Background. Plasmapheresis is one of the methods of extracorporeal blood purification involving the removal of inflammatory mediators and antibodies. The procedure is used in a variety of ailments, including autoimmune diseases. The aim of the present study was to analyse the incidence of plasmapheresis-related complications in patients treated in the intensive care unit (ICU). Methods. The analysis involved 370 plasmapheresis procedures in 54 patients. The data were collected from patients` medical records, including procedure protocols. Results. The most common diseases treated with plasmapheresis included: myasthenia gravis (33.3%), Guillain-Barré syndrome (14%), Lyell's syndrome (9.3%), systemic lupus erythematosus (7.4%), and thrombotic thromcytopenic purpura (7.4%). The adverse side effects observed most frequently during plasma filtration were decreases in arterial blood pressure (8.4% of all procedures), arrhythmias (3.5%), sensations of cold with temporarily elevated temperature and paresthesias (1.1%, each). In most cases, the symptoms were mild and transient. Severe and life-threatening episodes, i.e. shock, drops in arterial blood pressure requiring catecholamines administration, persistent arrhythmias and haemolysis, developed in 2.16% of procedures. Conclusions. Plasmapheresis can be considered a relatively safe method of treatment of ICU patients. Continuous observation and proper monitoring of patients provided by highly trained medical personnel are essential for its safety.
CLINICAL IMAGE Strawberry gingivitis as the first manifestation of granulomatosis with polyangiitis 551in the region of the left first premolar, canine, and incisors, and on the right side, in the second incisor (FIGurE 1B). Since these lesions are most often found in granulomatosis with polyangitis (GPA; formerly known as Wegener's granulomatosis), the patient was referred to the autoimmune diseases department for further tests. No tissue biopsy was taken owing to the history of intense bleeding. Further laboratory tests revealed positive results for antineutrophil cytoplasmic antibodies (ANCA; 1:40 titer) directed against proteinase 3 (PR3, cANCA; 72 RU/ml). A computed tomography scan showed inflammatory masses in the paranasal sinuses and middle ear on the right side, and multiple nodules in both lungs. Significant conductive hearing impairment was confirmed using pure tone audiometry, while pulmonary function tests remained normal. Diagnosis of GPA was established, and treatment was initiated with methylprednisolone and cyclophosphamide (CTX) pulses. After 10 weeks of treatment (cumulative CTX dose of 4 g), the patient's general condition improved, gingival lesions completely resolved, and no further bleeding episodes from the nose and gums were reported.A 49-year-old previously healthy male patient was referred to the Institute of Dentistry, Jagiellonian University Medical College, Kraków, Poland, because of bleeding hypertrophic lesions on his gum, which developed a few weeks earlier. In the past 6 months, he had lost 7 kg without dieting, and he complained of persistent fatigue. One month before the oral manifestations, he had had several episodes of epistaxis and developed significant persistent hearing loss and tinnitus on the right side. The laboratory tests revealed lymphopenia (0.8 × 10 3 /µl; 11% of the total leukocyte count of 7.26 × 10 3 /l), an increased level of C-reactive protein (90 mg/l), and discrete proteinuria (0.09 g/l) with active urine sediment presenting as 5 to 8 red blood cells per high power field. Other kidney function parameters were within the normal range. Intraoral examination showed circumscribed, erythematous gingival enlargement typical for "strawberry-like" gingivitis. The swollen, reddened, and granular pathological lesions were located mainly on the gingiva and mucosa in the region of the right maxillary first premolar and second incisor, and the left incisors and canine (FIGurE 1A). In the mandible, the lesions were less extensive and were located FIGurE 1 A -strawberry gingivitis in the maxilla; B -strawberry gingivitis in the mandible A B
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