bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical evaluation of a flat‐plate membrane plasma exchange system
Authors: Grossman L. , Benny W. B. , Buchanan J. , Erickson R. R. , Buffaloe G. W.
Published: February 2007

A new flat‐plate membrane plasma separation system specifically designed for therapeutic plasma exchange (TPE) was clinically evaluated in both research and routine clinical settings. The study included a comparison to a currently available centrifugal cell separation system employed for TPE. A total of 267 membrane procedures were performed on 39 patients over a 14‐month period.

Both qualitative and quantitative studies showed that membrane plasma exchange procedures were equivalent to centrifugal procedures in the removal of plasma constitutents from patients. A notable difference between the two types of procedure was the effect on the peripheral blood platelet count: the plasma filtrate from the membrane system was essentially cell‐free and platelet counts fell only 11% during the procedure, compared to a 53% decrease during the centrifugation runs.

Patient responses to both types of procedure were similar and the frequency of side‐effects was low. A sampling of patient opinion revealed a preference for the membrane system for a variety of reasons. Procedure times were shorter with the membrane system because of higher achievable blood flow rates, and thus higher plasma exchange rates, while the overall nursing time requirement was lower.

The results show that this flat‐plate membrane TPE system enables rapid and effective plasma exchange therapy, and offered a number of monitoring and control functions that provided a safer, more efficient therapeutic procedure in the majority of patient treatments performed in this study.
Apheresis donor safety ‐ changes in humoral and cellular immunity
Authors: Strauss Ronald G.
Published: February 2007

Modern techniques of mechanical hemapheresis have made it possible to selectively remove vast quantities of lymphocytes and plasma immunoglobulins, and the concentration of these substances in donor blood can fall below the normal range. It is feared that this may lead to immunosuppression; a condition associated in some clinical settings with infections, malignancy and autoimmune diseases. Using primary immunodeficiency diseases and induced immunodeficiency states (for example, therapeutic lymphocytapheresis, chronic thoracic duct drainage and intestinal lymphangiectasia) as models to judge competency of the immune system, it can be predicted that body defense mechanisms can become defective when serum IgG levels are < 200 mg/dl or the blood lymphocyte count is < 1000/μl. However, impaired immunologic function can occur in the presence of normal quantities of these substances in the blood stream; conditions that may be related either to imbalances of immune regulatory factors or to qualitative (rather than quantatitive) abnormalities of the immune system.

A number of investigators have documented the losses of lymphocytes and plasma immunoglobulins incurred by donors experiencing mechanical hemapheresis. In addition, both the immediate and long‐term decreases in the concentration of these substances in donor blood have been reported. In summary, the immediate decreases in blood lymphocyte counts and serum immunoglobulin concentrations are of slight to moderate degree and are without known adverse effects. Less information is available regarding long‐term alterations of the immune system, and little data have been collected from prospective studies in which large numbers of donors have been thoroughly evaluated by modern techniques. In general, results of many laboratory studies have been altered. However, these abnormalities have been transient for the most part, and it has been difficult to document clinically significant adverse effects. Thus, the quantities of blood lymphocytes and plasma immunoglobulins that can be removed from healthy donors without causing significant immediate or long‐term harm is unknown.

Bearing these limitations in mind, the following recommendations are suggested regarding the frequency of repeated mechanical plasma‐and‐cytapheresis. 1) The usual requirements for whole blood donation must be met if the frequency of mechanical hemapheresis does not exceed once every eight weeks. 2) Individuals expected to experience mechanical apheresis at more frequent intervals should comply with the following additional requirements in an attempt to avoid severe lymphocytopenia (blood lymphocytes < 1000/μl): a) subjects should not be permitted to donate with a preapheresis lymphocyte count < 1200/ 1; b) donor blood lymphocyte counts should be measured initially and again after each cumulative loss of 5 × 1010 lymphocytes; c) donors who develop lymphocytopenia (< 1000/μl of blood) should be excluded from donation until the blood lymphocyte count is > 1200/μl.
Exchange transfusion as an alternative to granulocyte concentrate administration in neonates with bacterial sepsis and profound neutropenia
Authors: Christensen Robert D. , Hill Harry R. , Anstall Harold B. , Rothstein Gerald
Published: February 2007

A high rate of mortality is observed in the subset of neonates with early‐onset bacterial sepsis who develop profound neutropenia and depletion of the marrow neutrophil reserve. Several studies suggest that transfusion of apheresis‐collected adult neutrophils into such subjects can be beneficial, yet inherent delays in preparation of neutrophil concentrates can limit their clinical utility. In six neonates with sepsis and profound neutropenia, we performed double‐volume exchange transfusions using freshly drawn donor blood and determined that a net gain of 0.3–0.7 × 109 neutrophils/kg body weight had occurred. The blood neutrophil count of the patients increased from 220 to 1,660/mm3 before the transfusion to 1,650–5,140/mm3 immediately afterward. We next attempted to further increase the number of neutrophils delivered by exchange transfusion by subjecting blood donors to 2 min of physical exercise in order to induce neutrophilia. After such exercise, 30% (range 18–55%) more neutrophils were harvested. The metabolic burst activity and in vitro migration of neutrophils after exercise did not differ from paired preexercise values.
Treatment of thrombotic thrombocytopenic purpura with plasma exchange: Five cases
Authors: Gupta Sharda , Funkhouser James W.
Published: February 2007

Five patients with thrombotic thrombocytopenic purpura (TTP) were treated with corticosteroids, plasma exchange (PE), and antiplatelet agents. ABO‐ and Rh‐compatible fresh‐frozen plasma (FFP) was used as the replacement fluid. None of the patients received FFP infusion without PE.

The patients were followed for 14–32 months after initial treatment. Four of the five patients are in complete clinical remission. One responded to plasma exchange but died of heart disease. This report shows an 80% survival rate which is markedly better than that without the use of PE and FFP infusion. We found dramatic clinical and hematologic improvement beginning shortly after initiating treatment.

Two patients showed reversal of their initial clinical and hematologic improvement when PE was discontinued, despite continuing treatment with antiplatelet drugs and in one with corticosteroids. Both patients showed hematologic and clinical remission after reinstitution of PE. None of the survivors had any neurologic or renal deficit. They were maintained on aspirin and dipyridamole for 1 year after discharge.
The clinical effectiveness and safety of chronic plasmapheresis in patients with primary biliary cirrhosis
Authors: Ambinder Edward P. , Cohen Larry B. , Wolke Anita M. , Field Steven P. , Adelsberg Bernard , Schaffner Fenton , Zaroulis Charles G.
Published: February 2007

Primary biliary cirrhosis (PBC) is a chronic nonsuppurative, destructive cholangitis, whose etiology is unknown. Morbidity arises early from pruritus and later from hypercholesterolemia with xanthoma formation. Therapy is supportive and directed at the complications of cholestasis. Plasmapheresis has been reported to benefit patients with hyperlipidemia and PBC; thus a pilot study of plasmapheresis utilizing the Haemonetics Model 30 with replacement by albumin and saline was conducted. Five patients (four female and one male) with a mean age of 43 (range 29–58) and a mean duration of illness of 9.5 years (range 6–21) with marked jaundice, xanthomas, xanthelasma, hepatomegaly, fatigability, anorexia, and pruritus, as well as mild nausea were studied. Peripheral neuropathy was present in two patients. Two patients had splenomegaly. Two patients had an associated Sjogren syndrome. All patients had high serum bilirubin, alkaline phosphatase, and cholesterol levels and mild elevations in aspartate amino transferase and alanine amino transferase activities. Immune complexes measured in four patients were present. Antimitochondrial antibody titers were significant in all patients. Patients underwent a mean of 63 plasmapheresis procedures over a mean of 112 weeks removing a mean of 94.7 liters of plasma. No serious toxicity was seen.

All patients showed a reduction in pruritus, xanthomas, xanthelasmas, and serum cholesterol values. The two patients who had evidence of Sjogren syndrome noted subjective improvement. All patients who had fatigue, anorexia and nausea also noted moderate improvement. There was no change in hepatomegaly or splenomegaly in patients demonstrating such organomegaly. Liver function did not change significantly. Overall, four patients had improvement in their condition and one patient achieved stability. We strongly recommend the use of chronic plasmapheresis for patients with PBC who have failed more “conventional” regimens.
Effect of plasmapheresis on E‐rosette receptors in sle patients
Authors: Vangelista Alba , Frascà Giovanni M. , Nanni‐Costa Alessandro , Bonomini Vittorio
Published: February 2007

The present study reports on the effects of plasmapheresis on both cellular (E‐rosette receptor‐ and Fc receptor‐bearing lymphocytes) and humoral (antilymphocyte antibodies) immunity in patients with active SLE. Ten untreated patients were studied before and after two plasma exchanges. The E‐rosette receptor‐positive cells were studied by OKT11 monoclonal antibody and Fc receptor‐bearing cells by Leu 15 monoclonal antibody. Antilymphocyte antibodies were studied before and after plasma exchange by an indirect immunofluorescence technique on autologous and normal lymphocytes. A reduction in OKT11+ and Leu 15+ lymphocytes was observed in all patients before plasmapheresis. Antilymphocyte antibodies were detected in five patients. After plasma exchange, an increase in E‐rosette receptor‐ and Fc receptor‐bearing lymphocytes was observed along with a reduction in the amount of antilymphocyte antibodies.
Optimization of parameters for maximization of plateletpheresis and lymphocytapheresis yields on the haemonetics model V50
Authors: Aubuchon James P. , Carter Charles S. , Adde Melissa A. , Meyer Donna R. , Klein Harvey G.
Published: February 2007

Automated apheresis techniques afford the opportunity of tailoring collection parameters for each donor's hemato‐logic profile. This study investigated the effect of various settings of the volume offset parameter as utilized in the Haemonetics Model V50 instrumentation during platelet‐ and lymphocytapheresis to optimize product yield, purity, and collection efficiency. In both types of procedures, increased product yield could be obtained by using an increased volume offset for donors having lower hematocrits. This improvement was related to an increase in collection efficiency. Platelet products also contained fewer contaminating lymphocytes with this approach. Adjustment of the volume offset parameter can be utilized to make the most efficient use of donors and provide higher‐quality products.
Centrifugal elutriation as a method for isolation of large numbers of functionally intact human peripheral blood monocytes
Authors: Turpin Jim , Hester Jeane P. , Hersh Evan M. , Lopez‐Berestein Gabriel
Published: February 2007

Centrifugal elutriation was used further to isolate human peripheral blood monocytes (HPBM) from mononuclear‐enriched cells harvested as a secondary component following platelet concentration collection samples. HPBM were recovered in either one or two populations consisting of either total HPBM or small (SM) and large monocytes (LM). The elutriation was carried out at 3,500 ± 5 rpm for the separation of lymphocytes and HPBM in Ca++ −and Mg ++ ‐free PBS without EDTA. An average of 5.05 ± 1.50 × 108 HPBM were recovered in the total HPBM with a purity of 95% ± 3%. The SM and LM were obtained by splitting the total HPBM into two equal populations with an HPBM purity of 92% ± 3% and 93% ± 3%, respectively, by nonspecific esterase staining. The elutriation media were shown to have no effect on viability by trypan blue exclusion. All three HPBM populations were shown to be histochemically (lack of reactivity to leu‐1 and leu‐7) and functionally (depletion of NK cell activity) purified from the lymphocyte population. The HPBM populations were enriched in HLA‐Dr, OKM‐1, OKM‐5, MY‐8, and leu M‐3 monoclonal antibody marker staining. There were no differences in percent positive cells between SM and LM populations for any of the monocyte‐specific monoclonal antibodies. All three monocyte populations mediated antibody‐dependent cell‐mediated cytotoxicity to human red blood cells, with LM mediating more lysis (27.0% ± 5%) than SM (7% ± 3%). The HPBM produced H2O2 and were activatable by bacterial lipopolysaccharide (LPS) and recombinant interferon gamma. HPBM did not have any spontaneous cytostasis to K562; HPBM, could be activated by 24‐hour exposure to 1.0 μg/ml of LPS (28.0%). The data obtained shows that mononuclear cell enriched plateletpheresis samples can be used to obtain large numbers of functionally active, highly purified HPBM.
The use of plasmapheresis, lymphocytapheresis, and staph protein‐A immunoadsorption as an immunomodulatory therapy in patients with aids and aids‐related conditions
Authors: Kiprov Dobri D. , Lippert Randolph , Miller Robert G. , Sandstrom Erik , Jones Frank R. , Cohen Richard J. , Abrams Donald , Busch David F.
Published: February 2007

Circulating immune complexes, autoantibodies, and suppressor factors to normal lymphoproliferation may play an important role in the induction and maintenance of the cellular immunodeficiency characteristic for the acquired immunodeficiency syndrome (AIDS) and its related conditions. In order to explore the possiblity that the removal of circulating humoral factors may have an immunomodulatory effect in patients with AIDS and AIDS‐related conditions (ARC), we used apheresis procedures to treat patients with different clinical presentations of AIDS and ARC. Five patients with AIDS and opportunistic infections were treated with plasmapheresis. Four patients with AIDS and Kaposi's sarcoma without opportunistic infections were treated with staph protein‐A immunoadsorption and two patients with ARC and peripheral neuropathy were treated with lymphoplasmapheresis. The treatments were tolerated well by all patients. Effective removal of circulating humoral immune factors was observed in all three groups. No significant clinical benefit was seen in the patients with AIDS and opportunistic infections treated with plasmapheresis. Partial tumor responses were observed in three of the four patients with AIDS related Kaposi's sarcoma treated with staph protein‐A plasma perfusion, and resolution of neurologic symptoms was seen in both patients with ARC and peripheral neuropathy treated with lymphoplasmapheresis. Our preliminary results suggest that lymphoplasmapheresis may be an effective treatment modality for patients with ARC related peripheral neuropathy, that protein‐A immunoadsorption is well tolerated by patients with AIDS‐related Kaposi's sarcoma, and that this treatment has antitumor and immunomodulatory effects in these patients.
Successful preoperative apheresis of factor VIII antibody using factor VIII concentrate as a replacement fluid
Authors: Apter Beth , Maccarthy Verna , Shapiro Sandor S. , Ballas Samir K.
Published: February 2007

Plasma exchange was performed on a patient with hemophilia A and inhibitor to factor VIIIC prior to bilateral cataract removal. Koate was used as replacement fluid with effective reduction of the inhibitor level. From the technical standpoint we found out that factor VIII is best reconstituted in water and directly infused through the venous line and not the centrifuge bowl.
Lack of short‐term effects on the donor during continuous‐flow selective mononuclear cell collection
Authors: Jacobs Peter , Wood Lucille
Published: February 2007

In 50 individuals, intensive harvesting of relatively pure mononuclear cell fractions from the peripheral circulation was carried out in 195 procedures. Serial collections from bone marrow donors (group 1: n = 35) or isolated procedures from volunteers (group 2: n = 15) were without morbidity. A median yield of 4.0 × 109 mononuclear cells were recovered in a final volume of 104 ml of cell‐rich plasma, for which 4,300 ml of venous blood was processed in 107 minutes. In neither group were changes documented in donor white cell count or lymphocyte numbers. In group I, a statistically significant but clinically unimportant and transient fall occurred in the platelet count at the end of the 5‐day intensive schedule. It is concluded that mononuclear fractions can efficiently be collected from normal donors without the development of relevant cell depletion.
Use of arteriovenous shunts and right atrial catheters for daily granulocyte collection
Authors: Williams B. M. , Sanders J. E. , Clift R. A. , Hickman R. O. , Bensinger W. I. , Buckner C. D. , Thomas E. Donnall
Published: February 2007

Between June 1982 and April 1984, 67 adult granulocyte donors were randomized to receive external arteriovenous shunts or modified right atrial catheters as vascular access for daily granulocyte collections using blood cell separators. Six of 32 donors with shunts and 2 of 35 donors with right atrial catheters experienced failure of the access method. Local infection occurred in one donor with a shunt and one donor with a right atrial catheter. Bacteremia occurred in one donor with a right atrial catheter. Specified whole blood flow rates of 50‐65 ml/minute were achieved with 28 of 32 shunts and 29 of 35 right atrial catheters (P = NS). The majority of the donors in each group tolerated the vascular access without significant problems. This study demonstrates that modified right atrial catheters can be successfully used as method of vascular access for single donor granulocyte collection with blood cell separators.
Evaluation of apheresis platelet concentrates stored for 5 days in PL 732 bags
Authors: Kiraly Thomas R. , Kalish Robert I. , Norton Diane F.
Published: February 2007

To assess the functional viability of platelets collected by standard apheresis techniques using the Fenwal CS‐3000 “closed system” and stored in Fenwal PL 732 plastic bags for 5 days at room temperature with agitation, a number of in vitro parameters (pH, morphology, platelet volume distribution, osmotic recovery, aggregation, and platelet‐associated IgG) were examined as a function of storage time. During the first 24 hours of storage, minimal changes were observed in the test parameters with the exception of ADP‐induced aggregation (75% decrease [10 uM], 84% decrease [5 μM]). Significant differences were observed between fresh (day 0) and 5‐day‐old platelet concentrates in all parameters except median platelet volume. These observed changes in in vitro test parameters with storage time are similar to those previously observed for comparably stored random single‐donor platelet concentrates. Thus, the “closed‐system” PL 732 apheresis platelet concentrates would be expected to be as effective in vivo as random single‐donor platelet concentrates, while minimizing recipient exposure to transmissible agents of infectious disease.
Waldenstrom macroglobulinaemia treated with sequential hemibody irradiation
Authors: Jacobs Peter , Wood Lucille , Roux Ingrid Le , Prior Clive , King Helen S.
Published: February 2007

A 40‐year‐old man presented with symptoms of anaemia and blurred vision. Waldenstrom macroglobulinaemia was diagnosed on the basis of plasmacytoid lymphocytes in the peripheral blood, extensive bone marrow involvement, and an IgM kappa monoclone in the plasma of 48 g/liter. Symptoms were immediately reversed by isovolaemic continuous‐flow plasmapheresis coupled with red cell transfusion. Specific therapy was undertaken with sequential hemibody irradiation. At two years of follow‐up the patient enjoys excellent health, has improved haematopoietic reserve in the bone marrow, and the only therapy required is intermittent plasmapheresis to control symptoms relating to rising viscosity. Thus, systemic irradiation, which is well tolerated and objectively reduces marrow tumour bulk, offers an alternative to chemotherapy in the palliative management of active macroglobulinaemia and may diminish but not prevent the need for intermittent plasmapheresis.
Nomograms for the prediction of patient's plasma volume in plasma exchange therapy from height, weight, and hematocrit
Authors: Sprenger Kuno B. G. , Huber Klaus , Kratz Werner , Henze Eberhard
Published: February 2007

The knowledge of plasma volume (PV) is a basic requirement for the standardization of plasma exchange therapy. PV has to be determined by calculation, as the measurement of PV before every plasma exchange is too cost‐and time consuming. A known correlation with measured values results from calculation of plasma volume by means of patient's height and weight. But the present equations are only reliable at normal hematocrit. For this reason we modified the Retzlaff‐equations and compared the validity of plasma volume predictions, calculated by these and own equations, with plasma volume measured by the 51Cr‐method in 59 patients with pathological hematocrit.

The correlation coefficient was 0.82 for men and 0.81 for women (2 0.001) with the modified Retzlaff‐equations. On the average the relative error was ‐ 1.5% for all and 2.8% for fat and thin men. No significant improvement of accuracy was achieved with other equations. Thus, plasma volume can accurately be calculated from height, weight, and hematocrit with our modified Retzlaff‐equations in patients with pathological hematocrit, even if they are very fat or thin.

Nomograms for men and women were constructed in order to facilitate the calculation.
Effects of plasmapheresis on peripheral blood mononuclear cell populations from patients with macroglobulinemia
Authors: Paglieroni Teresa , Caggiano Vincent , Mackenzie Malcolm R.
Published: February 2007

Effects of plasmapheresis on peripheral blood T‐cell, B‐cell, monocyte, and natural‐killer‐cell populations were studied in ten macroglobulinemia patients with hyperviscosity syndrome. Following plasmapheresis, there was a transient decrease in the number of T4 + helper cells and a longer‐lasting decrease in the number of Leu‐7 + natural killer cells and Mo2+ monocytes. In addition, there was a greater than 50% decrease in the in vitro ingestion capacity of monocytes. Although no significant changes in the numbers of IgM +, B1+, B4 +, or PCA + B cells (P > .05) were detected, there was a highly significant (P < .01) increase in I2 antigen density on the surface of IgM + B cells and in the bromodeoxyuridine uptake by these cells 7‐9 days after plasmapheresis. These findings suggest that following plasmapheresis, IgM+ B cells are activated. Using flow cytometry to determine when maximum IgM+ B cell activation occurs by measuring I2 antigen density on the cell surface may be useful in determining the postplasmapheresis timing of chemotherapy in macroglobulinemia patients with hyperviscosity syndrome who require more aggressive treatment.
Plasma exchange in the treatment of nonadvanced stages of progressive systemic sclerosis
Authors: Mascaro G. , Cadario G. , Bordin G. , Tarditi M. , Ferraris G. , Monteverde Anna , Castano L. , Monteverde Angelo
Published: February 2007

Ten patients suffering from progressive systemic sclerosis, who responded poorly to conventional therapy, underwent plasma exchange (PE) therapy in conjunction with drug therapy. The frequency of PE was twice weekly for 4‐6 weeks, two or three times per year, with a summer interruption, when in our own experience a spontaneous relief of symptoms occurs. To judge the efficacy of our therapeutic device, we assessed several laboratory and clinical parameters before and after therapy. The changes in circulating immune complexes, in IgG and IgA, and in some functional indices were significant (P < 0.001). Eight of 10 patients improved satisfactorily. The remaining two did not improve sufficiently to continue the apheretic treatment. In conclusion, our study suggests that the PE, together with conventional therapy, can be an effective therapeutic device in the treatment of progressive systemic sclerosis.
Cascade filtration with reverse rinse of the secondary filter
Authors: Valbonesi Mauro , Lercari Giuseppe , Angelini Gerardo , Malfanti Libera , Ferrari Mauro , Russo Emanuele , Nati Sandro
Published: February 2007

With cascade filtration (CF) secondary filter plugging may render some procedures difficult, particularly with cryoglobulinemia or macroglobulinemia patients, when filters are subjected to the most consistent burden. To prevent plugging, in the initial management of seven patients with cryoglobulinemia or macroglobulinemia we employed polymethylmethacrylate secondary filters produced by Toray Industries Inc., Tokyo, with pores calculated at 0.1 μm (QS‐12‐70). In the subsequent sessions, when circulating macroproteins were reduced to more acceptable levels, secondary filters with pores of 0.06 μm were used (QS‐12‐50). The filtration efficiency of both filters was maintained throughout the procedures with reverse rinses carried out when the transmembrane pressure from the values of 80‐130 mm Hg reached the values of 250 mm Hg. With this improved technique, 2.6‐3.31 liters of plasma could be treated, producing adequate clinical benefits. From a laboratory point of view, the differential sieving for albumin and macroglobulins was 61% for the QS‐12‐50 filters and 56% for the QS‐12‐70 models.
Remission of hyper‐lgE syndrome treated with plasmapheresis and cytotoxic immunosuppression
Authors: Dau Peter C.
Published: February 2007

A patient with a hyper‐IgE syndrome was treated with 60 plasmaphereses over a period of 2 years in conjunction with cytotoxic immunosuppressive drug therapy. During this time her severe dermatitis of 8 years' duration became almost completely inactive, and her circulating IgE level was reduced by 73%. An elevated pretreatment ratio of CD4+/CD8+ T lymphocytes fell to subnormal. The beneficial results of treatment may be attributed to the reduction of lymphocyte populations responsible for IgE production by the combined action of plasmapheresis and of cytotoxic drugs as well as the direct effect of removal of circulating IgE and possibly IgE‐potentiating factors.
Reduction of low‐density lipoproteins with dextran sulfate in patients with familial hypercholesterolemia
Authors: Antwiler G. Delbert , Dau Peter C. , Lobdell Donn D.
Published: February 2007

A novel on‐line system for the selective precipitation of low‐density lipoprotein (LDL) using dextran sulfate has been devised and tested in four patients with heterozygous familial hypercholesterolemia (type II). The mean pretreatment serum cholesterol was 410 mg/dl. Plasma was generated by membrane filtration and LDL and VLDL (very‐low‐density lipoprotein) were completely precipitated with 10–35 mg% dextran sulfate (Mr 5,000) in the presence of 55 mM Ca2+. The precipitate was removed by filtration and the excess Ca2+ by dialysis. For 41 procedures the mean reduction of plasma solutes was LDL + VLDL 65%, HDL 23%, fibrinogen 19%, albumin 15%, IgG 20%, IgA 19%, IgM 24%. We conclude that dextran sulfate precipitation is an effective method for selective on‐line removal of LDL from plasma.
Haemonetics plasma collection system (PCS): Automated collection of platelet‐poor or platelet‐rich plasma
Authors: Smith James W.
Published: February 2007

The PCS is an automated centrifugal system designed for rapid collection of platelet poor plasma (PPP) for source or fresh frozen uses, or platelet concentrate and PPP. The microprocessor‐controlled system increases plasma collection efficiency through improved plasma yields, increased donor safety, and operation of multiple machines per operator.

600 ml of plasma can be collected in an average of 35 minutes per procedure with greater than 50,000 collections by U.S. commercial organizations. PCS plasma yields 10% greater Factor VIII recovery through fractionation when compared to manually‐collected plasma based upon multiple studies throughout the world. Collection of PRP is an efficient, reliable, safe, and cost‐effective method for processing plasma and the only system available for combined platelet and plasma procurement.
Logistics of automated plasma collection
Authors: McCombie N. , Rock G.
Published: February 2007

Plasmapheresis is widely carried out to produce plasma for fractionation. Production of Factor VIII and albumin, two proteins in plasma, drives the plasma industry. The Canadian Red Cross would like to achieve national self‐sufficiency in plasma production to meet the rising demands for these proteins in the next 4 years. In order to achieve this goal we must make efficient use of our automated plasmapheresis machines and available human resources to produce a cost‐effective plasma product.

An assessment was undertaken at the Ottawa Centre to evaluate the number of procedures which could be performed on each machine per day and the staff required to operate these machines safely and efficiently. Donor availability, reliability and reasons for donating plasma were recorded to determine if our population could support such an escalated programme. Donor/staff interest and acceptance of automated equipment was determined. The results showed that four automated plasmapheresis devices could be operated by one nurse and one clinic assistant processing 32 donors a day with an average time of 27 min required for a 500‐ml donation of plasma. The donor population was available and extremely interested; however, the logistics of scheduling proved to be an area for concern requiring special attention.
Ex vivo activation of killer monocytes (AKM) and their application to the treatment of human cancer
Authors: Stevenson Henry C. , Lacerna Leocadio V. , Sugarbaker Paul H.
Published: February 2007

Human blood monocytes activated by gamma interferon have been shown to be highly tumoricidal against colon cancer cells in vitro. Monocytes from patients with peritoneal colorectal carcinomatosis (PCC) were purified by a combination of cytapheresis and elutriation procedures, followed by in vitro incubation with gamma interferon for 18 hours. After debulking surgery, activated killer monocytes (AKM) were reinfused into patients' peritoneal cavities weekly for 16 weeks. To date, six patients have completed the entire protocol and three have completed maintenance therapy. All have tolerated the therapy well with acceptable toxicity.

Midway through the protocol, we analyzed the trafficking pattern of the AKM by prelabeling them with 111in. Distribution was relatively homogeneous throughout the peritoneum; at the second staging celiotomy, three of the seven PCC patients were found to have very small amounts of recurrent disease in places to which the AKM were felt to have had limited access (other areas remained disease‐free); these areas of recurrent disease were surgically resectable.

AKM have also been infused systemically into five cancer patients. First, the patients were infused with unactivated 111in‐labeled monocytes; 1 month later each patient received 111In‐labeled gamma interferon‐activated AKM. Trafficking studies indicated that both forms of monocytes migrated to sites in the reticuloendothelial system. We have seen virtually no complications from intravenous infusions of either unactivated or gamma interferon‐activated AKM.

These studies indicate that the adoptive immunotherapy of cancer patients with AKM is a feasible and safe procedure.
Plasmapheresis in the treatment of acute relapsing inflammatory demyelinating polyradiculoneuropathy associated with human immunodeficiency virus infection: A case report
Authors: Wuest David , Goldflnger Dennis
Published: February 2007

Neurologic complications, including both the acute and chronic forms of inflammatory demyelinating polyradku‐loneuropathy (IDP) are becoming more prevalent among patients with the acquired immunodeficiency syndrome (AIDS) and AIDS‐related‐complex (ARC). Although the etiology of the above radicuioneuropathies is not known, an autoimmune process has been postulated. Plasmapheresis has been reported to be of benefit in both the acute and chronic forms of these neuropathies. In this report we describe the use of plasmapberesis in the treatnient of a patient with ARC and the acute relapsing form of IDP. The treatment consisted of an intensive canne of plasmapheresis following his initial presentation and after an acute relapse which occurred several weeks after his initial presentation. Both the initial presentation and relapse involved respiratory compromise necessitatig intubation and mechanical ventilation. In both instances marked clinical improvement was achieved after initiation of plasmapheresis. Thus, plasmapheresis may have a rote in the management of acute relxpsing IDP associated with human immunodeficiency virus infection.
Uncontrolled trial of cryofiltration in rheumatoid arthritis
Authors: Matehesky Paul S. , Smith James W. , Koo Anna , Clough John , Skibinski Christine , Beck Gerald J. , Nose Yukihiko
Published: February 2007

In an open trial of cryofiltration in rheumatoid arthritis at our institution, 19 patients received 464 treatments; the intensive schedule of ten treatments in 5 weeks was completed in 14 of the 19, and excellent to good clinical response was achieved in ten of these. The combined results demonstrated significant reductions in Ritchie index, morning stiffness, and 50‐foot walk time in the intensive treatment period, as well as significant increases in hand grip strengths. In the maintenance treatment period treatment frequency was individually selected and at less frequent intervals. Changes in clinical parameters were notably less. Although significant correlations were observed between the percent change in clinical parameters and the percent change in biochemical and hematolog‐ical parameters, no consistent pattern was found. The favorable results of this trial and other uncontrolled trials has led to a two‐center double‐blind controlled trial of cryofiltration in rheumatoid arthritis that is now in progress.
Preparation of leukocyte‐poor platelets by Filtration
Authors: Sniecinski Irena , Jean Janice St. , Nowicki Barbara
Published: February 2007

There is evidence that leukocyte contaminating red blood cells and platelet concentrates are responsible for refractoriness to platelet transfusions. The efficacy of a cotton‐wool filter to remove leukocytes from red blood cells has been documented previously. The present study was designed to evaluate whether the cotton‐wool filters can effectively remove leukocytes from platelet concentrates. Sixty pools of random‐donor platelets and single‐donor plateletpheresis products were filtered through a cotton‐wool filter. The efficacy of filtration was determined by measuring the absolute numbers of leukocytes and platelets and subpopulations of mononuclear cells. The average platelet loss was 8% per pool of random platelets and 10% per plateletpheresis product. The average leukocyte removal was 99% from a pool of random platelets and plateletpheresis concentrates collected by CS‐3000 and 90% from plateletpheresis concentrates harvested by single‐stage COBE/IBM‐2997. The filtration removed 100% of granulocytes, 95% of monocytes, 90% of B‐lymphocytes, and 85% of T‐lymphocytes. We conclude that filtration through a cotton‐wool filter is an efficient and cost‐effective method for preparation of leukocyte‐poor platelets.
Current status of granulocyte transfusions to treat neonatal sepsis
Authors: Strauss Ronald G.
Published: February 2007

Neonates are unusually susceptible to severe bacterial infections. Antibiotic therapy has been supplemented with granulocyte transfusions (GTX) to treat neonatal infections. The precise role of GTX to treat neonatal sepsis is controversial, and 11 reports (including six controlled studies) were critically analyzed. When all data are combined, 79% of 78 neonates receiving antibiotics plus GTX survived vs. 62% of 90 infants treated only with antibiotics. Among the six controlled trials, four found significantly better survival for neonates given GTX plus antibiotics. However, each of these trials can be criticized (few subjects, heterogeneous patients, defective design, inadequate granulocyte product, etc.). Although firm recommendations for GTX cannot be made currently, it seems reasonable to combine them with antibiotics to treat septic neonates that exhibit neutropenia for age and evidence of a diminished neutrophil marrow storage pool. Once the decision to transfuse is made, neonates should receive a minimum dose of 1 × 109 fresh neutrophils per kg per transfusion.
AIDS in Canada
Authors: Clayton Alastair J.
Published: February 2007

Since the first case of AIDS was diagnosed in 1982, there have been over 2,300 cases, as of February 1989, in Canada. The epidemiological pattern of the cases in Canada follows that of the United States with the exception of intravenous drug users.

In 1983, the federal government created a National Advisory Committee which is active in advising the Minister of National Health and Welfare on issues for the control and management of AIDS in Canada. In 1985, a $39 million program was announced. An enhanced program of AIDS control was established in July of 1987 with the creation of the Federal Center for AIDS (FCA). This has involved a substantial increase in financial and personnel resources.

Canada plays a significant role internationally vis‐à‐vis AIDS; $10 million has been provided to the World Health Organization. The FCA is a WHO Collaborating Centre. In June of 1989, Canada will host the Vth International Conference on AIDS in Montreal.
Plasma exchange in progressive IgA nephropathy
Authors: Nicholls Kathy , Becker Gavin , Walker Rowan , Wright Christopher , Kincaid‐Smith Priscilla
Published: February 2007

A therapeutic trial of plasma exchange was performed in 13 patients with documented progressive IgA nephropathy. Comparison of the rate of deterioration in renal function before, during, and after plasma exchange demonstrated significant improvement during plasma exchange. Seven patients had a slowed rate of deterioration by plasma exchange, but achieved a decrease in serum creatinine level. Favourable response was correlated with rapidity of deterioration preplasma exchange (P lt; 0.01) and was apparent within 4 weeks of commencing therapy in those patients who responded. There was no overall difference between the deterioration rates pre‐ and postplasma exchange. In patients in whom creatinine decreased on plasma exchange, the initiation of subsequent dialysis was delayed.
Antibody response to pneumococcal polysaccharide vaccine in Myasthenia gravis: Effect of therapeutic plasmapheresis
Authors: Nasca Thomas J. , Muder Robert R. , Thomas Dian B. , Schrecker Judith C. , Ruben Frederick L.
Published: February 2007

The removal of specific antibody in experimental animals has been reported to result in a subsequent increase in antibody to levels equal to (rebound) or exceeding those existing prior to removal (overshoot). Anecdotal reports suggest that rebound antibody synthesis after plasmapheresis may occur in humans with autoimmune disorders. We measured the antibody response to 12 pneumococcal polysaccharide antigens in patients with myasthenia gravis (MG) receiving a variety of therapies in order to determine whether the T‐cell‐independent IgG response to these antigens was augmented by plasmapheresis. MG patients receiving no immunotherapy or receiving prednisone had pre‐ and post‐immunization titers similar to those of control patients. MG patients receiving prednisone and chronic plasmapheresis had higher pre‐immunization titers than did other patient groups and had significantly higher post‐immunization titers against multiple pneumococcal serogroups. Aggregate post‐immunization geometric mean titers were more than three‐fold higher in the plasmapheresis group as compared with other MG treatment groups. Enhancement of antibody response by plasmapheresis was abolished by the concomitant administration of azathioprine. Antibody rebound and overshoot after antibody removal may have important implications for the therapy of immune disorders by plasmapheresis.
Plasma exchange in endocrine ophthalmopathy
Authors: Berlin Gösta , Hjelm Hans , Liedén Gudrun , Tegler Lennart
Published: February 2007

We studied the effects of intensive plasma exchange on endocrine ophthalmopathy in 12 patients with Graves' disease and one with Hashimoto's thyroiditis. All patients were euthyroid at the time of plasma exchange. All but five had concomitant treatment with azathioprine. Each patient had a treatment period consisting of six plasma exchanges performed in 2–3 weeks; two patients were treated in two periods. Each time a mean of 2.4 liters plasma was exchanged.

There was a prompt reduction in the concentration of circulating immune complexes and/or thyrotropin receptor antibodies following plasma exchange. Six of the 13 patients improved their proptosis; their median duration of eye symptoms before treatment was less than 8 months. In patients suffering from eye symptoms for more than 1 year improvement was rare. Overall the Hertel values were 24.1 ± 4.4 (SD) before and 22.8 ± 3.4 after plasma exchange for the left eyes (P = 0.07) and 23.8 ± 4.0 before and 23.0 ± 3.8 after for the right eyes (P = 0.09). Nine patients altogether improved their ophthalmopathy index and periorbital oedema.

In patients with disabling endocrine ophthalmopathy plasma exchange may sometimes be of value to induce a relief of the ophthalmopathy; when it is used it should be instituted before fibrotic changes occur. We suggest that concomitant immunosuppressive drugs should be given to prevent rebound phenomenon induced by plasma exchange. To establish the role of plasma exchange in the treatment of endocrine ophthalmopathy controlled studies should be performed.
Reactivity of pretransplant cytotoxic antibodies to a selected HLA panel is not influenced by cyclosporin a, with or without plasma exchange
Authors: Swanepoel Charles R. , Cassidy Michael J. D. , May Margaret , Oudshoorn Machteld , Toit Ernette Du , Wood Lucille , Jacobs Peter
Published: February 2007

The influence of 6 weeks of cyclosporin A (CYA), followed by a further 6 weeks of this agent in combination with plasma exchange (PE), was defined on panel reactivity and titre of preformed cytotoxic antibodies in stable patients on haemodialysis awaiting renal transplantation. Nine individuals with antibodies to 30% or more of the donor panel were entered into the study, but three failed to complete the programme. Comprehensive data are available on the remaining six patients, one of whom was studied twice. The pattern of reactivity to the panel was unaltered, but antibody titres were significantly reduced (P < 0.006). In one patient, a lymphocytoxic crossmatch performed between the patient and an HLA‐haploidentical sibling in the last week of the trial was positive, suggesting that neither procedure was successful in removing an antibody directed against the HLA antigens of a family donor. Three cadaver renal transplants were performed during or after the trial, and while two of the grafts were unsuccessful, one survives at 60 months, with good function. From these data it is concluded that neither cyclosporin A nor its combination with plasma exchange have any effect on the panel reactivity of preformed cytotoxic antibodies, whereas the titres were significantly reduced. An important and serious side effect of the apheresis procedure was the loss of fistulae in two patients.
Stimulatory effect of counterflow centrifugal elutriation in large‐scale separation of peripheral blood monocytes can be reversed by storing the cells at 37°c
Authors: Abrahamsen Tore G. , Carter Charles S. , Read Elizabeth J. , Rubin Marc , Goetzman Holly G. , Lizzio Elaine F. , Lee Young Lim , Hanson Michael , Pizzo Philip A. , Hoffman Thomas
Published: February 2007

Transfusion of peripheral blood monocytes may be of benefit as adjuvant treatment of leukopenic patients with serious infections. To study the feasibility of this approach, a large‐scale monocyte separation procedure employing leukapheresis, density gradient centrifugation, and counterflow centrifugal elutriation was established. By processing 5 to 6 liters of normal donor blood, it was possible to obtain a mean of 1.1 × 109 (range: 0.5–1.7 × 109 cells) of mononuclear cells, of which 89% (range: 82–94%) were monocytes by Wright's stain morphology. When the elutriation was performed in XVIVO‐10, a commercially available, serum‐free medium developed for adoptive immunotherapy, spontaneous secretion of superoxide by the monocytes was significantly higher than for monocytes elutriated in Hanks' balanced salt solution without calcium and magnesium or non‐elutriated peripheral blood mononuclear cells. This stimulated state of the monocytes was observed both immediately after elutriation and after overnight storage at 4°C, and it was not affected by the type of storage vessel used. Overnight storage of the monocytes at 37°C resulted in a reversal of the stimulated state of the cells. Monocytes elutriated in XVIVO‐10 and kept overnight at 4°C released high amounts of arachidonic acid. A subsequent decrease in this release was seen after additional storage at 37°C for 18 hours. These observations demonstrate that separation and storage variables have important effects on the state of stimulation of monocytes. Further investigations of such variables may suggest improved procedures for preparation and storage of these cells, as well as possible ways to stimulate monocytes prior to transfusion.
Concentration of activated t lymphocytes in extracorporeal blood circulation for plasma separation
Authors: Ijichi Shinji , Mishima Masaki , Matsuda Takemasa , Izumihara Tomomaro , Kojima Kazuhisa , Niimura Tatsuru , Maruyama Ikuro , Osame Mitsuhiro
Published: February 2007

To investigate whether the proportion of activated T lymphocytes changes in an extracorporeal blood flow, we compared paired samples collected at the inlet and outlet lines of an artificial circuit for plasma separation, using a dual‐immunofluorescence flow cytometric technique. In our series of materials from patients with rheumatoid arthritis or systemic lupus erythematosus, the percentages of HLA‐DR‐positive cells in both CD4+ (P < 0.01, n = 6) and CD8+ (P < 0.05. n = 10) subsets were significantly increased in the outlet lines compared with the inlet lines, suggesting that activated T lymphocytes pass through an extracorporeal blood circuit more easily than resting T lymphocytes.
Status of therapeutic apheresis in Europe
Authors: Gurland Hans J.
Published: February 2007

The development and future trend of therapeutic apheresis in Europe was analyzed. Demographic data on its distribution were collected with the help of the marketing departments of four commercial companies. The differences in application in European countries were examined and compared with North America and Japan.