bluuebunny/crossref_metadata_2025_split huggingface dataset:
Techniques, indications, and toxicity of therapeutic hemapheresis in children
Authors: Kasprisin Duke O. 
Published: February 2007

AbstractAlthough therapeutic hemapheresis has grown dramatically in the past decade, its utilization and popularity in pediatrics remain limited. The lack of well‐defined indications for treatment and technical difficulties in the management of hemapheresis for small patients have prevented its widespread use. However, there have been more than 130 reports describing the use of hemapheresis in children less than 15 years of age, including more than 20 reports describing it in children less than 5 years. Only one controlled trial of hemapheresis in children has been published. It studied the use of plasma exchange for the treatment of diabetes mellitus.In general, practitioners depend upon the accepted indications in adults to justify usage of this therapy in children. Unfortunately, major differences exist in the adult and pediatric presentation of certain diseases and there has not been universal acceptance of the indications for this therapy in children.Numerous technical difficulties continue to plague the development of hemapheresis therapy in pediatrics and therefore continue to limit the number of studies undertaken. The major technical difficulties include vascular access and excessive extracorporeal volume. These problems are not insurmountable since several patients less than 1 year of age have been successfully treated by hemapheresis. The various techniques used in these cases will be discussed.Additional problems unique to the pediatric population are the difficulty in getting approval for research studies that involve minors, the complexity of informed consent, the problem of patient cooperation and compliance, and the difficulty of explaining a complicated procedure to children of varying developmental levels. Although there are a few detailed studies, complications in the treatment of pediatric cases are usually a combination of technical problems and untoward reactions, and it is difficult to compare these studies with those published involving adult patients.
Thermofiltration in hypercholesterolemia treatment: Analysis of removal and posttreatment cholesterol recovery
Authors: Malchesky P. S. , Werynski A. , Nomura H. , Takeyama Y. , Yamashita M. , Nosè Y. 
Published: February 2007

AbstractThermofiltration, a system of membrane plasmapheresis for LDL apheresis, is used to treat patients with refractory hyperlipidemia. In this system, the separated plasma is warmed to or above physiologic temperature, filtered with a membrane filter, and returned to the patient on‐line. Plasma infusion products are not required.In this study one calculated plasma volume was treated weekly, biweekly, or monthly in patients classified as type II hypercholesterolemic. Reduction and sieving of lipoproteins were evaluated. The reduction ratios of high‐density lipoprotein cholesterol (HDLc) and low‐density lipoprotein cholesterol (LDLc) were 0.30 ± 0.06 and 0.58 ± 0.05, respectively (mean ± S.D.). Sieving coefficients of the plasma filter for HDLc and LDLc were 0.62 ± 0.12 and 0.03 ± 0.02, respectively (mean ± S.D. of 31 treatments).To evaluate the posttreatment recovery the apparent fractional catabolic rates (FCRa) for total cholesterol and LDLc were calculated. FCRa was 0.151 ± 0.06 and 0.148 ± 0.06 day−1 for total cholesterol and LDLc, respectively.The ratio of the posttreatment concentration on the seventh day to the concentration immediately pretreatment was found to be significantly higher for HDLc than for LDLc, 0.92 ± 0.8 vs. 0.77 ± 0.1 (mean ± S.D.), due to faster HDLc recovery. The ratio of LDLc/HDLc was lowered for up to 2 weeks after the treatments.
Modified method of exchange transfusion in sickle cell disease
Authors: Talacki Carol A. , Ballas Samir K. 
Published: February 2007

AbstractThe treatment of various complications of sickle cell disease has included red cell exchange in the past, and the development of automated pheresis equipment has greatly simplified such exchanges. Traditionally, the patient's red cells have been exchanged while their plasma was returned to them. Recently, plasma factors have been thought to play a role in the pathogenesis of vasoocclusive events. Therefore, we performed whole blood exchange, which consisted of replacement of the patient's plasma with albumin and saline in addition to the usual replacement of erythrocytes. A total of 32 whole blood exchanges were performed on 12 patients with a variety of complications of their disease. The procedure was done using standard pheresis equipment and was relatively simple to perform. There were no serious complications and the clinical outcome was good with 10 out of 12 patients experiencing improvement.
Thrombotic complications of subclavian apheresis catheters in cancer patients: Prevention with heparin infusion
Authors: Haire William D. , Edney James A. , Landmark James D. , Kessinger Anne 
Published: February 2007

AbstractTwenty‐two silicone rubber apheresis catheters were placed into the subclavian veins of 18 cancer patients to allow serial leukapheresis for collection of circulating hematopoietic stem cells. The tips of the catheters were placed in the innominate vein to avoid reinfusion of citrate into the right atrium and the resulting tendency to cardiac arrhythmias.Sixteen catheters were placed without prophylactic anticoagulation. Anticoagulation was prematurely discontinued in one patient because of the inconvenience of the portable heparin infusion pump. Six of these 17 catheters developed venographically proven thrombotic complications and five others had presumed thrombosis‐related access failure or caused symptoms of venous obstruction, but confirmation of the presence of a thrombus with venography was not obtained. Three catheters spontaneously withdrew from the vein, one during urokinase infusion for thrombosis. Only three catheters had uncomplicated apheresis courses.Prophylactic heparin infusions via portable infusion pumps were given after placement of six catheters. As long as the heparin infusions were continued all patients had uncomplicated apheresis courses. One patient's heparin was prematurely discontinued. Within 3 days of its discontinuance, radiographically proven thrombotic catheter occlusion occurred. Patients given heparin were less likely to develop complications (P lt; 0.001).No unexpected complications of apheresis were encountered as a result of the use of these catheters.Silicone rubber subclavian catheters can be used for peripheral stem cell collection but have a high frequency of thrombotic complications. Systemic anticoagulation with heparin can minimize the likelihood of these complications.
Computerization of plateletpheresis quality control records with a commercially available spreadsheet program
Authors: McLeod Bruce C. , Viernes Ann , Reed Susan , Sassetti Richard J. 
Published: February 2007

AbstractMany apheresis units lack the resources to acquire customized computer software for record keeping. We have adapted a commercially available “spreadsheet” program (Lotus 1‐2‐3) to aid in quality control activities for plateletpheresis. Data are entered in a grid pattern wherein each donation occupies one row and successive columns contain numerical data derived from the donation. The last two columns contain formulas that calculate yield and collection efficiency from values entered in preceding columns. The program runs on an IBM PC or equivalent with 512 K RAM; the combined cost of a computer and software is currently under $2,000.00. Data entry requires fewer keystrokes per record than computation of yield and efficiency with a calculator, and creates an inclusive permanent record for future analysis. Data sorting and statistical functions allow rapid identification of incomplete records, and derivation of average platelet yield and/or collection efficiency for any time period of interest. The program also facilitates determining the proportion of donations that fall below any chosen cutoff. Performance characteristics of a particular instrument or operator can be assessed easily by isolating the pertinent records and analyzing them separately. The system will thus accomplish a variety of quality control activities, including those mandated by licensing agencies. It can be implemented by apheresis personnel with limited “computer literacy” and is superior to manual tabulation of quality control data in both ease of data entry and facility of analysis.
Collection and cryopreservation of human stem and progenitor cells for bone marrow transplantation
Authors: Jacobs Peter , Wood Lucille , Horak Sue 
Published: February 2007

AbstractBone marrow collection was undertaken from human organ donors (Group 1; n = 7) to develop a closed‐system single‐step technique for stem and progenitor cell enrichment, using the Cobe 2997 continuous‐flow blood‐cell separator. The effects of programmed freezing, storage in liquid nitrogen, and thawing were then defined using these grafts. Once standardised, this method was extended to autografting following cryopreservation of a comparable fraction (Group 2; n = 8) and then to allogeneic transplantation after ex vivo exposure to the lytic monoclonal antibody, Campath‐1 IgM and human complement, but without cryopreservation (Group 3; n = 9). The median number of mononuclear cells harvested was 5.0 × 106/mL (n = 24), and this was not significantly different in the three groups. The ex vivo graft, composing marrow rich anticoagulated whole blood, was recirculated in the separator at a flow rate of 60 mL/minute, with a centrifuge speed of 1,100 r.p.m., and the mononuclear cell fractions were collected at the rate of 1.5 mL/minute. The average procedure time from formation of the interface in the single disposable channel to achievement of the final volume was 90 minutes. The mean recovery of the mononuclear cells was 101.4% (SD 38.0) and the GM:CFUc was 91% (SD 43.86). These figures were not significantly influenced by subsequent cryopreservation (Group 1; n = 7 and Group 2; n = 8) or following exposure to the monoclonal antibody, Campath‐1 IgM (Group 3; n = 9). The Cobe Model 2997 continuous‐flow blood fraction separator is ideally suited for the ex vivo enrichment of human bone marrow stem and progenitor cells in a volume that makes handling practical by a technique that is rapid and readily applicable to both autografting and allogeneic transplantation programmes.
The fenwal CS3000 inline pack is acceptable for donor blood sampling
Authors: Dayton Paula J. , Randels M. Joleen , Strauss Ronald G. 
Published: February 2007

AbstractA blood sampling pack is available on closed system apheresis kits for the Fenwal CS3000 blood cell separator to facilitate same day donor testing while maintaining the closed system. Conceivably, the accuracy of complete blood counts (CBC) performed using pack samples might be compromised by clotting in the pack, by adherence of blood cells to the inner surface of the pack, or by dilution of the sample with priming fluid—should it inadvertently contaminate the pack. We studied paired blood samples collected simultaneously via the pack and a separate venipuncture in 17 donors. When collected properly, CBC values from pack and vein were nearly identical. Even when purposely contaminated with saline, pack values were lowered only slightly. Thus, the inline pack permits accurate sampling of donor blood for CBC while maintaining a closed system.
Experimental models of plasma perfusion
Authors: Pusey Charles D. , Aslam Mohammed , Cohen Jon , Courtney James M. , Ryan Calvin J. 
Published: February 2007

AbstractA system allowing repeated plasma perfusion in the unrestrained conscious rat was developed in order to examine the effects of plasma filtration with on‐line sorbent treatment of plasma in various models of disease. In experimental autoimmune glomerulonephritis, perfusion over a column coated with glomerular basement membrane (GBM) antigen lowered circulating levels of anti‐GBM antibodies. In experimental endotoxaemia, perfusion over a column coated with polymixin B (PB) lowered circulating endotoxin levels and protected animals from haematological abnormalities and death. In experimental acute hepatic failure, perfusion over a combination of charcoal, resin, and PB columns improved survival in grades II and III hepatic coma. This experimental system has allowed preclinical evaluation of the effectiveness of different sorbents in the treatment of a range of disorders.
Preparation and storage of “leukocyte‐depleted single donor” platelet concentrate: A step forward in effective haemotherapy
Authors: Elias Mona K. , de Wolf Joost Th. M. , Blom Nel , Rijskamp Luit , Halie Ruud M. , Sibinga Cees Th. Smit 
Published: February 2007

Abstract“Leukocyte‐depleted” platelet concentrates (LD‐SDPC) were prepared by cotton‐wool and by polyester filtration of “leukocyte‐poor” PC collected by the elutriation technique. The storage characteristics of LD‐SDPC were comparable to those of the filtered pools of multiple donor platelet concentrates (LD‐MDPC). However, LD‐SDPC were less activated and less damaged than LD‐MDPC over a 7‐day storage period, as evidenced by β‐thromboglobin percent release and lactic dehydrogenase percent leakage in both products. LD‐SDPC were prophylactically transfused to 12 thrombocytopenic patients; the mean bleeding time was shortened from 12 min 20 sec to 4 min 39 sec. Corrected count increment (CCI) was 22.8 at 1 hr and 14.1 at 24 hr compared to 15.5 and 10.0, respectively, with standard PCs.
Use of continuous flow erythrocytapheresis in pregnant patients with sickle cell disease
Authors: Morrison John C. , Morrison Francis S. , Floyd Randall C. , Roberts William E. , Hess L. Wayne , Wiser Winfred L. 
Published: February 2007

AbstractThe role of partial prophylactic red cell exchange transfusion in the management of pregnant patients with major sickle hemoglobinopathies is unclear. Over a 10‐year period, 131 pregnant patients with major hemoglobinopathies (HbS 101, HbS‐C 30) were managed by the same group of physicians. Of these, 103 received partial prophylactic exchange transfusion early during prenatal care while 28 received blood only when serious complications developed (control group). Patients treated with exchange transfusion received continuous flow erythrocytapheresis on an outpatient basis. The results indicate that there were fewer crises (P = .0001), a reduction in other significant medical complications (P = .002), and a decrease in maternal hospital days (P = .05) in those receiving prophylactic transfusions compared to women in the control group. The number of preterm deliveries (P = .004), the prevalence of low birthweight infants (P = .01), and the perinatal death rate (P = .01) were significantly lower among those who were routinely transfused. Two patients developed hepatitis, five had transfusion reactions, and 11 were found to have alloantibodies among those receiving prophylactic transfusions versus one, two, and five patients, respectively, in the control group. The results indicate a benefit of this methodology in the treatment of pregnant sickle cell patients in our population. However, a national collaborative randomized study is needed to adequately address the controversy regarding the use of red cell exchange in the pregnant sickler.
Granulocyte collection
Authors: Strauss Ronald G. , Rohret Patricia A. , Randels M. Joleen , Winegarden Diane C. 
Published: February 2007

AbstractTechniques for collecting granulocytes for transfusion either to neutropenic patients or to neonates are described. Currently, the best granulocyte concentrates are prepared using continuous‐flow centrifugation leukapheresis of steroid‐stimulated donors in the presence of pentastarch. Donor reactions are mild and are similar to those expected with automated plateletpheresis.
Donor reactions during DDAVP‐stimulated plasmapheresis
Authors: Randels M. Joleen , Strauss Ronald G. , Cordle Delores , Koerner Theodore A. W. , Floss Alice S. 
Published: February 2007

AbstractDonor exposure can be strikingly reduced for patients with classical hemophilia A and von Willebrand's disease when large volumes of potent cryoprecipitated AHF are prepared from donors following DDAVP (1‐deamino‐8‐D‐arginine vasopressin) stimulation and automated plasmapheresis—a procedure called “plasma exchange donation.” Although this procedure has been reported to be relatively safe for donors, data are limited. Accordingly, we studied 20 donors during 48 procedures using DDAVP (0.3 μg/kg IV) followed by 2–3 L plasma collection. Replacement fluid for each initial plasma exchange donation was plasma protein fraction; autologous cryoprecipitate‐poor plasma was used for subsequent procedures. Mild reactions, particularly facial flushing, were noted in all 48 procedures. No procedure was discontinued, but four were modified due to either an increased pulse rate (≤20/min from baseline) or a fall in systolic or diastolic blood pressure (≤20 mm Hg from baseline). No donor was deferred or withdrew from the program. Based on our modest experience, DDAVP stimulated plasma exchange donation appears to be a safe and effective method for collecting large quantities of plasma from which potent cryoprecipitated AHF can be prepared. © 1992 Wiley‐Liss, Inc.
Selective removal of anti‐acetylcholine receptor antibody in the low temperature operation of membrane plasma fractionation
Authors: Sawada Koji , Malchesky Paul S. , Zborowski Maciej , Koo Anna P. 
Published: February 2007

AbstractThe removal of anti‐acetylcholine receptor antibody (anti‐AChR Ab) by the plasma fractionator, Kuraray EVAL 2A, was measured as a function of the filtration temperature (4 and 37°C). Plasmas procured from eight myasthenia gravis (MG) patients undergoing routine plasma exchanges (PE: membrane plasma filtration: n = 4, and centrifugation: n = 4) were used in the studies. Plasma flow rate was 20 ml/min, and plasma perfusion in single pass was terminated when the transmembrane pressure of the filter reached 300 mm Hg. Solute concentration data from before and after perfusion were used to assess the sieving coefficient (SC) of each solute. Results show that the SCs for anti‐AChR Ab and albumin were significantly (P < .0002) lower at 4°C (0.15 and 0.52, respectively) as compared to 37°C (0.44 and 0.72, respectively). The SC of anti‐AChR Ab (0.15) was significantly lower than the SC of IgG (0.42; P < .006) at 4°C, even though it also belongs to the IgG class. The ratio of the SC of anti‐AChR Ab to albumin at 4°C (0.29) was significantly lower than that at 37°C (0.57; P < .003). These data indicate that the selectivity of removal of anti‐AChR Ab from albumin is higher at 4°C than that at 37°C. The volume treated at 4°C was significantly lower than that treated at 37°C, and it was less than that required for a clinical treatment; however, it was shown that filter backwashing is possible without loss of solute removal selectivity. Membrane filtration at 4°C for the removal of anti‐AChR Abs in MG patients could provide an alternative to PE and reduce the demand on plasma replacement products. © 1992 Wiley‐Liss, Inc.
Hematopoietic stem cell processing and cryopreservation
Authors: Rowley Scott D. 
Published: February 2007

AbstractEither bone marrow or peripheral blood may be harvested to provide hematopoietic stem cells (HSC) for autologous transplantation. Both, however, comprise heterogeneous cell populations. The HSC necessary for successful engraftment constitute a very small fraction of the cells harvested. After collection, the harvested cells usually undergo several processing steps to reduce the product volume, remove cells (such as mature blood cells or tumor cells), or to cryopreserve the cells for later reinfusion. Granulocytes and red blood cells, for example, survive cryopreservation poorly using freezing techniques designed for HSC. Therefore, bone marrows being cryopreserved must be depleted of mature blood cells to avoid toxicity from infusion of damaged mature blood cells. Mature blood cells may also impede the variety of tumor cell purging techniques currently being studied. These processings are designed to minimize the loss of HSC while achieving an appropriate HSC product for the individual patient. A number of apheresis devices and cell washers simplify the enrichment of HSC in the harvested cell products. In contrast, tumor cell purging techniques are not standardized between the various transplant centers. © 1992 Wiley‐Liss, Inc.
Successful management of paraprotein‐associated peripheral polyneuropathies by immunoadsorption of plasma with staphylococcal protein A
Authors: Weinstein Robert , Sato P. T. Sachiko , Shelton Kimaada , Hartigan Nancy , Ropper Allan H. , Hayes Michael , Cardillo Kathleen 
Published: February 2007

AbstractTwo patients with paraprotein‐associated peripheral polyneuropathy were treated successfully using immunoadsorption of patient's plasma with staphylococcal protein A. Both had previously been treated with immunosuppressive agents or plasma exchange, and were rapidly relapsing at the time of their protein A immunoadsorption therapy. One patient was treated “on‐line” with a blood cell separator, and one was treated “off‐line.” Both responded well to therapy with minimal toxicity. Serum levels of circulating immune complexes were elevated in one patient and remained so during and after therapy. Immunoadsorption with protein A should be investigated as a therapeutic option for patients with paraprotein‐associated peripheral polyneuropathy. The therapy is relatively easy to administer, particularly “off‐line,” and was well tolerated by our patients. More experience, including formal clinical trials, will be required to properly define the indications for, and mechanism of response to, this therapy. © 1993 Wiley‐Liss, Inc.
Immunomodulation during treatment of polymyositis with plasmapheresis and immunosuppressive drugs
Authors: Dau Peter C. 
Published: February 2007

AbstractImmunologic studies were carried out in a patient with polymyositis (PM), who showed increasing muscle strength and decreasing serum creatine phosphokinase levels during 20 weeks of treatment with plasmapheresis in conjunction with prednisone and cyclophosphamide. After an initial rise, serum IgG declined with treatment. Natural killer (NK) lymphocytes were reduced by 74%, B cells by 95%, and T cells by 38%. Spontaneous proliferation of peripheral blood mononuclear cells increased dramatically. Within the CD4+ T cell subset there was increasing maturation as shown by a rise in percent mature (CD29+) cells and reciprocal decline of immature (CD45RA+) cells. At the same time CD4+ T cells became increasingly activated as shown by HLA‐DR expression.The percentage of CD8+ T cells increased strongly with treatment, and they showed increased activation and expression of the cytotoxic CD29+ and CD11b‐ phenotypes. CD8+ T cells exhibiting CD45RA or CD11b+ suppressor phenotypes were overall unchanged; however, on follow‐up a proportion of CD8+ cells expressed the activated suppressor effector (CD11b—CD28—) phenotype. In addition to control of PM by the possible deletion of activated autoreactive B and T lymphocyte clones with cyclophosphamide, the activation and maturation of CD4+ T cells during treatment may have downregulated the autoreactive disease process, either through direct antiidiotypic suppression or by induction of the observed increase in cytotoxic and suppressor CD8+ T cells. © 1994 Wiley‐Liss, Inc.