bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thrombotic thrombocytopenic purpura: Report of fourteen cases—occurrence during pregnancy and response to plasma exchange
Authors: Caggiano Vincent , Fernando Leonor P. , Schneider Jack M. , Haesslein Hanns C. , Watson‐Williams Edward J. 
Published: February 2007

AbstractThrombotic thrombocytopenic purpura (TTP), a syndrome of diverse etiology probably related to factors regulating platelet‐vessel wall interaction, is predominantly a disorder of women. We report our experience with 14 patients in an 11‐year period. Thirteen were female and aged between 25–69 years. Four were postmenopausal, and of the nine premenopausal women three were pregnant, one was immediately postpartum, and three were taking estrogennine premenopausal women three were pregnant, one was immediately postpartum, and three were taking estrogen‐containing oral contraceptives. A review of the literature confirms the two to one female/male preponderance and that TTP is reported in 56 women who are pregnant or recently postpartum. While this association with possible hormonal events has been noted, it has previously received little comment. We stress the similarity between TTP and some occurrences of preeclamptic toxemia, and that this may suggest not only a common etiology but that therapeutic attempts should be similar.While no single therapeutic modality is universally successful, our experience is that plasma exchange is the most effective, with five of seven patients so‐treated obtaining prolonged remission; four of five patients responded to splenectomy and corticosteroids, but one died of infection postoperatively. Five patients, including two treated exclusively with antiplatelet aggregating agents, died without achieving remission. The frequency of successful therapy is not changed by the concurrent pregnancy, but the fetal loss is high. There does seem to be an increased risk of recurrence of TTP in a subsequent pregnancy, and this might be considered when counseling premenopausal patients who have achieved remission of TTP.
A trial of immunotherapy in aplastic anemia and pure red cell aplasia
Authors: Young Neal S. , Klein Harvey G. , Griffith Patricia , Nienhuis Arthur W. 
Published: February 2007

AbstractImmunotherapy, consisting of lymphocyte depletion or plasmapheresis in combination with cyclophosphamide and prednisone, was employed in three patients with refractory pure red cell aplasia and six patients with aplastic anemia of various etiologies. All three patients with pure red cell aplasia responded to plasmapheresis. One patient with atypical aplastic anemia showed partial recovery following lymphocyte depletion; the other five patients showed no evidence of a clinical response. The effect of patients' sera or bone marrow on formation of myeloid or erythroid colonies by bone marrow from normal individuals was determined in vitro. A decline in serum inhibition of erythroid colony formation was observed in the patients with pure red cell aplasia following treatment. Any changes in serum inhibition were less marked or unrelated to treatment outcome in the patients with aplastic anemia, although the single patient who responded to lymphocyte depletion exhibited reversal of coculture bone marrow inhibition. Our experience suggests that in vitro assay methods may not adequately predict the response of patients with aplastic anemia to this form of immunotherapy, and furthermore clinical improvement was too sporadic for this treatment to be recommended. Plasmapheresis may be a useful adjunct in patients with pure red cell aplasia, but remissions may not be dramatic or sustained.
Intensive plasma exchange in small and critically ill pediatric patients: Techniques and clinical outcome
Authors: Fosburg Martin , Dolan Mary , Propper Richard , Wolfe Lawrence , Kevy Sherwin 
Published: February 2007

AbstractStandard apheresis techniques require modification of use in children, particularly those with serious concurrent medical problems, as they are prone to apheresis‐induced disturbances of volume, metabolism, and coagulation. We report 112 plasma exchanges (TPE) on 11 children, 9 of whom weighed less than 20 kg and 7 of whom were critically ill. All were treated on continuous flow apparatus; seven on centrifugal systems (CS), two on a membrane filtration system (MFS), and two on both. Perturbations of blood and red blood cell (RBC) volume were prevented by priming the extracorporeal circuits with a red cell saline mixture having an hematocrit equal to or greater than the patient's hematocrit. Priming volume and minimal flow rates were 170 ml and 40 cc/min (MFS) and 350 ml and 10 cc/min (CS). TPE dose varied from 1.3 to 3 plasma volumes. Immunoglobulins fell by the following amounts: IgG 43.7%, IgA 36.7%, and IgM 41% per plasma volume. Platelets fell by 20–90% (CS) and 5–7% (MFS). Vascular access was obtained by various means including Thomas shunts, dialysis catheters, and standard 16–19 gauge butterflies and angiocaths. Bleeding in patients with coagulopathies was prevented by using repeated small boluses of heparin to maintain a clotting time of 2.5–3 minutes. Morbidity from TPE was limited to citrate toxicity (2 patients) and transient pulmonary edema (1 patient).Treatment outcome was successful in 8 out of 11 patients. We have shown that if PEX is otherwise indicated, it should not be withheld solely for patient size or the complexity of concurrent medical problems.
Comparison of filtration to continuous‐flow centrifugation for plasma exchange
Authors: Wood Lucille , Bond Rodney , Jacobs Peter 
Published: February 2007

AbstractThe Asahi Plasmaflo Hollow Nylon Fibre Filtration System (n = 13) was directly compared to the NCI‐IBM 2990 Continuous‐Flow Blood Fraction Separator (n = 10) for plasma exchange. The systems were equally efficient in achieving plasma separation. There were significant differences favouring filtration for clearance of fibrinogen (P < 0.05), and the fourth component of complement (P < 0.01). Greater loss of urea (P < 0.05) was found after plasma exchange, using the cell separator. The flow characteristics were markedly different. In a standardised 4‐L plasma exchange, filtration took place at 35 ml/minute, with a procedure time of 109 ± 45 minutes in contrast to centrifugation at a plasma flow collection rate of 19 ml/minute, requiring 208 ± 17 minutes. This time advantage for the former procedure was offset by 195 minutes required to regenerate the hollow nylon fibre unit and a further 90 minutes required for cleaning under strictly controlled aseptic techniques prior to reuse. Each filter was regenerated at least twice and reused without infection, but there was incremental loss of filtration efficiency demonstrated by decreasing clearance of an intravascular marker dye. In two of the 13 procedures using the Plasmaflo system, serious reactions necessitated termination of the procedure; this did not occur using the cell separator. Restriction of the number of times that the filter unit could be regenerated without loss of efficiency, the prolonged time required for regeneration and cleaning, coupled with the need for artifical vascular access to meet high blood flow rates required, limit the usefulness of this technique for plasma exchange.
Plasmapheresis versus lymphoplasmapheresis in rheumatoid arthritis: Immunologic comparisons and literature review
Authors: Wallace Daniel J. , Medici Michael A. , Nichols Sherri , Klinenberg James R. , Brck Miriam , Gatti Richard , Goidfinger Dennis 
Published: February 2007

AbstractEight patients with Functional Class III. seropositive, erosive rheumatoid arthritis unresponsive to remittive drugs each underwent nine aphereses over 3 weeks. Four had a 40‐ml/kg plasma exchange and four others had a 40‐ml/ kg plasma exchange plus a mean 5.67 × 109 lymphocyte depletion. Both groups appeared to improve clinically. T and B cell counts and OK T4 and OK T8 ratios decreased in the lymphoplasmapheresis group. Phytohemagglutinin stimulation decreased in lymphoplasmapheresis and increased in plasmapheresis patients with significant comparisons (p = 0.02). These findings confirm and extend previous work. Plasmapheresis and lymphoplasmapheresis appear to have fundamentally different actions on lymphocyte function.
Drug‐resistant bronchial asthma successfully treated with plasma exchange
Authors: Bambauer R. , Jutzler G. A. , Micka K. , Austgen M. , Schlimmer P. , Trendelenburg F. 
Published: February 2007

AbstractTwo patients suffering from allergic bronchial asthma who showed no improvement despite six and four weeks, respectively, of drug therapy were successfully treated with therapeutic plasma exchange. The first patient had no attacks over a period of five months, and the other patient had none for over one year. Although this report only deals with single observations, we believe that therapeutic plasma exchange is of particular value for patients with severe allergic bronchial asthma because it eliminates in addition to immunocomplexes other substances, including antigens, rapidly from the blood. This means that it is possible to directly intervene in the pathomechanism. However, further investigations are necessary in order to corroborate this successful therapy.
Therapeutic trial of plasma exchange in osteosclerotic myeloma associated with the poems syndrome
Authors: Silberstein L. E. , Duggan D. , Berkman E. M. 
Published: February 2007

AbstractA patient with osteosclerotic myeloma and POEMS syndrome, unresponsive to pulse prednisone and melphalan therapy, was admitted to the hospital for a trial of plasma exchange therapy. The presentation included IgG lambda monoclonal gammopathy, peripheral neuropathy, hepatosplenomegaly, hyperpigmentation and thickening of the skin, edema, and tense ascites. Laboratory tests confirmed hypothyroidism, hypogonadism, and adrenal insufficiency. Six exchange procedures failed to affect the clinical course, and the patient died. Greater‐than‐one‐plasma‐volume exchanges (patient's measured plasma volume, 2,703 cc) were performed. When IgG and cholesterol removal were compared to the predicted removal, based on the volume of plasma removed, significantly less reduction in concentration than predicted was measured. IgG concentrations increased postapheresis and, at 2 weeks, three‐fourths of the removed IgG had reaccumulated. A reduced efficiency of removal of both IgG and cholesterol can be explained by postulating increased vascular permeability with free exchange of soluble substances from one compartment to another. If an abnormal product is produced by the disease and is responsible for the clinical syndrome, a more intensive schedule of plasma exchange therapy may be needed to achieve a sustained depletion of the responsible soluble substance. Alternatively, neither increased vascular permeability or the clinical manifestations are responsive to removal of a soluble substance or are caused by a soluble substance produced by the malignancy.
Acquired immunodeficiency syndrome (AIDS) ‐ apheresis and operative risks
Authors: Kiprov Dobri D. , Lippert Randolph , Sandstrom Erik , Jones Frank R. , Cohen Richard J. , Abrams Donald , Busch David F. 
Published: February 2007

AbstractThe removal of immune complexes, autoantibodies and suppressor factors from the circulation of patients with AIDS and AIDS related conditions by plasmapheresis and selective immunoadsorption may play a role as a therapeutic modality in these disorders. Lymphocytapheresis may also be of potential use in AIDS related conditions with presumed autoimmune basis. Perfusion of plasma over immobilized protein A columns is being evaluated as a possible immunomodulatory and antitumor therapy in patients with AIDS related Kaposi's sarcoma. Although apheresis procedures as a therapeutic modality in AIDS related conditions are still at the experimental stage, preliminary results are encouraging. The possible transmission of the disease by blood products presents a health hazard to health workers involved in the field of apheresis. Since the mode of transmission of the disease appears to be similar to hepatitis B, strict hepatitis B precautions should be enforced in every case in which AIDS suspected blood is being processed.
The effect of serial therapeutic plasmapheresis on platelet count, coagulation factors, plasma immunoglobulin, and complement levels
Authors: Wood Lucille , Jacobs Peter 
Published: February 2007

AbstractOne hundred therapeutic phasmaphereses were carried out at biweekly intervals in seven patients, without morbidity or mortality, using the IBM 2997 blood fraction separator. In standardised procedures, 1.5 times the calculated plasma volume was replaced with an electrolyte solution containing 4% salt‐free human albumin. Anticoagulation was achieved using a whole venous blood to acid‐citrate dextrose ratio of 11 to 1. Median flow rates, plasma collection, and procedure times were respectively 40 ml/minute, 20 ml/minute, and 3 hours. Haemoglobin and total white cell counts were not significantly affected by the procedures. In contrast, platelet count, fibrinogen, immunoglobulin levels, total haemolytic complement, as well as C3 and C4 fractions fell, and the prothrombin and partial thromboplastin times were lengthened by the exchanges. All these measurements had returned to normal within 24 hours, apart from the fibrinogen, which took between 48 and 72 hours, and the immunoglobulin level, which required 35 days to return to baseline. In a further patient, more detailed studies (n = 13) were carried out to characterise the behaviour of antithrombin III and factor VIII. Both levels were markedly reduced immediately following the procedure and, like fibrinogen, had returned to normal within 48 hours. These data indicate that in an isovolaemic plasmapheresis there was a transient but rapidly reversible effect on all the factors studied, with fibrinogen level, antithrombin III, and factor VIII returning more slowly to normal than the others, and immunoglobulin levels responding the slowest. None of these changes was associated with clinically significant haemostatic abnormalities. It is concluded that there is no need to use fresh frozen plasma as replacement fluid, thereby avoiding the risk of hepatitis, and, secondly, that although transient decrease is demonstrable in coagulation and associated factors, patients can nevertheless be safely treated once every 48 hours using an albumin and electrolyte solution unless there is a pre‐existing abnormality in the haemostatic mechanism.
Risk of AIDS‐related virus (human immunodeficiency virus) transmission through apheresis procedures
Authors: Kiprov Dobri , Simpson Denyse , Romanick‐Schmiedl Sue , Lippert Randolph , Spira Thomas , Busch David 
Published: February 2007

AbstractSince exposure to blood products occurs on a daily basis during hemapheresis, the acquired immunodeficiency syndrome (AIDS) epidemic has a serious impact both for patients undergoing apheresis procedures as well as for health professionals working in the field. We studied serum samples from 110 patients who underwent therapeutic plasmapheresis for a variety of diseases not related to AIDS for the presence of antibodies to human immunodeficiency virus (HIV). Exchange fluids used in the majority of the patients were plasma protein fraction and 5% human albumin. Four patients received only fresh‐frozen plasma. Fifty‐five patients also received IV gammaglobulin. The follow‐up period exceeded 24 months. All patients who did not belong to any known high‐risk group for AIDS were negative for HIV antibodies prior to treatment and remained negative at last follow‐up. Seven patients were homosexual men. All seven were seropositive prior to plasmapheresis and remained so throughout the treatment period.Seven health professional working in a busy haemapheresis unit were followed for 2 1/2 years. All remain HIV seronegative with normal immune function.These data indicate that transmission of HIV is unlikely through haemapheresis procedures.
Phenytoin removal during plasma exchange
Authors: White Roger L. , Garnett William R. , Allen Jody H. , Kline Berry J. , Sharp David E. 
Published: February 2007

AbstractPlasma exchange is currently being used to treat a variety of disorders including immune complex and hematologic disorders. It has been shown that the removal of plasma removes drugs bound to plasma proteins. This case documents the removal of phenytoin during plasma exchange therapy. Total and free phenytoin serum concentrations were obtained before and after each exchange. Aliquots were obtained from each pass, and total phenytoin concentrations were determined. The total phenytoin serum concentration increased during the first exchange, while the total concentration decreased as a result of the second exchange. It was determined that approximately 27.7 mg and 30.4 mg of phenytoin were removed by the first and second plasma exchanges, respectively.
Aluminium loading during therapeutic plasma exchange
Authors: Monteagudo Felix , Wood Lucille , Jacobs Peter , Folb Peter , Cassidy Michael 
Published: February 2007

AbstractGraphite furnace atomic absorption spectroscopy was used to demonstrate a fivefold increase in the median plasma aluminium levels of four patients undergoing therapeutic plasmapheresis. This plasma aluminium loading resulted from contamination of albumin incorporated in the replacement fluids and took place during its preparation, with albumin aluminium levels of 646, 669, and 715 μg/liter present in three representative samples. Aluminium overload may result in the development of encephalopathy and osteomalacia in patients with renal impairment, indicating the need to monitor aluminium levels in the albumin‐containing replacement fluids to avoid this potential hazard.
Leukocytapheresis in inclusion body myositis
Authors: Dau Peter C. 
Published: February 2007

AbstractA patient with inclusion body myositis was treated with a course of 22 leukocytaphereses combined with prednisone and azathioprine therapy. He improved clinically during an induction phase of frequent cytapheresis, which reduced the circulating levels of T lymphocytes and monocytes and decreased the ratio of the T4+ to T8+ lymphocyte subsets. During subsequent maintenance cytapheresis there was partial recovery of the T4+ population without recovery of T8+ lymphocytes, and the patient lost most of his clinical improvement. In contrast to T lymphocytes and monocytes, there was no persistent reduction in circulating Blymphocyte levels during the course of therapy. T8+ lymphocyte populations may regenerate more slowly than T4+ lymphocytes following depletion with leukocyatpheresis combined with prednisone and azathioprine therapy. A loss of of T8+ suppressor relative to T4+ helper‐cell function could lead to an intensification of autoimmune conditions.
The effect of plateletpheresis on the fenwal CS‐3000 on donor platelet counts
Authors: Kalish Robert I. , Chambers Linda A. , Linden Jeanne V. 
Published: February 2007

AbstractTo evaluate the risk of significant plateletpheresis‐induced thrombocytopenia in normal volunteer donors undergoing plateletpheresis less frequently than every 56 days and to help understand factors influencing platelet yield in these donors, pre‐ and postapheresis platelet counts (×103/μl) and platelet yields were analyzed from 916 plateletpheresis procedures (Fenwal CS‐3000) on 607 donors (405 men, 202 women). The mean preaphresis platelet count was 265 ± 59 (SD) (range 155‐650) (men 256 ± 55 [170‐444]; women 284 ± 65 [155‐650]; P < .001, t‐test). After an average platelet yield of 4.08 × 1011, the mean postplatelet count was 185 ± 46 (range 72‐420) (men 184 ± 42 [80‐345]; women 194 ± 52 [72‐500]; P < 0.1). The percent decrease in platelet count (mean 29.4 ± 13, range −28.1‐65.5) had positive correlations with platelet yield (P < .01, r = 0.10), predonation platelet count (P < .001, r = 0.29), and age (P < .01, r = .10) and a negative correlation with weight (P < .001, r = 0.18) Both the percent decrease and platelet yield were significantly higher in women than in men (P < .001, t‐test), and platelet yield was best predicted by preapheresis platelet count in both sexes (r = 0.65). The effects of plateletpheresis on donor platelet count thus vary widely among donors. Although a decrease of greater than 50% was not a rare event (5.9% of all procedures), in only three instances (0.3%) was the actual postapheresis platelet count below 100 (72, 94, 95). Thus, plateletpheresis in normal donors appears unlikely to produce clinically significant thrombocytopenia immediately after apheresis.
Multiple use of plasmafilters
Authors: Lai Kar Neng , Lai Fernand Mac‐Moune , Lam Christopher W. K. , Kung Jean L. S. 
Published: February 2007

AbstractThe practice of multiple use of membrane plasmafilters was examined in six patients receiving intermittent or regular plasmapheresis treatment. The plasmafilters were cleaned by flushing and ultrafiltration using positive pressure in the blood and filtrate compartments of the plasmafilter. Twenty‐six plasmafilters were studied and the membrane permeability characteristics were examined during 56 plasmapheresis treatments with reused plasmafilters. The clearances of nitrogen urea and creatinine, and the sieving coefficients of albumin and immunoglobulins remained unchanged with the reuse of plasmafilters. The practice is safe, efficient, and can contribute to cost containment in plasmapheresis treatment.
New application of the autotrans: Autologous support of the organ donor and salvage of the donor's red blood cells for the transfusion support of organ recipients
Authors: Valbonesi Mauro , Ferrari Mauro , Zia Susanna , Piri Carlo , Fella Mauro , Pittaluga Pierantonlo , Zat Carla , Concaro Alessandro , Fontana Iris , Destefano Francesco , Ciappina Gian Franco , Canale Marcello 
Published: February 2007

AbstractOrgan donation is usually limited to solid tissues; paradoxically, organ donors undergoing expiant are often transfused in preparation for or during surgery. This practice increases the requirement for blood and adds immunological and infectious risks for both recipients and donors of grafts. We have investigated the possibility of supporting an expiant with intraoperative blood salvage and, in the case of a cadaver donor, at the end of the operation, salvaging blood for potential use in the graft recipient. This preliminary report describes the technique and the results obtained in two procedures. The volume of red cells with a hematocrit of 55% obtained from the two donors was 2,090 and 1.180 ml, respectively. These components were employed for the transfusion support of the organ recipients.