Blood transfusion and rhesus disease
Michael J. O’Dowd in The History of Medications for Women, 2020
Transfusion was a life-saver in many cases of maternal hemorrhage and of course many infants affected by congenital hemolytic anemia were rescued by exchange blood transfusion. In the ‘developed’ world the availability of antibiotics and blood replacement therapy reduced maternal mortality rates from almost 800 per 100 000 births in the 1920s to less than 20 per 100 000 in the late 1980s. Interest in the therapeutic aspects of blood transfusion was aroused again in the eighteenth century. The London-based obstetrician, James Blundell, observed at first hand the disastrous consequences of obstetric hemorrhage. Unexpected non-fatal immune reactions also occurred and, until the rhesus factor was discovered, many rhesus-negative mothers were adversely affected by transfusion of ABO compatible, but rhesus-positive blood. In the 1980s John Abel’s (modified) technique of plasmapheresis was used to good effect in the treatment of maternal blood and consequent reduction of maternal antibody levels in cases of severe rhesus iso-immunisation.
Idiopathic Pulmonary Hemosiderosis
Lourdes R. Laraya-Cuasay, Walter T. Hughes in Interstitial Lung Diseases in Children, 2019
Pulmonary hemosiderosis (PH) is a rare disease which primarily affects children and adolescents, and was described first by Virchow in 1864. It is characterized by acute and chronic blood loss which occurs from pulmonary capillaries and often results in the triad of hemoptysis, interstitial pulmonary infiltrates, and anemia. The presentation and clinical course of idiopathic PH (IPH) are variable and depend upon the intensity, duration and frequency of the hemorrhages. Chronic and acute blood loss occurs in IPH, and since the iron contained in hemosiderin trapped within the lung is only scantily reutilized for erythropoiesis, iron deficiency anemia develops in most cases. Pulmonary functions improve during remissions, and may revert to normal before interstitial fibrosis supervenes. Cardiovascular disease leading to pulmonary venous hypertension, especially mitral valve stenosis, can cause diffuse pulmonary hemorrhage and PH. Pulmonary symptoms generally precede renal involvement, and although the clinical course is variable, the disease is often fatal despite treatment with corticosteroids, immunosuppressives and plasmapheresis.
Blood Microfiltration
J. Zeman Leos, Andrew L. Zydney in Microfiltration and Ultrafiltration, 2017
Blood microfiltration is used to separate whole blood into plasma and a more concentrated cellular fraction. Therapeutic plasmapheresis is used for the treatment of a variety of diseases and disorders characterized by the presence of abnormal proteins in the circulation that are believed to be involved in the progression of that particular condition. Membrane devices provide a particularly attractive alternative to centrifugal plasmapheresis. The chapter discusses the design of a rotating cylinder module. The most attractive module designs for blood microfiltration are the hollow fiber, open flat plate, and rotating (annular) systems. A. L. Zydney and C. K. Colton developed a model for red-cell lysis during blood microfiltration in which the red cells were assumed to rupture following their deformation into the porous structure of the membrane. In order to avoid red-cell damage and blood leakage, the rotation of the inner cylinder is accomplished using a magnetic coupling device, thereby eliminating the need for a rotating seal.
Postnatal outcome and placental blood flow after plasmapheresis during pregnancy
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2017
Mária Jakó, Andrea Surányi, Márta Janáky, Péter Klivényi, László Kaizer, László Vécsei, György Bártfai, Gábor Németh
Purpose: Plasmapheresis in pregnancy adversely affects maternal hemodynamics, however there are studies suggesting it to reduce pregnancy loss in immunological diseases when medication is more harmful to the fetus. The overall optimal plasmapheresis treatment protocol remains unknown. Materials and methods: A pregnant with neuromyelitis optica was followed up after receiving six volumes of fresh frozen plasma via plasmapheresis. Results: The placenta compensated the hemodynamic change until the 33rd week of gestation, resulting a small for gestational age, otherwise healthy girl. Conclusions: More research is needed on plasma exchange during pregnancy because in our observation placental circulation can adapt to the change in blood pressure.
Successful treatment of recurrent focal segmental glomerulosclerosis with a low dose rituximab in a kidney transplant recipient
Published in Renal Failure, 2014
Jang-Hee Cho, Jong-Hak Lee, Ga-Young Park, Jeong-Hoon Lim, Jun-Seop Kim, Yoon-Jung Kang, Owen Kwon, Ji-Young Choi, Sun-Hee Park, Yong-Lim Kim, Hyung-Kee Kim, Seung Huh, Chan-Duck Kim
Recurrence of focal segmental glomerulosclerosis (FSGS) is a major therapeutic challenge in kidney transplantation (KT). Although intensive plasmapheresis and high-dose rituximab have been introduced to treat recurrent FSGS, the most effective dosage and regimen of rituximab have not been determined. Herein we reported the first case of successful treatment of recurrent FSGS with a low-dose rituximab. The patient showed marked proteinuria (3.5 g/d) and oliguria 2 d after KT. Two courses of plasmapheresis and immunoglobulin were applied to the patient, however, nephrotic range proteinuria persisted and creatinine level increased to 3.56 mg/dL. Five months post-transplant, the patient received injection with only one dose of rituximab 100 mg, without further plasmapheresis, which resulted in immediate reduction of serum creatinine and full remission of proteinuria during the following 18 months. This case suggested that recurrent FSGS, which frequently relapses after plasmapheresis, could be treated successfully with a low-dose rituximab even without plasmapheresis.
Encephalopathy following melphalan administration
Published in Journal of Chemotherapy, 2017
Divyanshu Dubey, Matthew Freeman, Om James Neeley, Gregory Carter
Objective:: To describe a rare case of encephalopathy following melphalan administration. Presentation and intervention:: A 59-year-old female with multiple myeloma developed encephalopathy following administration of melphalan. After ruling out other aetiologies, we hypothesized elevated cytokines from systemic inflammatory response to melphalan as the likely aetiology. The TNF-alpha level was found to be significantly elevated. Plasmapharesis was performed which reduced the level of cytokines, and also improved the patient’s neurological status. Conclusion:: Melphalan administration, especially in renally impaired patients, may lead to development of encephalopathy. Based on our case report, we suggest that elevated levels of cytokines could be the underlying mechanism of worsening mental status.
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