Plasmapheresis Effect on Hematological and Biochemical Parameters in Athletic Horses Subjected to Exercise

To evaluate the effect of plasmapheresis on clinical, hematological, and biochemical parameters after exercise, a plasmapheresis session was realized on six jumping horses (plasmapheresis group) that underwent three consecutive days of physical graded exercise. The control group (n = 6) went through the same exercise but not subjected to the plasmapheresis session. Seventeen milliliters of plasma/kg of body weight was harvested from each horse. The procedure was well tolerated by the horses. The plasmapheresis leads to a significant increase of the hemoglobin, hematocrit, red blood cell, white blood cell, and lymphocytes counts. Plasmapheresis induced a very significant decrease (P < .001) of albumin and globulin levels and of total protein, which were reestablished 24 hours later. Plasmapheresis also generated a very significant increase (P < .001) in sodium levels and a significant decline of potassium (P < .05) and calcium (P < .01) levels. Several other biochemical variables remained unchanged. Results also showed that, after a significant rise of lactate, aspartate aminotransferase, and creatine kinase levels which are subsequent to the exercise, the plasmapheresis session induced a very significant continuous decrease (P < .001) of these parameters. The present work has demonstrated that the plasmapheresis is able to modify the physiology after exercise and to affect both the hematology and the biochemistry of the blood hematobiochemical parameters in horses subjected to physical exercise.

Effects of storage over a 36-month period on coagulation factors in a canine plasma product obtained by use of plasmapheresis

OBJECTIVE

To evaluate stability of coagulation factors in canine plasma obtained by use of plasmapheresis and stored over a 36-month period.

SAMPLE

Canine plasma obtained by use of plasmapheresis acquired from a commercial blood bank.

PROCEDURES

Coagulation testing for fibrinogen concentration and activity of factors II, V, VII, VIII, and IX and von Willebrand factor was performed on canine plasma obtained by use of plasmapheresis. Samples were obtained for testing at 6-month intervals from plasma stored for up to 36 months.

RESULTS

A simple mixed linear regression model was created for each analysis. Median value for the fibrinogen concentration was > 150 mg/dL for all time points, except at 467, 650, and 1,015 days of storage. Median value for factor VIII was > 70% only at 650 days. Median value for factor V was > 50% through 650 days. Median value for factors VII and X was > 50% through 833 days, and median value for factors II and VII was > 50% through 1,015 days. Median value for von Willebrand factor was > 50% for the entire study (1,198 days). Median value for factor X was always < 50%.

CONCLUSIONS AND CLINICAL RELEVANCE

Coagulation factors degraded over time at variable rates, and all labile factors remained at > 50% activity for longer than 1 year. Plasma collected by plasmapheresis potentially offers prolonged life span of some clotting factors. Plasmapheresis is an acceptable form of canine plasma collection for transfusion purposes, and further studies should be performed to determine all of its benefits.

Characteristics of canine platelet-rich plasma prepared with five commercially available systems

OBJECTIVE

To characterize platelet-rich plasma (PRP) products obtained from canine blood by use of a variety of commercially available devices.

SAMPLE

Blood samples from 15 dogs between 18 months and 9 years of age with no concurrent disease, except for osteoarthritis in some dogs.

PROCEDURES

PRP products were produced from blood obtained from each of the 15 dogs by use of each of 5 commercially available PRP-concentrating systems. Complete blood counts were performed on each whole blood sample and PRP product. The degree of platelet, leukocyte, and erythrocyte concentration or reduction for PRP, compared with results for the whole blood sample, was quantified for each dog and summarized for each concentrating system.

RESULTS

The various PRP-concentrating systems differed substantially in the amount of blood processed, method of PRP preparation, amount of PRP produced, and platelet, leukocyte, and erythrocyte concentrations or reductions for PRP relative to results for whole blood.

CONCLUSIONS AND CLINICAL RELEVANCE

The characteristics of PRP products differed considerably. Investigators evaluating the efficacy of PRPs need to specify the characteristics of the product they are assessing. Clinicians should be aware of the data (or lack of data) supporting use of a particular PRP for a specific medical condition.

The effects of automated plasmapheresis on clinical, haematological, biochemical and coagulation variables in horses

The goal of this study was to determine the effects of plasmapheresis on the behaviour, general condition, haematological, biochemical and coagulation variables of donor horses for 32 days following the procedure. Twenty millilitres of plasma/kg body weight were collected via plasmapheresis in six clinically healthy horses. The general behaviour and condition of the horses was not affected by the procedure. During plasmapheresis, there was a mild increase in the haematocrit, haemoglobin concentration and total erythrocyte and leucocyte counts (P < 0.01). The mean concentrations of total protein and albumin decreased significantly (P < 0.01) and total protein did not normalise for about three weeks. Several other biochemical variables also decreased significantly during plasmapheresis, but mostly remained within reference ranges. After plasmapheresis, the mean value of the activated partial thromboplastin time and the thrombin time were mildly but significantly increased (P < 0.01), and the mean activities of factor V, factor VIII and antithrombin decreased significantly (P < 0.01), although all coagulation values remained within reference ranges. Our results indicate that, in horses, the collection of 20 mL of plasma/kg body weight via plasmapheresis results in mild changes in several haematological, biochemical and coagulation variables, although these were of no clinical relevance for the donors.

Automated plasmapheresis compared with other plasma collection methods in the horse

The purpose of this study was to evaluate plasmapheresis as a method for plasma extraction in comparison with centrifugation or gravity sedimentation. The study was designed as a cross over trial with six Freiberger horses undergoing plasma donation by plasmapheresis followed by whole-blood donation and subsequent plasma production 4 weeks later. Automated plasmapheresis and whole-blood donation were well tolerated in all horses. The plasmapheresis method achieved an almost complete removal of erythrocytes and leucocytes from plasma at all flow rates. After blood bag centrifugation, significantly more erythrocytes (P < 0.01) and leucocytes (P < 0.01) were present in the prepared plasma compared with plasmapheresis plasma. Plasma prepared by gravity sedimentation contained significantly more erythrocytes and leucocytes than plasma prepared with the other techniques (P < 0.01), and platelet aggregation was observed. The coagulation proteins and the total protein content of plasma prepared after plasmapheresis and blood bag centrifugation did not differ significantly from values measured prior to collection (P > 0.05). However, the activity of factor VIII was significantly lower 24 h after gravity sedimentation of blood than activity prior to blood collection (P < 0.01). In conclusion, automated plasmapheresis is the method of choice for the production of high quality equine plasma.

Therapeutic plasmapheresis

Plasmapheresis is the process by which plasma containing components causing or thought to cause disease is removed from the circulation, and the remaining blood components are returned with plasma or a harmless plasma substitute to the donor. It primarily removes protein-bound solutes or high-molecular-weight solutes such as circulating protein-bound toxins, autoantibodies, immune complexes, or other abnormally occurring molecules. Plasmapheresis has been used in the treatment of more than 100 diseases in human medicine, including immune-mediated diseases, neoplasia, infectious diseases, sepsis, hyperlipidemia, thyrotoxicosis, and removal of toxins. In immune-mediated disease, it is most useful to rapidly decrease plasma concentrations of antibodies or immune complexes, whereas other immunosuppressive measures are used to prolong the effect.

Temporal effects of plasmapheresis on serum proteins in horses

The temporal response of blood and serum proteins to chronic plasmapheresis was determined in 8 horses used in a commercial antibody enterprise. Plasmapheresis of between 4 and 11 L induced significant decreases in total protein, albumin, and IgG values. With the exception of a high hematocrit value for the first postplasmapheresis blood sample, there were no changes in erythrocyte or leukocyte measurements, and no changes in the proportions of serum protein in an electrophoretic profile. Regression equations generated for recovery of proteins after plasmapheresis indicated a return to preplasmapheresis values of total protein and albumin at approximately 1 month. Complications of repeated plasmapheresis were not detected when plasma extractions were done between 7 and 19 times at 30-day intervals.

Serum hyperviscosity syndrome associated with multiple myeloma in two cats

Serum hyperviscosity syndrome was diagnosed in 2 cats with multiple myeloma. Clinical signs included pale mucous membranes, dehydration, retinal hemorrhages, dilated and tortuous retinal vessels, seizures, head-tilt, nystagmus, systolic murmur, and gallop rhythm. Laboratory abnormalities included hyperglobulinemia, azotemia, hyperphosphatemia, nonregenerative anemia, and thrombocytopenia. Both cats had IgG monoclonal gammopathy, Bence Jones proteinuria, increased numbers of bone marrow plasma cells, and high values for relative serum viscosity. Renal disease was suspected in both cats. Cardiac hypertrophy was documented in 1 cat and was suspected in the other cat. Chemotherapy, using melphalan, prednisone, and vincristine, caused short-term remission in both cats, and plasmapheresis was used to lower serum protein concentration in 1 cat. Serum hyperviscosity syndrome rarely develops in cats, but should be suspected when monoclonal gammopathy exists with signs of neurologic, cardiac, or retinal disease.

Clinical remission following plasmapheresis and corticosteroid treatment in a dog with acquired myasthenia gravis

A 7-year-old sexually intact male Labrador Retriever with regurgitation and generalized muscular weakness resulting from acquired myasthenia gravis received 2 plasmapheresis treatments in combination with corticosteroid treatment. Plasmapheresis was performed in an attempt to rapidly lower serum acetylcholine receptor binding antibody (AChR Ab) concentration. Seven days after the second plasmapheresis treatment, the dog's muscular strength was normal, which coincided with a 70% decrease in serum AChR Ab concentration. Because the dog also received corticosteroids, it is impossible to determine how much of the clinical improvement resulted from plasmapheresis.

Total and antigen-specific serum immunoglobulin isotype concentrations in hyperimmunized cattle that have undergone plasmapheresis

The effects of prolonged plasmapheresis of cattle on total and antigen-specific immunoglobulin production were evaluated. Five adult cows were hyperimmunized by repeated IV administration of live, logarithmic-phase Pasteurella haemolytica A1 organisms. Three of the cows underwent plasmapheresis daily for 3 weeks. From 2 cows, serum was only obtained periodically. Anti-P haemolytica antibody was assayed by indirect hemagglutination and a kinetic-augmented, antigen-capture ELISA for capsular polysaccharide and lipopolysaccharide/outer membrane protein antigens. Total serum immunoglobulin concentration was determined for IgM, IgG1, and IgG2 by primary radial immunodiffusion. Anti-P haemolytica A1 activity increased rapidly after immunization. After beginning plasmapheresis, the antigen-specific antibody activities remained nearly constant. In general, antilipopolysaccharide/outer membrane protein activity (in terms of concentration) was higher than anti-capsular polysaccharide activity and was not affected as much by the plasmapheresis. Total serum Ig concentration decreased transiently by a small amount after beginning plasmapheresis.

Use of plasmapheresis and chemotherapy for treatment of monoclonal gammopathy associated with Ehrlichia canis infection in a dog

Monoclonal gammopathy associated with Ehrlichia canis infection was diagnosed in a German Shepherd Dog. The dog was treated by use of chemotherapy and tetracycline and by plasmapheresis. The dog tolerated plasmapheresis and long-term drug therapy well, and clinical signs resolved over a 90-day period. The monoclonal gammopathy resolved after treatment, but specific antibody to E canis indicated suppression followed by a rebound to the initial high titer.

Current experimental therapy

For successful experimental therapy of canine hematopoietic tumors, one must have a randomized homogeneous population of patients in reasonably good condition. Drug combinations should contain several agents, each with antitumor effect, acceptable toxicity, and of reasonable cost. Other modalities include biological response modifiers, radiation, differentiation-inducing agents, and marrow transplantation. Ways must be found to prevent drug resistance of tumor cells.

Plasmapheresis as adjuvant therapy for autoimmune hemolytic anemia in two dogs

Severe, acute, autoimmune hemolytic anemia in 2 dogs was treated, using prednisone, cyclophosphamide, plasmapheresis, and blood transfusion. In 1 case, splenectomy was performed successfully after plasmapheresis and blood transfusion. Antibody removal by means of plasmapheresis effected short-term stabilization to severe hemolysis in both dogs, but was suspected to have contributed to the death of 1 dog.

Plasmapheresis-immunoadsorption for treatment of systemic lupus erythematosus in a dog

Systemic lupus erythematosus was diagnosed in a 3-year-old, male German Shepherd Dog. Clinical signs included lethargy, partial anorexia, fever, joint swelling, and skin and oral ulceration. The diagnosis was confirmed on the basis of an antinuclear antibody titer of 1:640 and immunofluorescence for immunoglobulin G at the dermal-epidermal junction in skin biopsy specimens. Treatment with prednisone and cyclophosphamide failed to induce remission. Intensive plasmapheresis-immunoadsorption, using purified Staphylococcus protein A in combination with low-dose prednisone therapy, resulted in sustained remission.