Plasmapheresis therapy of immunologic disease: Report of nine cases and review of the literature

Mathematical modeling of the impact of recirculation on exchange kinetics in tandem extracorporeal membrane oxygenation and therapeutic plasma exchange

“…We have also demonstrated that variations in the inlet flow rate, hematocrit, and cardiac output in hypothetical patient scenarios involving representative parameters from both children and adults do not appear to influence these findings. Additionally, the exponential decay curve observed from our mathematical model retains the relationships of previously developed equations modeling theoretical depletion of soluble substances from plasma by continuous flow TPE using a one‐compartment model (i.e., the commonly used equation = e −(plasma volumes processed) , where γ ( t ) and γ (0) represent the fractions of an intravascular substance remaining at times t and 0, respectively) 11‐14 …”

“…Importantly, assessing any detrimental clinical impacts of recirculation as a function of vascular access configuration in tandem ECMO and TPE may also be simultaneously addressed, though this would require a much larger study with a more restricted study population. It is noteworthy that other conceptual mathematical models have generated accurate analyses of clinical issues in transfusion medicine and therapeutic apheresis with similar assumptions 8‐11,20‐30 …”

Circulating Immune Complexes in Rheumatoid Arthritis

“…The system described was designed to enable such long-term therapy to occur without requirement for extensive replacement of plasma protein by selectively removing circulating immune complexes in low volume and with 2,000 1,000 MPS tt t t t t t tt t t t t t t t t t lt t t Days minimal loss of other plasma proteins. The procedure was successful in (1) selectively removing circulating immune complexes in rheumatoid arthritis as measured by Clq binding, with only a modest loss of other serum proteins, (2) requiring minimal protein replacement therapy, and (3) having no noticeable morbidity. In a patient with severe unremitting seropositive rheumatoid arthritis for 40 years in whom all conventional and several experimental modes of therapy had failed, this procedure resulted in the first real clinical improvement she had ever experienced.…”

Plasma Exchange for Non‐Renal Indications

“…Standard TPE may, however, be useful in the treatment of rheumatoid vasculitis. Two reports have described rapid clinical improvement in the management of 5 patients with severe necrotiz-ing rheumatoid vasculitis, with clinical resolution and healing of ulcerations concomitant with the lowering of high titers of circulating immune complexes (106,107). In one report, describing success in 2 patients, treatment prescription was initiated with 2 to 3 TPE treatments per week, gradually reducing treatment frequency for a total of 6 to 9 weeks (107).…”

“…In one report, describing success in 2 patients, treatment prescription was initiated with 2 to 3 TPE treatments per week, gradually reducing treatment frequency for a total of 6 to 9 weeks (107). Another report describes clinical improvement in 3 patients after a series of three 2-liter exchanges (106).…”