Plasma exchange: Why we do what we do

Brecher, Mark E.

doi:10.1002/jca.10041

Cited by 52 publications

(61 citation statements)

References 20 publications

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“…The absence of severe ADAMTS13 deficiency in patients with quinine-associated TMA calls into question the need to treat these patients with the same therapeutic regime as is used for idiopathic TTP. If the goal is simply to remove autoantibodies, drug and drug metabolites, we may be placing our patients at unnecessary risk by exposing the patient to 10 to 12 U of plasma per day for 7 to 14 days [27][28][29][30]. Such plasma exposure is often associated with allergic reactions (66% of patients) and transfusion-related acute lung injury, life-threatening viral transmission, or severe allergic/anaphylactic reactions, while rare, can also occur [29].…”

Section: Discussionmentioning

confidence: 93%

Is it quinine TTP/HUS or quinine TMA? ADAMTS13 levels and implications for therapy

Park

Hay

King

et al. 2009

J of Clinical Apheresis

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Thrombocytopenia with or without microangiopathy following quinine is often referred to as quinine "hypersensitivity." When schistocytes are present it is frequently termed "quinine-associated TTP/HUS." A severe deficiency of the vWF-cleaving protease, ADAMTS13, is associated with idiopathic TTP. A previous study of patients with "quinine-associated TTP/HUS" found that ADAMTS13 activities were not abnormal in 12/12 patients. A retrospective review of TTP patients with quinine-associated thrombotic microangiopathy (TMA) for whom ADAMTS13 was measured before plasma exchange was performed. Six patients were identified. All were females (age range: 43 to 73, mean = 61.7 years) and had taken quinine for leg cramps. Four of the six experienced renal failure requiring dialysis. Five of the patients had D-Dimers levels measured, all were elevated. In four patients the levels were > or = 18 times the upper limit of normal. ADAMTS13 was normal in four patients and mildly decreased in two patients. We conclude that while thrombocytopenia and schistocytosis can be seen in quinine-associated TTP/HUS, the pathophysiology seems to be distinct from that seen in most cases of idiopathic TTP (i.e., severely decreased ADAMTS13 with an inhibitor). We recommend that a TMA in association with quinine be consistently referred to as quinine-associated thrombotic microangiopathy (quinine-TMA) to better distinguish this entity from idiopathic TTP. The use of plasma exchange in quinine-TMA is called into question.

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Section: Discussionmentioning

confidence: 93%

Is it quinine TTP/HUS or quinine TMA? ADAMTS13 levels and implications for therapy

Park

Hay

King

et al. 2009

J of Clinical Apheresis

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“…Moreover, about half of the whole‐body IgG is distributed in the interstitium (extravascular compartment) and the transcapillary escape rate (the transfer rate from the extra‐ to intravascular compartment) is about 3% per hour of the intravascular mass 38. Therefore, the steady state of IgG levels in blood is obtained in approximately 2 days39 and returns to pre‐PLEX levels in a few weeks. Therefore, we consider that 2 days are sufficient to reach a steady state of IgG levels in blood and CSF.…”

Section: Discussionmentioning

confidence: 99%

Estimation of intrathecal IgG synthesis: simulation of the risk of underestimation

Bonnan

Gianoli-Guillerme

Courtade

et al. 2018

Ann Clin Transl Neurol

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ObjectiveThe low level of passively diffused IgG through the blood–brain barrier is sufficient to blur the estimation of intrathecal IgG synthesis (ITS). Therefore, this estimation requires a mathematical calculation derived from empirical laws, but the range of normal values in healthy controls is wide enough to prevent a precise calculation. This study investigated the precision of various methods of ITS estimations and their application to two clinical situations: plasma exchange and immune suppression targeting ITS.MethodsBased on a mathematical model of ITS, we constructed a population of healthy controls and applied a tunable ITS.ResultsWe demonstrate the following results: underestimation of ITS is common at individual level but true ITS is well fitted by cohorts; Q IgG increases after plasma exchange; IgG Loc calculation based on Qlim falsely increases when Q Alb decreases; the sample size required to demonstrate a decrease in ITS increases exponentially with larger Q Alb.InterpretationStudies evaluating changes in ITS level should be adjusted to Q Alb. Low amounts of ITS could be largely underestimated.

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“…Basically, the goal of PLEX (or plasmapheresis) is to remove a given volume of patient's plasma containing harmful targeted substances and to reinfuse an artificial plasma substitute in its place -the plasma exchange (Brecher, 2002).…”

Section: Principles and Goalsmentioning

confidence: 99%

Plasma Exchange in Severe Attacks Associated with Neuromyelitis Optica Spectrum Disorder

Mickael¹,

Philippe²

2012

Recent Advances in Immunology to Target Cancer, Inflammation and Infections

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Plasma exchange: Why we do what we do

Cited by 52 publications

References 20 publications

Is it quinine TTP/HUS or quinine TMA? ADAMTS13 levels and implications for therapy

Is it quinine TTP/HUS or quinine TMA? ADAMTS13 levels and implications for therapy

Estimation of intrathecal IgG synthesis: simulation of the risk of underestimation

Plasma Exchange in Severe Attacks Associated with Neuromyelitis Optica Spectrum Disorder

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