China
Africa
Explore chapters and articles related to this topic
Optic Neuropathies Associated With Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorders (NMO-SD)
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
In patients of NMO-SD-ON/anti-MOG syndrome also intravenous methyl prednisolone is the first choice. In patients who do not or partially respond to the steroid treatment, therapeutic plasma exchange (PLEX) should be planned. A retrospective analysis also suggests use of combine steroid+PLEX for patients of NMO-SD to improve disability outcomes (39). Limited data on any role of IVIG in acute stages of isolated ON are available.
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 Hemapheresis in American Red Cross Blood Services
Published in James L. MacPherson, Duke O. Kasprisin, Therapeutic Hemapheresis, 2019
S. G. Sandler, Glenda E. Sweeney, Margaret N. Owen
Of 70 patients with renal diseases treated by plasma exchange, those with primary diagnoses of Goodpasture’s syndrome had the highest percentage of objective improvement (52%) (Table 6). Therapeutic plasma exchange for rheumatoid arthritis was of short-term benefit for 18% of 11 patients; 82% were categorized as not improved or not evaluable (Table 7).
Severe acute kidney injury following Sri Lankan Hypnale spp. envenoming is associated with thrombotic microangiopathy
Published in Clinical Toxicology, 2021
Eranga S. Wijewickrama, Lalindra V. Gooneratne, Ariaranee Gnanathasan, Indika Gawarammana, Mangala Gunatilake, Geoffrey K. Isbister
TMA has been previously reported following Hypnale spp. envenomation in association with AKI. Most of these are limited to single case reports or case series. Withana et al. reported a female who developed AKI following a bite from Hypnale spp. in association with thrombocytopaenia and MAHA, which required haemodialysis [11]. de Silva et al. reported another female who developed severe AKI and acute myocardial infarction in association with TMA following a bite from Hypnale spp. [7]. Rahnayake et al. reported four cases of TMA in association with AKI following bites from Hypnale spp. with three of them requiring haemodialysis [26]. All these patients except for one received therapeutic plasma exchange as part of the treatment. In a recent study involving 465 patients with bites from Hypnale spp. (which involved both probable and proven cases), 44 (9.5%) had AKI. Of the 23 patients who developed AKI following proven bites from Hypnale spp., twelve (52%) had thrombocytopaenia and MAHA confirming TMA [6]. In comparison 3/10 (30%) patients with AKI had TMA in our study. We previously published a series of Hypnale spp. and D. russelii cases, in which TMA was seen in 76% of patients who developed severe AKI [13].
Discontinued disease-modifying therapies for Alzheimer’s disease: status and future perspectives
Published in Expert Opinion on Investigational Drugs, 2020
Bruno P. Imbimbo, Madia Lozupone, Mark Watling, Francesco Panza
Both young plasma infusion and therapeutic plasma exchange have been tested in patients with AD with the aim of providing protective and neurotrophic factors and/or removing senescent or toxic elements [105]. Therapeutic plasma exchange involves removing blood plasma and exchanging it with donated blood products. In animal in vivo studies, administration of plasma from young wild-type mice to AD transgenic mice improved cognitive deficits without affecting brain amyloid plaques [106]. A small, double-blind, placebo-controlled study demonstrated that repeated infusions of young plasma from healthy donors are feasible and well tolerated in patients with AD [107]. A 14-month double-blind, placebo-controlled study in 322 patients with AD of therapeutic plasma exchange enriched with albumin with or without immunoglobulins showed slowing of cognitive, functional and clinical decline, especially in moderately affected patients [108]. Clinical trials of plasma fractions containing putative beneficial proteins are also underway. These initially encouraging clinical results need to be confirmed in larger double-blind, placebo-controlled studies. The potential cognitive and functional benefits of therapeutic plasma exchange must be carefully weighed against the expected side effects of prolonged multiple infusion procedures.
Recent advances in the understanding of enterovirus A71 infection: a focus on neuropathogenesis
Published in Expert Review of Anti-infective Therapy, 2021
Han Kang Tee, Mohd Izwan Zainol, I-Ching Sam, Yoke Fun Chan
Many papers have showed promising antiviral effects of herbal medicine, repurposing drugs, and novel therapeutics against EV-A71 infection [181–183]. Antiviral drugs against EV-A71 is based on viral functions including viral entry, replication, translation, and polyprotein processing. These include capsid binders, 2C or 3C inhibitors, and RNA-dependent-RNA polymerase inhibitors. A recent antiviral strategy is based on targeting host functions. Treatment for severe EV-A71 infection has often been supportive, and only milrinone, dexamethasone (steroid) and intravenous immunoglobulin (IVIG) have been used clinically. Milrinone is an inotrope that is administered intravenously into patients with brainstem encephalitis and pulmonary edema within 2 to 6 hours after admission, followed by continuous infusion for up to 72 hours [184,185]. Instead of having an antiviral effect, milrinone reduces the mortality of infected patients by enhancing the myocardial contractibility and suppresses generation of pro-inflammatory cytokines [185]. The use of steroid is controversial and when administered within 48 hours after onset, has been shown to worsen the condition of EV-A71 patients [186,187]. World Health Organization which recommends IVIG infusion for halting the progression of severe HFMD is effective when administered within 1–4 hours after admission [188,189]. Therapeutic plasma exchange has been explored in 3 patients within 48 hours after onset, and showed positive outcome [190]. This therapy will remove the autoantibodies, cytokines, and other inflammatory humoral factors from the blood. Traditional Chinese herbs such as Lan-Qin and andrographolides have also been used for HFMD management in China [186,191].