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Therapeutic apheresis
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
In 1914, Abel, Rowntree and Turner1 coined the term plasmaphaeresis (from the Greek word aphairesis – a withdrawal). Their early experiments were for the relief of symptoms following bilateral nephrectomy in dogs. Although these experiments were associated with deaths (due to apparent overbleeding and hemorrhage), the improvement in the clinical condition of the animals successfully treated was ‘marked’. The term apheresis has since been generalized to refer to the separation of blood into its components, removing one component, and returning the remainder. Thus, leukapheresis means the removal of leukocytes and erythrocytapheresis means the removal of erythrocytes. Alternative terminologies such as plasma exchange and red cell exchange are frequently used interchangeably for plasmapheresis and erythrocytapheresis, respectively. Some authors have suggested that the term ‘plasma exchange’ or therapeutic plasma exchange be reserved for low-volume procedures involving no more then 500–600 ml of plasma and plasmapheresis for large-volume procedures; however, these terms are frequently used interchangeably. Hemapheresis is also used as a broad term encompassing all apheresis procedures.
Therapeutic Apheresis in Children
Published in James L. MacPherson, Duke O. Kasprisin, Therapeutic Hemapheresis, 2019
As the technological difficulties of apheresis in children are solved and apheresis can be conducted in small infants, treatment of a myriad of diseases in children may be tried with this new therapy. Diseases which currently have a dreadful prognosis such as certain metabolic, autoimmune, and neoplastic diseases and where no adequate form of therapy exists may benefit from a trial of apheresis. The immunosuppressive effects of PE and lymphocytapheresis, the removal of toxins by PE, and the addition of missing factors with plasma and leukocyte infusions offer several new approaches that can be tried in previously untreatable childhood diseases.
Collection of stem cells in (autologous) donors by apheresis
Published in Cut Adeya Adella, Stem Cell Oncology, 2018
White blood cells (WBCs) can be collected with apheresis techniques. This is named leuka- pheresis or leukocytapheresis. Apheresis is a method of obtaining one or more blood components by machine processing of whole blood in which the residual components are returned to the donor or patient during or at the end of the process. The majority of the leukapheresis procedures are performed to collect cells for cellular therapies, of which the collections of autologous or allogeneic hematopoietic stem/progenitor cells (HPCs) are most frequent performed. HPCs are found in the bone marrow and are identified by the presence of the CD34 antigen on their surface, and therefore these cells are often named CD34 positive cells. HPCs are multipotent stem cells that can develop into all the blood cell types constituting from the myeloid (monocytes and macrophages, neutrophils, basophils, eosinophils, erythrocytes, megakaryocytes/platelets, dendritic cells), and lymphoid lineages (T-cells, B-cells, NK-cells).
Prevalence and Risk Factors for Pulmonary Embolism in Pediatric Sickle Cell Disease: A National Administrative Database Study
Published in Pediatric Hematology and Oncology, 2023
Natasha Bala, Joseph Stanek, Vilmarie Rodriguez, Anthony Villella
Apheresis was identified as an independent risk factor associated with PE in this study. While the presence of a catheter itself is a risk factor for thrombosis, it is unclear if children receiving apheresis in this cohort had a catheter placed on a short-term or long-term basis. Another plausible explanation is severity of the disease as most patients with SCD who undergo apheresis have underlying severe SCD associated complications such as stroke, ACS, priapism, sickle cell hepatopathy or recurrent painful crises.24,25 The association between apheresis and development of PE could indicate that patients with more severe SCD may be at higher risk of PE. Moreover, apheresis has shown to reduce levels of natural anticoagulant proteins such as protein S, protein C and anti-thrombin thus contributing to a more procoagulant state.26
Conjoined Consent: Informed Consent When Donor and Recipient Are Both Research Participants
Published in The American Journal of Bioethics, 2021
Liza-Marie Johnson, Devan M. Duenas, Benjamin S. Wilfond
An investigator would like to conduct a study to determine if a single infusion of stem cells from an HLA-matched kidney donor into the recipient can induce tolerance and ultimately preserve transplant function and prevent transplant rejection. The study will harvest stem cells from the donor to create an investigational cellular immunotherapy. Several weeks prior to kidney donation, the donor will undergo twice-daily injections of granulocyte-colony stimulating factor (G-CSF) for 5 or 6 days in order to stimulate the bone marrow to release large numbers of stem cells into the blood stream. Then, peripheral blood stem cells will be collected over 1 or 2 days of apheresis by the placement of a central venous catheter if adequate peripheral venous access is not available. If an insufficient number of stem cells is released or an insufficient amount of investigational product is created, a donor may need to undergo a second apheresis procedure over another 1–2 days. The kidney recipient will then receive infusions of the investigational cellular immunotherapy 10 days after the kidney transplant.
Lipoprotein(a) in atherosclerosis: from pathophysiology to clinical relevance and treatment options
Published in Annals of Medicine, 2020
Andreja Rehberger Likozar, Mark Zavrtanik, Miran Šebeštjen
A more physical approach to treating hyperlipoproteinemia(a) is lipoprotein apheresis. This is a nonsurgical therapy that removes LDL cholesterol from the blood, and it is primarily indicated for patients with FH with extremely high LDL cholesterol levels that persist despite optimal hypolipemic therapy. The basis of lipoprotein apheresis is thus the elimination of lipoprotein particles, which include Lp(a) [104]. Although this is an invasive procedure, lipoprotein apheresis is generally safe, with most complications related to the puncture site [105]. Moreover, a recent observational multicenter study suggested that lipoprotein apheresis can provide prognostic benefits [74]. An analysis of a large German registry from 2012 to 2016 reported an average of 68% decrease in Lp(a) and 78% reduction in coronary events after 1 year of adjuvant treatment with lipoprotein apheresis [105]. It should be noted, however, that this evidence for prognostic benefit is based on nonrandomized registry data. Stronger evidence would be provided by a controlled multicenter intervention trial to explore the CV benefits of regular treatment with lipoprotein apheresis, compared to patients who receive only conventional lipid-lowering therapies.