Extra corporeal membrane oxygenation and plasmapheresis for pulmonary hemorrhage in microscopic polyangiitis

Abstract

Early initiation of extracorporeal membrane oxygenation to treat acute hypoxemic respiratory failure secondary to massive pulmonary hemorrhage in microscopic polyangiitis in children can be life-saving while awaiting control of the autoimmune disease process by plasmapheresis and immunosuppression.

Therapeutic plasma exchange performed in parallel with extra corporeal membrane oxygenation for antibody mediated rejection after heart transplantation

“…A single case report exists of a patient with pulmonary hemorrhage in microscopic polyangiitis requiring ECMO support. TPE was performed in parallel with the ECMO circuit without adverse events or complications; the patient clinically improved and was eventually discharged [13]. None of these studies demonstrated safety and efficacy in patients post cardiac transplant; nor did they closely follow efficacy in reducing in HLA titers.…”

“…The procedures also pose clinical challenges with respect to maintenance of hemodynamic stability (with pressor support) and electrolyte levels. Although a few reports have been published on the use of TPE in tandem with hemodialysis [11,12], data is scarce on the safety, feasibility, and efficacy of performing TPE in parallel with ECMO [13]. In addition, the efficacy of TPE in parallel with ECMO in reducing anti-HLA antibodies or improving ventricular function has not been reported.…”

Analysis of the classical, alternative, and mannose binding lectin pathway of the complement system in the pathogenesis of oligoarticular juvenile idiopathic arthritis

“…Our data point to the AP as the main contributor in the pathogenesis of oligoarticular JIA. Therefore, intraarticular complement activation is initiated predominantly by the AP [1]. The complement activation produces the proinflammatory protein C5a, which activates macrophages and T and B lymphocytes.…”

“…Miller found an intraarticular deficiency of C3c and C3d in JIA [6]. Analysis of the peripheral blood (PB) suggested that activation of the alternative pathway (AP) of the complement system is the major contributor in the pathogenesis of JIA, culminating in the formation of the terminal membrane attack complex (MAC) and potentially leading to joint destruction [1,2,5]. A partial C4 deficiency and also elevation of C3 und C4 could be evaluated in JIA [4].…”

Pulmonary involvement in microscopic polyangiitis

“…Extracorporeal membrane oxygenation has been used successfully in a few cases [48,49]. Hayes-Bradely [50 • ] suggested that prone position ventilation could improve oxygenation by better ventilation-perfusion matching and improved drainage of blood from the dorsal lung.…”