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Disorders in tHemostasis System and Changes in the Rheological Properties of the Blood in Ischemic Heart Disease and Diabetes Mellitus Patients
Published in E.I. Sokolov, Obesity and Diabetes Mellitus, 2020
The mechanism of plasmapheresis in DM is based on the removal from an organism of high-molecular compounds (cholesterol, LDLP, fibrin, immune complexes) and their replacement with vasoactive solutions. Plasmapheresis was performed on a domestic blood fractionator. A heparin solution in a concentration of 10,000 units per 400 ml of physiological solution was used as the anticoagulant. The ratio of the anticoagulant and blood content in the course of extracorporal therapy was 1:5. To conduct the procedure, disposable sterile silicone tube lines were used. The subclavian veins and less often peripheral ones were used to take blood from a patient and introduce erythrocytes and plasma-substituting solutions. After mixing with an anticoagulant, the blood was fed by a pump at a speed of 20–25 ml/min into a rotor, where under the effect of gravitational and centrifugal forces (centrifuging at 1100–1200 rpm) it was separated into two fractions — plasma and erythrocyte matter. After separating the blood, we mixed the erythrocytes with rheopolyglucin and returned the mixture to the patient, while the plasma was collected in a separate reservoir. The course of plasmapheresis consisted of four sessions with an interval of two or three days. During one session, 789.0 ml of plasma was removed. The plasma was replaced with rheopolyglucin in a proportion of 1:1.2.
Novel Treatments of Autoimmune Conditions
Published in Irun R. Cohen, Perspectives on Autoimmunity, 2020
Y. Shoenfeld, Y. Tomer, O. Ben-Yehuda
The first major application of PE in autoimmune diseases was in GS. Most studies show that plasmapheresis is effective in this disorder.4 For example, in a recently published series of 41 patients with GS treated by PE and immunosuppression, pulmonary hemorrhage was controlled in 29 of 33 patients and renal function improved in 16 of 22 patients.7 However, it has not been established that PE improves survival in this condition.7 In cold agglutinin disease, an autoantibody-mediated hemolytic disorder, PE proved effective in preventing life-threatening complications (e.g., massive hemolysis) when conservative measures were ineffective.4,7 Plasmapheresis has been used in idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia with mixed results,7,8 and its usefulness in these disorders is yet to be proven by larger, controlled trials.
Pathogenic role of antigen-antibody complexes
Published in Gabriel Virella, Medical Immunology, 2019
Gabriel Virella, George C. Tsokos
The most common types of therapy in IC disease are based on four main approaches: Eradication of the source of persistent antigen production (e.g., infections).Turning off the inflammatory reaction (using corticosteroids and nonsteroidal agents).Suppression of antibody production using immunosuppressive drugs such as cyclophosphamide, azathioprine, cyclosporine, or CD20 antibodies (e.g., rituximab). This is the mainstay of IC disease treatment, particularly when autoimmune reactions are present.Removal of soluble IC from the circulation by plasmapheresis, a procedure that consists of the removal of blood (up to 5 L each time), separation and reinfusion of red cells, and replacement of the patient's plasma by normal plasma or plasma-replacing solutions. Plasmapheresis appears most beneficial when associated with the administration of immunosuppressive drugs; by itself, it can even induce severe clinical deterioration perhaps related to changes in the immunoregulatory circuits.
Efficacy and safety of plasmapheresis without plasma transfusion tandem with chemotherapy to treat multiple myeloma
Published in Hematology, 2022
Yigang Guo, Lulu Zhang, Rongyao Zhang, Meiling Zhou, Xu Chen, Chucheng Wan, Ping Hu, Yuanyuan He, Hua Jiang, Wei Geng, Weixing Zhang, Fariha Kanwal, Muhammad Fayyaz ur Rehman, Zhangzhi Li
Traditional plasma exchange has many adverse reactions in rescuing critically ill patients, limiting the wide application of plasma exchange. Kaszuba-Zwoińska [14] showed that the incidence and intensity of the anaphylactic reaction of allogeneic plasma would enlarge with the increase of the number and amount of plasma received and even lead to severe anaphylactic shock. In our study, for 40 patients with MM, 120 plasma exchange treatments were given without plasma transfusion and no allergic reactions. The reason is that crystal and albumin were used as the exchange fluid in plasmapheresis without plasma, which can save plasma resources and significantly reduce allergic reactions. As the patients with establish and diagnosed MM evaluated for heart and lung and liver functions, we started implementation of plasmapheresis, each exchange interval was around 24–48 h. After finishing three times plasmapheresis, the patients were started chemotherapy. Median time to start plasmapheresis from diagnosis need s2.5 ± 1.3 days. Median time to start chemotherapy need 5.6 ± 2.7 days.
Plasmapheresis in hypertriglyceridemia-induced acute pancreatitis
Published in Baylor University Medical Center Proceedings, 2022
Hafeez Shaka, Zain El-amir, Abdul Jamil, Robert Kwei-Nsoro, Farah Wani, Dushyant Singh Dahiya, Asim Kichloo, Ambika Amblee
The mean age of hospitalizations for patients with HTGAP who had plasmapheresis was significantly lower than the overall mean age for patients with HTGAP. A 3-year retrospective study based in a tertiary care center in India found that the mean age of patients undergoing plasmapheresis was 37.5, with a range of 15 to 79 years.12 This was similar to the findings from our study. Older patients are reported to have higher risks of complications following plasmapheresis, with some reports showing a risk of complications of 11.5% in patients >65 years old vs 3.9% in younger patients.13 Plasmapheresis is rarely used in older adults and may come with the risk of numerous adverse effects including clotting, blood access difficulty, and allergic reactions (13). Our findings reflect this lower use of plasmapheresis in older adults.
Different aspects of convalescent plasma therapy for COVID-19 treatment; a critical review
Published in Immunopharmacology and Immunotoxicology, 2021
Sitaram Khadka, Shameem Nisar, Nawazish-i-Husain Syed, Dhan Bahadur Shrestha, Pravash Budhathoki
CP therapy is a classical adaptive immunotherapy, where antibodies from plasma of patient recovered from a viral disease with a high neutralizing antibody titer are transfused to the patient infected with the same virus. Plasmapheresis is used for extensive collection of plasma. Antibodies specific in nature bind to the virus and neutralize its virulent activity. The use of virus- neutralizing antibodies increase the clearance of the viral load and prevent its penetration into human cells, which are not invaded so far [23]. Antibody from CP may suppress viremia, which peaks within 7 days of infection, and patients normally initiate a primary immune response by 10–14 days, which is followed by virus clearance, thus, theoretically necessitating CP therapy in the early period of COVID-19 [11]. Other antibody-mediated pathways like complement activation, antibody-dependent cytotoxicity may also have therapeutic benefaction [24]. The neutralizing antibodies prevent virus from attacking the human body while the non-neutralizing antibodies mediates entry of virus into macrophages [25]. A critical question that is alarming is whether CP contained non – neutralizing antibodies that enhance viral entry.