
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | - Sadeq A. Quraishi
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Ala Nozari
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
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21
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Bose P. Central pontine myelinolysis and the osmotic demyelination syndromes: an open and shut case? Acta Neurol Belg 2021; 121:849-858. [PMID: 33713026 DOI: 10.1007/s13760-021-01634-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 12/01/2022]
Abstract
Central pontine myelinolysis and extrapontine myelinolysis are collectively called the osmotic demyelination syndromes. Despite being described in 1959, there are several aspects of the disorder that remain an enigma. Animal models and neuroimaging techniques have allowed us to understand the condition better. From being a universally fatal disorder that was diagnosed post mortem, increased awareness, neuroimaging techniques and supportive care have enabled us to make the diagnosis ante-mortem. This has also led to a significant drop in associated mortality. The aim of this review is to highlight the clinical spectrum, neuroimaging findings, and recent developments.
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Affiliation(s)
- Pyari Bose
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand.
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22
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Bian RT, Wang ZT, Li WY. Immunoadsorption treatment for dilated cardiomyopathy: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26475. [PMID: 34190171 PMCID: PMC8257917 DOI: 10.1097/md.0000000000026475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND As one of the leading causes of heart failure, dilated cardiomyopathy (DCM) is characterized by dysfunctional muscle contraction and enlarged ventricular chamber. Patients with DCM have been shown to respond well to immunoadsorption (IA) therapies. However, the efficacy and safety of IA treatment for DCM patients remained to be evaluated. METHODS This study was designed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis. We searched the databases such as Cochrane library, Cochrane Central Register of Controlled Trials, Embase, OVID, and Web of Science from January 1990 to March 20, 2020, and performed meta-analysis using Stata MP Version 13.0. RESULTS We performed meta-analysis on 12 studies that included a total of 395 patients with DCM. Overall, IA treatment significantly improved the left ventricular ejection fraction (6.01, 95% confidence interval [CI] [4.84-7.19]), reduced the left ventricular end diastolic diameter (-3.62, 95% CI [-4.06 to -3.19]), reduced severity of symptoms according to the New York Heart Association (NYHA) functional classification (-1.37, 95% CI [-1.73 to -1.02]) as compared with the controls, but had no effect on values for safety parameters (1.13, 95% CI [0.58-2.19]). CONCLUSIONS Results of this meta-analysis indicated that the IA treatment can improve the left ventricular ejection fraction, reduce left ventricular end diastolic diameter, and thus improve clinical outcome in DCM patients. However, further evidence are required to validate the relative safety of IA treatment. Multi-center, double blind studies should be conducted to elucidate the precise effect of IA treatment in DCM patients.
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Affiliation(s)
- Ru-tao Bian
- Department of Cardiology, Henan University of Chinese Medicine
| | - Zhen-tao Wang
- Department of Cardiology, The Second Affiliated Hospital of Henan University of Chinese Medicine
| | - Wei-yu Li
- Department of Nephropathy, Zhengzhou Traditional Chinese Medicine Hospital, Zhengzhou, China
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Lemarquis A, Campbell T, Aranda-Guillén M, Hennings V, Brodin P, Kämpe O, Blennow K, Zetterberg H, Wennerås C, Eriksson K, Landegren N, Bryceson Y, Berg S, Ekwall O. Severe COVID-19 in an APS1 patient with interferon autoantibodies treated with plasmapheresis. J Allergy Clin Immunol 2021; 148:96-98. [PMID: 33892926 PMCID: PMC8051851 DOI: 10.1016/j.jaci.2021.03.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Andri Lemarquis
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Tessa Campbell
- Centre for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maribel Aranda-Guillén
- Centre for Molecular Medicine, Department of Medicine (Solna), Karolinska Institute, Stockholm, Sweden
| | - Viktoria Hennings
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Petter Brodin
- Science for Life Laboratory, Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Olle Kämpe
- Centre for Molecular Medicine, Department of Medicine (Solna), Karolinska Institute, Stockholm, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, United Kingdom; UK Dementia Research Institute at UCL, London, United Kingdom
| | - Christine Wennerås
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Eriksson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nils Landegren
- Centre for Molecular Medicine, Department of Medicine (Solna), Karolinska Institute, Stockholm, Sweden; Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Yenan Bryceson
- Centre for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Division of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden; Broegelmann Research Laboratory, Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Stefan Berg
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olov Ekwall
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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do Valle DA, Santos MLSF, Spinosa MJ, Telles BA, Prando C, Cordeiro ML. GABAA receptor encephalitis associated with human parvovirus B19 virus infection: Case report. Medicine (Baltimore) 2021; 100:e26324. [PMID: 34115048 PMCID: PMC8202551 DOI: 10.1097/md.0000000000026324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Human parvovirus B19 (B19) infection can produce a spectrum of clinical syndromes, including neurological manifestations, most notably encephalitis. Although symptoms suggestive of autoimmune disease in patients with B19 infection have been previously described, a clear association of autoimmune encephalitis with B19 infection has yet to be established. PATIENT CONCERNS We describe the case of a 6-year-old boy who was hospitalized due to status epilepticus, which evolved to super-refractory status epilepticus that was only mildly responsive to anticonvulsant drugs. DIAGNOSIS A cerebrospinal fluid study identified slight pleocytosis and B19 positivity. A subsequent autoimmunity cerebrospinal fluid study revealed the presence of anti-γ-aminobutyric acid type A (GABAA) receptor antibodies. INTERVENTIONS After pulse therapy with methylprednisolone and continuous therapy with prednisolone with cyclosporine, the patient experiencing seizure persistence with disordered motor function manifestations and only minor improvement in consciousness, and so, plasmapheresis was performed. With continued immunosuppressive treatments with cyclosporine and prednisolone, the patient's clinical picture showed progressive improvement, with good control of seizures. Although the patient tolerated withdrawal of the anticonvulsant drugs well, he developed seizures when corticosteroid therapy withdrawal was attempted, so was started on azathioprine. OUTCOMES After immunosuppressive therapy, the patient evolved with complete remission of symptoms, normal neurological examination and age-appropriate neuropsychomotor development. LESSONS The present case characteristics, together with previous findings, support the hypothesis that autoimmunity may be triggered by extensive antigen release due to degeneration of infected neurons. This case highlights the importance of early clinical suspicion and treatment.
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Affiliation(s)
- Daniel Almeida do Valle
- Faculdades Pequeno Principe
- Neurology Department, Hospital Pequeno Principe
- Instituto de Pesquisa Pelé Pequeno Principe
| | | | | | | | - Carolina Prando
- Faculdades Pequeno Principe
- Instituto de Pesquisa Pelé Pequeno Principe
- Immunology Department, Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Mara L. Cordeiro
- Faculdades Pequeno Principe
- Instituto de Pesquisa Pelé Pequeno Principe
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, CA
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Roy P, Koetter P, Cunningham J, Komanduri S, Cinicola J. A rare case of diabetic ketoacidosis presenting with severe hypertriglyceridemia requiring plasmapheresis in an adult with type-2 diabetes mellitus: Case report. Medicine (Baltimore) 2021; 100:e26237. [PMID: 34115010 PMCID: PMC8202650 DOI: 10.1097/md.0000000000026237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Severe hypertriglyceridemia (HTG) is a rare complication of insulin resistance. Its presentation with diabetic ketoacidosis (DKA) has been reported in a few cases, where most patients have type-1 diabetes mellitus (DM). Our case represents a unique presentation of DKA associated with severe HTG above 10,000 mg/dL in an adult with type-2 DM. PATIENT CONCERNS AND DIAGNOSIS Case Report: A 51-year-old man with no prior illnesses presented to the emergency department with abdominal pain and nausea. He was found to have DKA with a blood glucose level of 337 mg/dL, pH of 7.17, beta-hydroxybutyrate of 7.93 mmol/L, and anion gap of 20 mmol/L. His triglyceride levels were >10,000 mg/dL. His serum was found to be lipemic. Computerized tomography scan of the abdomen demonstrated mild acute pancreatitis. Negative GAD65 antibodies supported the diagnosis of type-2 DM. INTERVENTIONS AND OUTCOMES Endocrinology was consulted and one cycle of albumin-bound plasmapheresis was administered. This therapy significantly improved his HTG. DKA gradually resolved with insulin therapy as well. He was discharged home with endocrinology follow-up. CONCLUSION This unique case highlights an uncommon but critical consequence of uncontrolled DM. It brings forth the possibility of severe HTG presenting as a complication of uncontrolled type-2 DM. Severe HTG commonly presents with acute pancreatitis, which can be debilitating if not managed promptly. Most patients with this presentation are managed with insulin infusion. The use of plasmapheresis for management of severe HTG has not been well studied. Our case supports the use of plasmapheresis as an effective and rapid treatment for severe HTG.
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Affiliation(s)
- Pooja Roy
- Internal Medicine Residency Program, UPMC Pinnacle Harrisburg Hospital
| | | | | | | | - John Cinicola
- Internal Medicine Residency Program, UPMC Pinnacle Harrisburg Hospital
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Tang S, Liu Y, Liu C, Zhao J. Effect of plasmapheresis versus standard treatment in preventing recurrent acute pancreatitis in Chinese patients with hypertriglyceridemia. Pak J Pharm Sci 2021; 34:1255-1259. [PMID: 34602397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The present study designed to compare the effect of plasmapheresis (PPH) versus standard treatment (STD) in preventing recurrent AP in Chinese patients with severe hypertriglyceridemia. Chinese patients aged 18 to 65 years who had history of hypertriglyceridemia (>1000mg/dl) induced acute pancreatitis were assigned to plasmapheresis (up to 1.5 ml daily TG level reaches 500 mg/dl or less) or standard treatment (1:1). Standard treatment (STD) includes limited oral intake (pancreatic rest), intravenous hydration and pain management. Primary endpoint was incidence of recurrent acute pancreatitis. A total of 14% of patients in PPH group (N=50) had experienced recurrent pancreatitis as compared to 24% of patients in STD group (N=50). Also, TG clearance rate in 24 hours was substantially higher in PPH group as compared to STD. Time required to reach target TG was significantly lower in patients treated with PPH as compared to STD. Lower incidence of local complications was observed in PPH group as compared to STD. Length of stay was significantly shorter in patients of plasmapheresis group as compared to standard treatment. The results of this study recommend the use of plasmapheresis as a better alternative in preventing recurrent AP in Chinese patients with severe hypertriglyceridemia.
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Affiliation(s)
- Shunyu Tang
- Department of Gastroenterology, Jingmen First People's Hospital, Jingmen, Hubei, China
| | - Yun Liu
- Department of Endoscopic Center, Jingmen First People's Hospital, Jingmen, Hubei, China
| | - Changqing Liu
- Department of Gastroenterology, Jingmen First People's Hospital, Jingmen, Hubei, China
| | - Jiayun Zhao
- Department of Hepatobiliary and Pancreatic Surgery, Jingmen First People's Hospital, Jingmen, Hubei, China
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Liu C, Liu P, Ma M, Yang H, Qi G. Efficacy and safety of double-filtration plasmapheresis treatment of myasthenia gravis: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25622. [PMID: 33907116 PMCID: PMC8084046 DOI: 10.1097/md.0000000000025622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 12/09/2020] [Accepted: 04/03/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of double-filtration plasmapheresis (DFPP) treatment of myasthenia gravis (MG) through a systematic review and meta-analysis. METHODS PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang databases were searched for randomized controlled trials (RCTs) and clinical controlled trials (CCTs) on DFPP for MG from database establishment to June 2019. Two researchers independently screened the articles, extracted the data, and cross checked the results. RevMan 5.3 was used for statistical analyses. RESULTS Seven RCTs and 2 CCTs were found comprising 329 patients. The results showed that clinical MG remission rate after DFPP treatment was significantly higher (OR = 4.33; 95% confidence interval [CI], 1.97-9.53; P < .001) and the serum levels of antititin antibody was significantly decreased (standardized mean difference [SMD] = 9.30; 95% CI, 7.51-11.08; P < .001). In addition, the quantitative MG (QMG) score, hospital stay and time to remission of MG symptoms, and acetylcholine receptor antibody (AchRAb) decreased in the DFPP treatment group; however, these outcomes had high heterogeneity among the studies. Only one study has reported on the adverse effects, including hypotension and hematoma. CONCLUSION This meta-analysis suggests that DFPP can be recommended for the short-term mitigation of MG. Because our review was limited by the quantity and quality of the included studies, the above conclusions should be verified by additional high-quality studies.
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Perrottet N, Fernández-Ruiz M, Binet I, Dickenmann M, Dahdal S, Hadaya K, Müller T, Schaub S, Koller M, Rotman S, Moll S, Hopfer H, Venetz JP, Aubert V, Bühler L, Steiger J, Manuel O, Pascual M, Golshayan D. Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study. PLoS One 2021; 16:e0250829. [PMID: 33930037 PMCID: PMC8087104 DOI: 10.1371/journal.pone.0250829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/15/2021] [Indexed: 01/13/2023] Open
Abstract
Acute antibody-mediated rejection (AMR) remains a challenge after kidney transplantation (KT). As there is no clear-cut treatment recommendation, accurate information on current therapeutic strategies in real-life practice is needed. KT recipients from the multicenter Swiss Transplant Cohort Study treated for acute AMR during the first post-transplant year were included retrospectively. We aimed at describing the anti-rejection protocols used routinely, as well as patient and graft outcomes, with focus on infectious complications. Overall, 65/1669 (3.9%) KT recipients were treated for 75 episodes of acute AMR. In addition to corticosteroid boluses, most common therapies included plasmapheresis (56.0%), intravenous immunoglobulins (IVIg) (38.7%), rituximab (25.3%), and antithymocyte globulin (22.7%). At least one infectious complication occurred within 6 months from AMR treatment in 63.6% of patients. Plasmapheresis increased the risk of overall (hazard ratio [HR]: 2.89; P-value = 0.002) and opportunistic infection (HR: 5.32; P-value = 0.033). IVIg exerted a protective effect for bacterial infection (HR: 0.29; P-value = 0.053). The recovery of renal function was complete at 3 months after AMR treatment in 67% of episodes. One-year death-censored graft survival was 90.9%. Four patients (6.2%) died during the first year (two due to severe infection). In this nationwide cohort we found significant heterogeneity in therapeutic approaches for acute AMR. Infectious complications were common, particularly among KT recipients receiving plasmapheresis.
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Affiliation(s)
- Nancy Perrottet
- Service of Pharmacy, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Mario Fernández-Ruiz
- Transplantation Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Isabelle Binet
- Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | - Michael Dickenmann
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Suzan Dahdal
- Division of Nephrology, Hypertension and Clinical Pharmacology, Inselspital Bern, Bern, Switzerland
| | - Karine Hadaya
- Division of Nephrology and Division of Transplantation, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Müller
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Schaub
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Michael Koller
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Solange Moll
- Division of Clinical Pathology, Department of Pathology and Immunology, Geneva University Hospitals, Geneva, Switzerland
| | - Helmut Hopfer
- Pathology Institute, University Hospital Basel, Basel, Switzerland
| | - Jean-Pierre Venetz
- Transplantation Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Vincent Aubert
- Service of Immunology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Léo Bühler
- Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Jurg Steiger
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Oriol Manuel
- Transplantation Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Service of Infectious Diseases, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Manuel Pascual
- Transplantation Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Dela Golshayan
- Transplantation Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- * E-mail:
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Kamimura H, Kamimura K, Tsuchiya A, Terai S. Successful treatment of positive-sense RNA virus coinfection with autoimmune hepatitis using double filtration plasmapheresis. BMJ Case Rep 2021; 14:14/3/e236984. [PMID: 33766959 PMCID: PMC8006769 DOI: 10.1136/bcr-2020-236984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/04/2022] Open
Abstract
Double filtration plasmapheresis (DFPP) is an apheretic technique that selectively removes high molecular weight substances using a plasma component filter. DFPP has been used to treat positive-sense RNA virus infections, mainly chronic hepatitis C virus (HCV) infection, because of its ability to directly eliminate viral particles from blood plasma from 2008 to about 2015, before direct-acting antiviral agents was marketed. This effect has been termed virus removal and eradication by DFPP. HCV is a positive-sense RNA virus similar to West Nile virus, dengue virus and the SARS and Middle East respiratory syndrome coronaviruses. SARS-CoV-2 is classified same viral species. These viruses are all classified in Family Flaviviridae which are family of single-stranded plus-stranded RNA viruses. Viral particles are 40-60 nm in diameter, enveloped and spherical in shape. We present a rare case of HCV removal where an RNA virus infection that copresented with virus-associated autoimmune hepatitis was eliminated using DFPP. Our results indicate that DFPP may facilitate prompt viraemia reduction and may have novel treatment applications for SARS-CoV-2, that is, use of therapeutic plasma exchange for fulminant COVID-19.
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Affiliation(s)
- Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Atsunori Tsuchiya
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Zhang G, Liu W, Li J, Wang D, Duan J, Luo H. Efficacy and safety of blood purification in the treatment of deep burns: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23968. [PMID: 33592850 PMCID: PMC7870217 DOI: 10.1097/md.0000000000023968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/02/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION This meta-analysis aimed to systematically review and evaluate randomized controlled trials (RCTs) and cohort studies examining the efficacy and safety of blood purification in the treatment of patients with deep burns. METHODS The PubMed, Cochrane Library, and Embase databases and relevant references were systematically searched for RCTs and cohort studies published until the end of September 2020 to investigate the potential of blood purification in improving the prognosis of severely burned patients. The primary outcome of this systematic review was overall patient mortality; secondary outcomes included the incidence of sepsis and infection prevention (vital signs and routine blood tests). RESULTS A total of 6 RCTs and 1 cohort study were included, with a total of 538 burn patients (274 patients who received blood purification and 264 control patients). Compared with patients who received conventional treatment, those treated with blood purification displayed significant 2-day reduction in mortality and sepsis with relative risks of 0.62 and 0.41, respectively (95% confidence intervals [CIs], 0.74-0.82 and 0.25-0.67, respectively; P < .05). In terms of vital signs and blood biochemistry, the respiratory rates and blood urea nitrogen levels of patients in the blood purification group 3 days post-treatment were significantly higher than those in the control group (randomized standard deviations (SMDs), 0.78 and 0.77, respectively; 95% CIs, 0.33-1.23 and 1.22-0.31, respectively; P < .05). However, there were no significant differences between groups on day 3 with regard to temperature (P = .32), heart rate (P = .26), white blood cell count (P = .54), or neutrophil count (P = .74), potentially owing to the small sample size or the relatively short intervention time. Heterogeneous differences existed between the groups with respect to blood urea nitrogen (SMD = -1.22; 95% CI, -2.16 to -0.40; P < .00001) and Cr (SMD = -3.13; 95% CI, -4.92 to -1.33; P < .00001) on day 7. No systematic adverse events occurred. CONCLUSIONS Blood purification treatment for deep burn patients can significantly reduce the mortality rate and the incidence of complications.
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Affiliation(s)
| | - Wenjun Liu
- Department of Burn and Injury, Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan, China
| | - Jiamei Li
- Department of Burn and Injury, Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan, China
| | - Di Wang
- Department of Burn and Injury, Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan, China
| | - Jianxing Duan
- Department of Burn and Injury, Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan, China
| | - Hanxiao Luo
- Department of Burn and Injury, Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan, China
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Ramirez-Guerrero G, Sevillano Prieto AM, Jara-Vilugrón F, Polanco Fernandez N, Gonzalez Monte E, Henandez Vicente A, Rodriguez Gayo LC, Praga Terente M, Andrés Belmonte A. Long-term plasmapheresis therapy in the management of focal segmental glomerulosclerosis recurrence after kidney transplantation. Transfus Apher Sci 2021; 60:103046. [PMID: 33455879 DOI: 10.1016/j.transci.2020.103046] [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: 10/11/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
The recurrence of primary focal segmental glomerulosclerosis (FSGS) after kidney transplantation (KT) appears in 30 % of the recipients. Sometimes it can cause the loss of the allograft. Although many treatments for this condition have been reported, 20 %-40 % of the affected patients are refractory or presents frequents relapses. In this paper we describe the evolution of three recipients treated with long-term plasmapheresis therapy after a recurrence of FSGS with a bad or incomplete response to other treatments. Although our findings require confirmation, long-term plasmapheresis could be a therapeutic option for this condition.
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Affiliation(s)
- Gonzalo Ramirez-Guerrero
- Department of Nephrology, Hospital Carlos Van Buren, Valparaiso. Street San Ignacio 725, Valparaíso, Chile
| | - Angel M Sevillano Prieto
- Department of Nephrology, Hospital 12 de Octubre, Avda. de Córdoba, s/n Madrid, PC: 28041, Spain.
| | - Fernando Jara-Vilugrón
- Department of Nephrology, Hospital Las Higueras, Alto Horno Street, Number 777, Talcahuano, Chile
| | | | - Esther Gonzalez Monte
- Department of Nephrology, Hospital 12 de Octubre, Avda. de Córdoba, s/n Madrid, PC: 28041, Spain
| | - Ana Henandez Vicente
- Department of Nephrology, Hospital 12 de Octubre, Avda. de Córdoba, s/n Madrid, PC: 28041, Spain
| | - Lucia C Rodriguez Gayo
- Department of Medicine, Universidad Complutense, Plaza Ramón y Cajal, Madrid, PC:28040, Spain
| | - Manuel Praga Terente
- Department of Nephrology, Hospital 12 de Octubre, Avda. de Córdoba, s/n Madrid, PC: 28041, Spain; Department of Medicine, Universidad Complutense, Plaza Ramón y Cajal, Madrid, PC:28040, Spain
| | - Amado Andrés Belmonte
- Department of Nephrology, Hospital 12 de Octubre, Avda. de Córdoba, s/n Madrid, PC: 28041, Spain
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Hähnel V, Peterhoff D, Bäuerlein V, Brosig AM, Pamler I, Johnson C, Bica A, Totir M, Ossner T, Stemmer B, Toelge M, Schütz A, Niller HH, Schmidt B, Wagner R, Gessner A, Burkhard R, Offner R. Manufacturing of convalescent plasma of COVID-19 patients: Aspects of quality. PLoS One 2020; 15:e0243967. [PMID: 33351831 PMCID: PMC7755199 DOI: 10.1371/journal.pone.0243967] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic emerged in December 2019. Convalescent plasma represents a promising COVID-19 treatment. Here, we report on the manufacturing of a plasma-based product containing antibodies specific to SARS-CoV-2 obtained from recently recovered COVID-19 patients. Convalescent plasma donors were screened as follows: 1) previously confirmed SARS-CoV-2 infection (by real-time PCR (RT-PCR)); 2) a subsequent negative PCR test followed by a 2-week waiting period; 3) an additional negative PCR test prior to plasmapheresis; and 4) confirmation of the presence of SARS-CoV-2 specific antibodies. Convalescent plasma was stored fresh (2-6°C) for up to 5 days or frozen (-30°C) for long-term storage. Donor peripheral blood and final plasma product were assayed for binding antibodies targeting the SARS-CoV-2 S-protein receptor-binding domain (RBD) and their titers measured by an enzyme-linked immunosorbent assay (ELISA). We performed 72 plasmaphereses resulting in 248 final products. Convalescent plasma contained an RBD-specific antibody titer (IgG) ranging from 1:100 to 1:3200 (median 1:800). The titer was congruent to the titer of the blood (n = 34) before collection (1:100-1:6400, median 1:800). Levels of IL-8 and LBP of donors were slightly increased. Therapeutic products derived from a human origin must undergo rigorous testing to ensure uniform quality and patient safety. Whilst previous publications recommended RBD-specific binding antibody titers of ≥ 1:320, we selected a minimum titer of 1:800 in order to maximize antibody delivery. Production of highly standardized convalescent plasma was safe, feasible and was readily implemented in the treatment of severely ill COVID-19 patients.
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Affiliation(s)
- Viola Hähnel
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - David Peterhoff
- Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Veronika Bäuerlein
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Andreas-Michael Brosig
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Irene Pamler
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Christian Johnson
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Adelina Bica
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Monica Totir
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Ossner
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Stemmer
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Martina Toelge
- Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Anja Schütz
- Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Hans-Helmut Niller
- Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Schmidt
- Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Ralf Wagner
- Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - André Gessner
- Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Ralph Burkhard
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Robert Offner
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
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Abstract
RATIONALE Multiorgan/system injury was observed in severely infected coronavirus disease 2019 (COVID-19) patients, in addition to viral pneumonia. Recognizing and correcting the key and immediate dysfunctions may reduce mortality. PATIENT CONCERNS A 66-year-old previously healthy male patient was referred to the isolation ward in Guanggu Branch of Hubei Province Maternity and Childcare Hospital with a high fever and nonproductive cough for twenty days. DIAGNOSES Diagnosis of severe COVID-19 infectious pneumonia was established by travel history, clinical features, chest imaging, and a positive oropharyngeal swab specimen result for the severe acute respiratory syndrome coronavirus 2 RT-PCR assay. INTERVENTIONS In addition to standard supportive care, combined inflammatory cytokine depletion therapy (double filtration plasma pheresis and tocilizumab) and convalescent plasma were administered. OUTCOMES The patient's homeostatic parameters (blood pressure, heart rate, spontaneous respiration, SPO2, and blood gas) recovered, along with the recovery on chest imaging. All the intravenous catheters were removed. Supportive care continued for several days, and the patient was transferred to a non-ICU isolation ward. LESSONS It is not safe to draw causal conclusions between cytokine depletion and clinical manifestation improvement with only 1 case, but this is a potential research direction in facing the COVID-19 crisis.
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Affiliation(s)
- Bo Yang
- Internal Medicine III (Nephrology & Endocrinology), Naval Medical Center of PLA, Second Military Medical University, Shanghai
| | - Jing Yang
- Internal Medicine III (Nephrology & Endocrinology), Naval Medical Center of PLA, Second Military Medical University, Shanghai
- The Fourth Department of Infectious Disease, Guanggu Branch of Hubei Province Maternity and Childcare Hospital, Wuhan
| | - Lan Zhou
- The Fourth Department of Infectious Disease, Guanggu Branch of Hubei Province Maternity and Childcare Hospital, Wuhan
- Intensive Care Unit, Naval Medical Center of PLA
| | - Cheng Xue
- Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hongxian Li
- Internal Medicine III (Nephrology & Endocrinology), Naval Medical Center of PLA, Second Military Medical University, Shanghai
| | - Weifeng Hu
- Internal Medicine III (Nephrology & Endocrinology), Naval Medical Center of PLA, Second Military Medical University, Shanghai
| | - Nanmei Liu
- Internal Medicine III (Nephrology & Endocrinology), Naval Medical Center of PLA, Second Military Medical University, Shanghai
- The Fourth Department of Infectious Disease, Guanggu Branch of Hubei Province Maternity and Childcare Hospital, Wuhan
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Abstract
RATIONALE Acquired hemophilia A (AHA) is a rare autoimmune disease caused by autoantibodies directed against the activity of factor VIII (FVIII) and presents with prolonged bleeding. 5.7% of systemic lupus erythematosus (SLE) patients are affected by AHA. PATIENT CONCERNS A 51-year-old female patient with SLE presenting with the fatigue and spontaneous clinical bleeding symptoms such as hematuria and ecchymoses for 1 week. DIAGNOSIS Laboratory examinations revealed prolongation of the activated partial thromboplastin time (APTT) (65.7 s), decreased FVIII activity (1.4%), and a titer of FVIII inhibitors of 8.5 Bethesda units/mL. INTERVENTIONS Transfusion of recombinant human FVIII (ADVATE) in combination with intravenous methylprednisolone, cyclophosphamide, plasmapheresis, and fresh frozen plasma successfully stopped the bleeding and reduced the level of FVIII inhibitor. OUTCOMES The size of the hematoma slowly decreased. The skin ecchymosis was gradually absorbed, the hemoglobin count increased, and the coagulation index gradually improved. There was no new bleeding or bleeding site. The patient was discharged and transferred to a local hospital for hospice care. LESSONS AHA in a patient with SLE is rare. Once it occurs, it can be life-threatening. Clinicians should remain aware that because some cases of AHA may have features of SLE, appropriate distinction and diagnosis of these different but associated diseases is necessary.
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Affiliation(s)
- Pan Shen
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital
| | - Jing Li
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital
| | - Shenghao Tu
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital
| | - Gang Chen
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital
| | - Chao Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
RATIONALE Neuromyelitis optica spectrum disorders (NMOSDs) are inflammatory demyelinating disorders of the central nervous system; they are characterized by severe optic neuritis and transverse myelitis. Intravenous methylprednisolone pulse (IVMP) therapy is an effective treatment that is administered to patients in the acute phase of NMOSD; this therapy has achieved remarkable results in clinical practice. However, there are no reports on NMOSD patients who have experienced an acute bilateral cerebral infarction while undergoing IVMP treatment. PATIENT CONCERNS We report on a 62-yr-old woman who was undergoing IVMP therapy for the primary diagnosis of NMOSD. Unexpectedly, the patient's existing limb weakness worsened, and she developed motor aphasia on the second day of IVMP treatment. Additionally, brain magnetic resonance imaging revealed acute bilateral cerebral infarction. DIAGNOSIS The patient's clinical manifestations, medical imaging results, and laboratory test results were taken into consideration; the final diagnosis was acute bilateral cerebral infarction in the presence of NMOSD. INTERVENTIONS Subsequent to the onset of acute cerebral infarction, the patient was immediately treated with oral aspirin, atorvastatin, and intravenous butylphthalide. The hormone dose was adjusted to an oral 60-mg/d dose for maintenance; this was followed by immunoadsorption plasmapheresis for 3 days, and double-filtration plasmapheresis for 2 days. OUTCOMES Following treatment onset, the patient's ocular symptoms significantly improved, and her limb muscle strength gradually recovered. Two months after discharge, the patient's husband reported that she was able to walk with the help of others and take care of herself, and that there was no recurrence. LESSONS Medical professionals must be aware of the possibility of NMOSD patients with cerebrovascular risk factors suffering an acute cerebral infarction while undergoing high-dose IVMP therapy, as this therapy can exacerbate existing problems.
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Zhong Z, Tan J, Tang Y, Li Z, Qin W. Goodpasture syndrome manifesting as nephrotic-range proteinuria with anti-glomerular basement membrane antibody seronegativity: A case report. Medicine (Baltimore) 2020; 99:e22341. [PMID: 32991448 PMCID: PMC7523814 DOI: 10.1097/md.0000000000022341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE The Goodpasture syndrome is an extremely rare disease, with renal and pulmonary manifestations, and is mediated by anti-glomerular basement membrane (anti-GBM) antibodies. Renal pathological changes are mainly characterized by glomerular crescent formation and linear immunofluorescent staining for immunoglobulin G on the GBM. There are few reports on the atypical course of the syndrome involving serum-negative anti-GBM antibodies. Therefore, we present a case of Goodpasture syndrome that presented with nephrotic-range proteinuria and was seronegative for anti-GBM antibodies. PATIENT CONCERNS A 38-year-old Chinese man presented with a lung lesion that was discovered by physical examination a month prior to presentation. The chief concern was occasional hemoptysis without fever, cough, chest pain, and edema. DIAGNOSES Laboratory testing revealed that the urinary protein level and urine erythrocyte count were 7.4 g/24 hours and 144/high-power field (HPF), respectively. Serological testing for anti-GBM antibodies was negative. Chest computed tomography revealed multiple exudative lesions in both lungs, indicating alveolar infiltration and hemorrhage. Electronic bronchoscopy and pathological examination of the alveolar lavage fluid indicated no abnormalities. However, kidney biopsy suggested cellular crescent formation and segmental necrosis of the globuli, with linear IgG and complement C3 deposition on the GBM. These findings were consistent with the diagnosis of anti-GBM antibody nephritis. INTERVENTIONS The patient underwent 7 sessions of double filtration plasmapheresis. He was also administered with intravenous methylprednisolone and cyclophosphamide. After renal function stabilization, he was discharged under an immunosuppressive regimen comprising of glucocorticoids and cyclophosphamides. OUTCOMES Three months later, follow-up examination revealed that the 24-hour urine protein had increased to 13 g. Furthermore, the urine erythrocyte count was 243/HPF. After a 6-month follow-up, the patient achieved partial remission, with a proteinuria level of 3.9 g/24 hours and a urine erythrocyte count of 187/HPF. LESSONS This extremely rare case of Goodpasture syndrome manifested with seronegativity for anti-GBM antibodies and nephrotic-range proteinuria. Our findings emphasize the importance of renal biopsy for the clinical diagnosis of atypical cases. Furthermore, because renal involvement achieved only partial remission despite therapy, early detection and active treatment of the Goodpasture syndrome is necessary to improve the prognosis of patients.
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Affiliation(s)
- ZhengXia Zhong
- Division of Nephrology, Department of Medicine, Affiliated Hospital of Zunyi Medical University, Guizhou
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - JiaXing Tan
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Yi Tang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - ZhengFu Li
- Department of Respiration, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
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de Vos RJ, van Middelkoop M, Bierma-Zeinstra SMA. [Effectiveness of treatment with platelet-rich plasma (PRP) injections in degenerative joint and tendon disorders]. Ned Tijdschr Geneeskd 2020; 164:D4950. [PMID: 32779915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Osteoarthritis and tendon disorders of the lower extremities are common problems for which it can be challenging to find effective treatments. Injection of platelet-rich plasma (PRP) is a treatment that locally affects inflammation and repair of tissues. In the last decade, many clinical studies have been conducted into treatment with PRP injections, with varying results. In this article, we put the results of these studies in the proper perspective. The quality of randomised studies and systematic literature reviews on the effectiveness of PRP injections clearly varies. It should be pointed out that studies that show positive effects often have methodological flaws or have compared treatments with PRP injections with glucocorticoid injections. These studies are giving a distorted impression of the effectiveness of PRP injections due to the less positive medium- and long-term effects of glucocorticoid injections in patients with tendon disorders. Based on the literature, we are discouraging treatments using PRP injections to treat patients with osteoarthritis and tendinopathies of the lower extremities.
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Affiliation(s)
- Robert-Jan de Vos
- Erasmus MC, Rotterdam, afd. Orthopedie en Sportgeneeskunde
- Contact: Robert-Jan de Vos
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38
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Xing Y, Wang S, Liu C, Wang H, Zhao M, Jin B, Kong X. Efficacy and safety of dual filtration plasmapheresis combined with biological agents in active refractory rheumatod arthritis: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e20966. [PMID: 32664100 PMCID: PMC7360202 DOI: 10.1097/md.0000000000020966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To investigate the effectiveness of dual filtration plasmapheresis (DFPP), a novel blood purification treatment, as a rapid and sustained disease-modifying therapy for active refractory rheumatoid arthritis (RA).A retrospective cohort study had been conducted. One hundred fifty three patients aged 18 years or older with active refractory RA were treated with DFPP combined with infliximab (IFX), IFX, or glucocorticoid (GC), all the above treatments were combined with methotrexate (MTX).Baseline characteristic of the 153 patients (DFPP: n = 53; IFX: n = 51; GC: n = 49) were similar across groups. The remission rate of CDAI (SDAI) in the DFPP treatment group was significantly higher than that of the IFX and GC group after 3 months of treatment. The remission rate of DFPP treatment group was above 50%, while in IFX and GC group, the rate of CDAI (SDAI) remission was 41.2% (37.3%) and 22.4% (14.2%) after 3 months of treatment.A combination of DFPP and biological agents can quickly induce remission or low disease activity of active refractory RA.
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Affiliation(s)
- Yida Xing
- Department of Rheumatology, the Second Affiliated Hospital of Dalian Medical University
| | - Shouquan Wang
- Department of Neurosurgery, Dalian Municipal Central Hospital of Dalian Medical University, Dalian, Liaoning
| | - Changyan Liu
- Department of Rheumatology, the Second Affiliated Hospital of Dalian Medical University
| | - Hongjiang Wang
- Department of Rheumatology, the Second Affiliated Hospital of Dalian Medical University
| | - Mingli Zhao
- Department of Rheumatology, the Second Affiliated Hospital of Dalian Medical University
| | - Bo Jin
- College of innovation and Entrepreneurship, Dalian University of Technology, China
| | - Xiaodan Kong
- Department of Rheumatology, the Second Affiliated Hospital of Dalian Medical University
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Dogan L, Kaya D, Sarikaya T, Zengin R, Dincer A, Akinci IO, Afsar N. Plasmapheresis treatment in COVID-19-related autoimmune meningoencephalitis: Case series. Brain Behav Immun 2020; 87:155-158. [PMID: 32389697 PMCID: PMC7204750 DOI: 10.1016/j.bbi.2020.05.022] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
Severe SARS-CoV-2 (COVID-19) infection has the potential for a high mortality rate. In this paper, we report the results of plasmapheresis treatment in a series of severely ill patients with COVID-19-related autoimmune meningoencephalitis in the Intensive Care Unit (ICU).
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Affiliation(s)
- Lerzan Dogan
- Department of Anesthesiology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Dilaver Kaya
- Neurology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Tugce Sarikaya
- Department of Anesthesiology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Rehile Zengin
- Infectious Diseases, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Alp Dincer
- Radiology, and Center for Neuroradiological Applications and Research, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Ibrahim Ozkan Akinci
- Department of Anesthesiology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey
| | - Nazire Afsar
- Neurology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey.
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40
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Kosoku A, Uchida J, Shimada H, Kabei K, Nishide S, Iwai T, Nakatani T. ABO-Incompatible Kidney Transplantation After Bone Marrow Transplantation: A Case Report. Transplant Proc 2020; 52:2754-2757. [PMID: 32586664 DOI: 10.1016/j.transproceed.2020.01.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/10/2020] [Indexed: 11/15/2022]
Abstract
Many studies have been made on ABO-compatible kidney transplants following hematopoietic stem cell transplantation. However, there have been few reports on ABO-incompatible kidney transplantation following hematopoietic stem cell transplantation (HSCT). We report on the case of a successful ABO-incompatible kidney transplantation with high titers after bone marrow transplantation experienced no infectious episodes. The patient was a 38-year-old man with end-stage kidney disease resulting from interstitial nephritis induced by drug toxicity or graft-vs-host disease (GVHD). He had received allogeneic bone marrow transplantation from a human leukocyte antigen-identical unrelated donor to treat chronic myelogenous leukemia. The patient with high anti-B antibody titers (IgM 1:1024 IgG 1:256) received a desensitization protocol consisting of 2 doses of rituximab and 5 courses of plasmapheresis. The patient had prolonged depletion of circulating B cells 2 years after the transplant and was infected with cytomegalovirus viremia, pneumocystis jiroveci pneumonia, and adenovirus urinary tract infection at 2, 3, and 17 months post-transplant, respectively. Currently, at 6 years after his transplant, the patient has had no rejection and is in good clinical condition with only mild renal insufficiency. Our results suggest that ABO-incompatible kidney transplantation may be an effective renal replacement therapy for patients with end-stage kidney disease after HSCT, but desensitization in combination with immunosuppressants could lead to a state of over-immunosuppression, causing various infections.
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Affiliation(s)
- Akihiro Kosoku
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Junji Uchida
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisao Shimada
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Kabei
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shunji Nishide
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoaki Iwai
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
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41
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Tard C, Cassim F, Maurage CA, Provot F, Coiteux V. Graft-versus-host disease-related neuropathy: AMAN phenotype with improvement after plasmapheresis. Acta Neurol Belg 2020; 120:719-722. [PMID: 31552556 DOI: 10.1007/s13760-019-01211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Céline Tard
- Univ Lille, CHU Lille, INSERM U1171, Lille, France.
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France.
- Department of Neurology, Salengro Hospital, University Lille Hospital, Emile Laine Street, 59037, Lille Cedex, France.
| | - François Cassim
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France
- Service de Neurophysiologie Clinique, CHU de Lille, Lille, France
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Abstract
The real issue with the COVID-19 pandemic is that a rapidly increasing number of patients with life-threatening complications are admitted in hospitals and are not well-administered. Although a limited number of patients use the intensive care unit (ICU), they consume medical resources, safety equipment, and enormous equipment with little possibility of rapid recovery and ICU discharge. This work reviews effective methods of using filtration devices in treatment to reduce the level of various inflammatory mediators and discharge patients from the ICU faster. Extracorporeal technologies have been reviewed as a medical approach to absorb cytokines. Although these devices do not kill or remove the virus, they are a promising solution for treating patients and their faster removal from the ICU, thus relieving the bottleneck.
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Affiliation(s)
- Khaled Al Shareef
- Department of Medical Equipment Technology, College of Applied Medical Science, Majmaah University, Majmaah, Saudi Arabia
| | - Mohsen Bakouri
- Department of Medical Equipment Technology, College of Applied Medical Science, Majmaah University, Majmaah, Saudi Arabia,
- Department of Physics, College of Arts, Sebha University, Traghen, Libya,
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43
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Marí Sáez A, Ronse M, Delamou A, Haba N, Bigey F, van Griensven J, Peeters Grietens K. The Plasma Mobile, 'A gift from heaven': The impact of health technology transfer on trial perceptions and expectations during the Ebola-Tx Trial, Conakry. PLoS Negl Trop Dis 2020; 14:e0008206. [PMID: 32320398 PMCID: PMC7176081 DOI: 10.1371/journal.pntd.0008206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/10/2020] [Indexed: 01/22/2023] Open
Abstract
During the West African Ebola Virus Disease (EVD) epidemic from 2014 to 2016, a variety of technologies travelled considering the context of the emergency: a highly contagious fast-killing disease outbreak with no known remedy and a rapidly increasing number of cases. The Ebola-Tx clinical trial tested the efficacy of Convalescent Plasma (CP) as a treatment for EVD in Guinea. This paper is based on ethnographic research in the Ebola-Tx trial and focuses on the introduction of a mobile plasma collection centre, referred to as the 'Plasma Mobile', equipped with plasmapheresis and pathogen inactivation technologies, as well as how the transfer itself of this technology entailed complex effects on CP donors as trial participants (i.e. providers of the therapeutic product), directly involved staff and more broadly on the trial implementation as a whole. The transfer led to the emergence of a dimension of hope as CP donors hoped that the plasma would cure and, as providers of the therapeutic, hoped it would decrease their stigmatization and the economic impact of the disease. We conclude that, in light of the intricate effects that the transfer of such health technology can entail-in the localization to the specific context, as well as in the consequences they can have on actors involved in the implementation of such technologies-global health technologies should be put at the services of next epidemic and pandemic (preparedness) on condition that they are accompanied by an understanding of the technologies' own cultural meanings and social understandings.
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Affiliation(s)
- Almudena Marí Sáez
- Robert Koch Institute, Center for International Health Protection, Berlin, Germany
- Institute of Tropical Medicine, Medical Anthropology Unit, Department of Public Health, Antwerp, Belgium
| | - Maya Ronse
- Institute of Tropical Medicine, Medical Anthropology Unit, Department of Public Health, Antwerp, Belgium
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinée
- Centre d’Excellence Africain pour la prévention et le contrôle des maladies transmissibles (CEA-PCMT), Faculty of health Sciences and Techniques, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - Nyankoye Haba
- Centre d’Excellence Africain pour la prévention et le contrôle des maladies transmissibles (CEA-PCMT), Faculty of health Sciences and Techniques, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
- Centre National de Transfusion sanguine, Conakry, Guinea
| | - Frédéric Bigey
- Établissement Français du Sang Grand-Est, Strasbourg, France
| | - Johan van Griensven
- Institute of Tropical Medicine, HIV and Neglected Tropical Diseases Unit, Department of Clinical Sciences, Antwerp, Belgium
| | - Koen Peeters Grietens
- Institute of Tropical Medicine, Medical Anthropology Unit, Department of Public Health, Antwerp, Belgium
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Wang L, Zheng C, Zhao D. Successful management of germanium poisoning-induced multiple organ dysfunctions by combined blood purification therapy. Curr Med Res Opin 2020; 36:687-691. [PMID: 31951756 DOI: 10.1080/03007995.2020.1717452] [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: 10/25/2022]
Abstract
Background: Blood purification therapy has not been applied in the detoxification of germanium compounds. This report described a case of germanium poisoning with renal failure, liver dysfunction, and acute pancreatitis which was successfully treated by continuous venovenous hemodiafiltration (CVVHDF) combined with plasmapheresis.Case report: A 58-year-old male was admitted to a local hospital due to polydipsia, polyuria, and weight loss for 2 months. The patient was definitely diagnosed with germanium poisoning and was treated with blood purification therapy, CVVHDF combined with plasmapheresis. The blood and urinary germanium concentrations decreased rapidly during the first week after the combined blood purification therapy. The blood germanium concentration gradually reduced to within the normal range within the next three weeks and fluctuated at a normal level. However, the urinary germanium concentration exceeded the normal level after three months, indicating an accumulation of germanium in the organs and tissues. The patient's clinical symptoms ameliorated and the functions of kidney, liver and pancreatitis gradually recovered.Conclusion: Combined CVVHDF with plasmapheresis is an effective treatment for germanium poisoning and the associated multiple organ dysfunctions.
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Affiliation(s)
- Luyun Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Changlong Zheng
- Department of Emergency, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Daqiang Zhao
- Department of Organ Transplantation, Renmin Hospital, Wuhan University, Wuhan, China
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, USA
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Abstract
A 41-year-old woman presented with paresthesia and inability to walk for 7 days. She had history of fatigue, polyarthralgia and difficulty in swallowing food for the last 1 year. She became edentulous over the last 5 years and wore dentures for the same. She appeared pale, emaciated and had oral thrush. She had areflexic quadriparesis with weakness more in lower limbs compared with upper limbs. With the initial diagnosis of Guillian-Barre syndrome, she was given five cycles of plasmapheresis following which there was a significant improvement in power. Sjogren's syndrome was suspected based on edentulous state in a middle-aged woman with multisystem involvement. Evaluation with Schirmer's test, parotid scintigraphy and labial minor salivary gland biopsy confirmed the diagnosis. She was treated with steroids following which a dramatic improvement in haemoglobin and total leucocyte count was noted. We report a varied presentation of primary Sjogren's syndrome.
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Affiliation(s)
- Naveen Kumar
- Medicine, Jawaharlal Institute of Post Graduate Medical Education, Pondicherry, Puducherry, India
| | - Deepanjali Surendran
- Medicine, Jawaharlal Institute of Post Graduate Medical Education, Pondicherry, Puducherry, India
| | | | - Chanaveerappa Bammigatti
- Medicine, Jawaharlal Institute of Post Graduate Medical Education, Pondicherry, Puducherry, India
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Lin ZS, Liu XL, Cui Z, Wang SX, Yu F, Zhou FD, Zhao MH. Acute tubulointerstitial nephritis with germinal centers in antineutrophil cytoplasmic antibody-associated vasculitis: A case report and literature review. Medicine (Baltimore) 2019; 98:e18178. [PMID: 31770269 PMCID: PMC6890356 DOI: 10.1097/md.0000000000018178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Occasionally, tubulointerstitial lesions can be found in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, significantly isolated tubulointerstitial nephritis (TIN) with germinal centers is rare. PATIENT CONCERNS A 17-year-old Chinese Han patient showed rapidly progressive glomerulonephritis, anuria, and serum creatinine of 19.4 mg/dL. DIAGNOSIS He had positive ANCA targeting myeloperoxidase (55.0 RU/mL). The renal biopsy showed crescent formation in 100% of glomeruli. Of special note, the glomerular crescents were surrounded by granulomatous inflammation, extensive tubular destruction or disappearance, and massive interstitial infiltration. A diagnosis of AAV was thus made with the involved organ restricted to the kidney. INTERVENTIONS The patient underwent 7 rounds of plasmapheresis, 3 pulses of methylprednisolone therapy (500 mg per pulse), and oral prednisolone (50 mg/d). Rituximab (500 mg) was used after the plasma exchange treatment. OUTCOMES ANCA was negative, while anti-modified C-reactive protein (anti-mCRP) antibodies remained positive. The patient was dependent on hemodialysis. We found anti-mCRP antibody in the serum of the patient, with the major epitope on amino acids 35 to 47 of mCRP. LESSONS We proposed that the anti-mCRP antibody might play an important role in this case of acute TIN in AAV.
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Affiliation(s)
- Zi-Shan Lin
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Renal Pathology Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Xiao-Ling Liu
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Renal Pathology Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Zhao Cui
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Renal Pathology Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Su-Xia Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Renal Pathology Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
- Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital
| | - Feng Yu
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Renal Pathology Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
- Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital
- Department of Nephrology, Peking University International Hospital
| | - Fu-De Zhou
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Renal Pathology Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Renal Pathology Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
- Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital
- Peking-Tsinghua Center for Life Sciences, Beijing 100034, P.R. China
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Sendogan DO, Saritas H, Kumru G, Erdogmus S, Tuzuner A, Keven K, Sengul S. Therapeutic Effect of Plasmapheresis and Intravenous Immunoglobulin in Recipients of Kidney Transplant With High Panel-reactive Antibody Levels: A Single-center Experience. Transplant Proc 2019; 51:2254-2256. [PMID: 31474291 DOI: 10.1016/j.transproceed.2019.04.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/01/2019] [Accepted: 04/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE High panel-reactive antibody (PRA) levels limit patients' access to kidney transplantation from potential living donor candidates and decrease renal graft survival by causing acute antibody-mediated rejection (AAMR). In this article, we report our experiences about the efficiency of plasmapheresis (PP) and intravenous immunoglobulin (IVIG) in reduction of serum PRA levels in candidates for renal transplantation and in patients with AAMR. METHODS We examined retrospectively 47 patients with high PRA levels (18 for desensitization (DS) and 29 with AAMR) at Ankara University. The reduction in PRA class 1 and PRA class 2 levels before and after the PP, IVIG, and rituximab or eculizumab therapy were evaluated. RESULTS In the DS group, mean reduction in PRA class I ± SD was 28.0 ± 9.10 to 22.1 ± 8.14 (P <.05), and mean reduction in PRA class II ± SD was 40.3 ± 6.89 to 32.2 ± 5.68 (P < .05). In the AAMR group; mean reduction in PRA class I ± SD was 23.9 ± 9.56 to 17.8 ± 8.64 (P > .05), and mean reduction in PRA class II ± SD was 28.1 ± 8.37 to 26.7 ± 7.96 (P > .05). In total, mean reduction in PRA class I was 25.7 ± 6.66 to 19.7 ± 6.00 (P < .01). Mean reduction in PRA class II was 33.8 ± 5.93 to 29.2 ± 4.96 (P > .05). In the DS group, 3 (16.7%) patients were treated with rituximab. In the AAMR group, 9 (31.0%) patients were treated with rituximab, and 1 (5.5%) patient received eculizimab.In the DS group, the mean follow-up period in years ± SD was 5.06 ± 3.01 and no patient had graft loss. In the AAMR group, the mean follow-up period in years was 5.06 ± 2.74 and 6 (33.3%) patients had graft loss with acute rejection. CONCLUSIONS PP and IVIG treatment provide significant reduction in PRA levels and can be used in DS protocols.
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Affiliation(s)
- Damla Ors Sendogan
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey.
| | - Hazen Saritas
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Gizem Kumru
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Siyar Erdogmus
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Acar Tuzuner
- Department of General Surgery, Ankara University Medical School, Ankara, Turkey
| | - Kenan Keven
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Sule Sengul
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
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Jang SK, Sitek A, Said S, Shields RC. Catastrophic Antiphospholipid Syndrome as a Cause of Severe Gastrointestinal Bleeding. Am J Med 2019; 132:e661-e662. [PMID: 30904512 DOI: 10.1016/j.amjmed.2019.02.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Sae K Jang
- Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
| | - Andrea Sitek
- Department of Internal Medicine, Mayo Clinic, Rochester, Minn
| | - Samar Said
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
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Shabtaie SA, Codipilly DC, Sweetser S. 32-Year-Old Man With New Onset Abdominal Pain. Mayo Clin Proc 2019; 94:1589-1593. [PMID: 31378233 DOI: 10.1016/j.mayocp.2018.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Samuel A Shabtaie
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Don Chamil Codipilly
- Resident in Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Seth Sweetser
- Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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Song X, Shi D, Cui Q, Yu S, Yang J, Song P, Walline J, Xu J, Zhu H, Yu X. Intensive insulin therapy versus plasmapheresis in the management of hypertriglyceridemia-induced acute pancreatitis (Bi-TPAI trial): study protocol for a randomized controlled trial. Trials 2019; 20:365. [PMID: 31215460 PMCID: PMC6582523 DOI: 10.1186/s13063-019-3498-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 06/05/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is widely agreed that triglyceride (TG)-lowering therapy is imperative in early hypertriglyceridemia-induced acute pancreatitis (HTG-AP). Intravenous insulin with or without heparin, and plasmapheresis are available regimens. However, there is no consensus on first-line therapy. METHODS/DESIGN The Bi-TPAI trial is a multicenter, parallel group, randomized, controlled, non-inferiority trial in patients with early HTG-AP. The Bi-TPAI trial will include 220 patients with HTG-AP from 17 large tertiary hospitals in China. Patients assigned to the intensive insulin group will be administered an intravenous continuous infusion of regular human insulin at a rate of 0.1 units/kg·h and up to 0.3 units/kg·h. Patients allocated to the plasmapheresis group will receive standard-volume plasmapheresis. The primary endpoint is the time it takes for the TG level to reduce to 500 mg/dl. The secondary endpoints are ICU and hospital lengths of stay, 28-day mortality, severity of HTG-AP, incidence of hypoglycemia, HTG-AP complications, and cost-effectiveness. DISCUSSION The Bi-TPAI trial will prove that intensive insulin therapy is non-inferior to plasmapheresis. Intensive insulin therapy should be an effective, safe, available, and cheaper triglyceride-lowering therapy for hypertriglyceridemia-induced acute pancreatitis. TRIAL REGISTRATION ClinicalTrials.gov, NCT03342807 . Registered on 5 Nov 2017.
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Affiliation(s)
- Xiao Song
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Di Shi
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qinghong Cui
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shanshan Yu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Yang
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Priscilla Song
- Center for the Humanities and Medicine, The University of Hong Kong, B926, 9F, Run Run Shaw Tower, Centennial Campus, Pokfulam Road, Hong Kong, China
| | - Joseph Walline
- Accident and Emergency Medicine Academic Unit, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT Hong Kong SAR
| | - Jun Xu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huadong Zhu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuezhong Yu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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