Severe adverse effects of protein A immunoadsorption

Kabisch, Andreas; Kroll, Hartmut; Wedi, Bettina; Kiefel, V.; Pralle, H.; Mueller-Eckhardt, C.

doi:10.1016/s0140-6736(94)90843-5

Cited by 30 publications

(10 citation statements)

References 2 publications

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“…Other studies have documented much less favorable results and considerably greater toxicity. 141,142 The mechanisms of this therapy are unknown, but reduction in platelet-binding immunoglobulin and in circulating immune complex levels has been the postulated mechanism by which protein A immunoadsorption elicits its clinical effects. Protein A immunoadsorption may decrease platelet activation, and this may be an additional mechanism underlying its efficacy.…”

Section: Other Treatmentsmentioning

confidence: 99%

Management of Immune Thrombocytopenic Purpura in Adults

Stasi

Provan

2004

Mayo Clinic Proceedings

177

185

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Primary immune thrombocytopenic purpura (ITP), also referred to as idiopathic thrombocytopenic purpura, is an organ-specific autoimmune disorder in which antibody-coated or immune complex-coated platelets are destroyed prematurely by the reticuloendothelial system, resulting in peripheral blood thrombocytopenia. The disease is heterogeneous with regard to its severity and clinical course and is unpredictable in its response to therapy. Although the basic underlying pathophysiology of ITP has been known for more than 50 years, current treatment guidelines are based on expert opinion rather than on evidence because of a lack of high-quality clinical trials and research. The only patients for whom treatment is clearly required are those with severe bleeding and/or extremely low platelet counts (< 10 x 10(9)/L). Treatment of patients with ITP refractory to corticosteroids and splenectomy requires careful evaluation of disease severity, patient characteristics related to risk of bleeding, and adverse effects associated with treatment. Clinical trials with numerous new agents are under way, which we hope will add more effective and targeted strategies to our therapeutic armamentarium. We describe a logical and structured approach to the clinical management of ITP in adults, based on a literature review and our personal experience.

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Section: Other Treatmentsmentioning

confidence: 99%

Management of Immune Thrombocytopenic Purpura in Adults

Stasi

Provan

2004

Mayo Clinic Proceedings

177

185

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“…However, because of fewer adverse reactions and the ability to reuse the columns, the Immunosorba system is more widely used than are Prosorba columns in clinical studies for the highly selective removal of immunoglobulins or immune complexes. 14,15 The second method (Ig-Therasorb; Miltenyi Biotech, Teterow, Germany) contains Sepharose-bound polyclonal sheep antibodies to human immunoglobulins. The main differences between the two Sepharosebased devices (i.e., Immunosorba and Ig-Therasorb) comprise the target (protein A [Immunosorba] binds only IgG subclasses 1, 2, and 4, whereas Ig-Therasorb columns bind all classes and subclasses of immunoglobulins) and the protein binding capacity (respectively 1.2 g vs. 4 g per column).…”

Section: Methods For Immunoadsorptionmentioning

confidence: 99%

Extracorporeal Immunoadsorption for the Treatment of Coagulation Inhibitors

Franchini¹,

Sassi²,

Dell’Anna³

et al. 2009

Semin Thromb Hemost

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Extracorporeal immunoadsorption is a widely used technique for the removal of pathogenic antibodies in a variety of immunologic disorders. This procedure has been used in patients with high-titer inhibitors against coagulation factors for the temporary removal of antibodies before initiating replacement therapy to achieve hemostasis and stop acute bleeding or to cover a surgical procedure. Inhibitor removal by immunoadsorption has also been included at the onset of immune tolerance protocols in both acquired and congenital hemophilia. This article summarizes the current knowledge on the use of this technique in patients with inhibitors against coagulation factors. Overall, the published literature documents that extracorporeal immunoadsorption is a safe and useful technique for the elimination of coagulation inhibitors. However, further randomized clinical trials are needed to better assess the cost-effectiveness of such procedures.

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“…The majorsymptoms are related to acute hypersensitivity, that is hypotension, chillsand fever (12). Vasculitis is an occasional complicationof PAI treatment (13).…”

Section: Biotechnological Aspects Of Immune Hematologymentioning

confidence: 99%

Plasmapheresis in Immune Hematology: Review of Clinical OutcomeData with Respect to Evidence‐Based Medicine and Clinical Experience

Baeyer¹

2003

Ther Apher Dial

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The objective of this paper is to assess the role of plasmapheresis in immune hematology by reviewing published clinical outcome data and narrative review articles. This information will be used to define evidence levels for appraisal of the efficacy and rank of plasmapheresis among other management options. This evidence-based strategy conforms to the concepts of the American Society of Hematology (ASH). as put forward in 1996 in the context of immune thrombocytopenia (ITP) treatment. The term 'experimental' is used to describe indications where the only scientific evidence of the efficacy of plasmapheresis consists of pathophysiological reasoning and empiric clinical findings. We reviewed the available literature on the use of plasmapheresis in autoimmune hemolytic anemia (AIHA), hemolytic disease of the newborn (HDN), autoimmune thrombocytopenic purpura (AITP), heparin-induced thrombocytopenia type II (HIT II), post-transfusion purpura (PTP), refractoriness to platelet transfusion (RPT), coagulation factor inhibitor (CFI) and catastrophic antiphospholipid syndrome (CAS). Plasmapheresis completes the spectrum of management options as it eliminates physically circulating free antibodies involved in the pathogenesis of these immune hematological syndromes. Because of the paucity of data, evidence levels had to be defined based on the findings of uncontrolled case series and the opinions of independent experts. In many cases, randomized clinical trials were not feasible because the syndromes are so rare. When defined as an 'experimental indication', plasmapheresis has a firm scientific basis, but larger scale clinical experience with the method is still lacking. In these cases, the detection and monitoring of symptomatic disease-related circulating free antibodies or immune complexes is a mandatory prerequisite for the use of plasmapheresis. The therapeutic benefit of plasmapheresis is substantiated by the level V of evidence of its efficacy in treatment of HDN, HIV-associated AITP, induction of tolerance in CFI and in CAS. The goal of future studies should be to establish a firmer base of scientific evidence for indications classified as experimental by setting up case series large enough for proper assessment of plasmapheresis alone or combination with other treatment measures. This goal can only be achieved through multiinstitutional cooperation.

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Severe adverse effects of protein A immunoadsorption

Cited by 30 publications

References 2 publications

Management of Immune Thrombocytopenic Purpura in Adults

Management of Immune Thrombocytopenic Purpura in Adults

Extracorporeal Immunoadsorption for the Treatment of Coagulation Inhibitors

Plasmapheresis in Immune Hematology: Review of Clinical OutcomeData with Respect to Evidence‐Based Medicine and Clinical Experience

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