The Effect of Prolonged Plasmapheresis on Immunoglobulins, other Serum Proteins, Delayed Hypersensitivity and Phytohemagglutinin-Induced Lymphocyte Transformation

Abstract

Serum protein concentrations and lymphocyte function, were determined in prisoner volunteers undergoing prolonged biweekly plasmapheresis and appropriate control subjects. Prolonged biweekly removal of 800 ml of plasma was well tolerated clinically. Neither circulating lymphocyte counts, PHA-induced in vitro lymphocyte ³H-TdR incorporation, or delayed hypersensitivity were affected. However, mean immunoglobulin, β₁^c-globulin and albumin levels decreased significantly during the initial year of plasmapheresis and individual values were below the accepted normal minimum range in over half the donors tested. Low levels of IgG, IgA, IgM, β₁^c-globulin and albumin were also detected in several ‘normal’ prisoner volunteers. These findings suggest that individual immunoglobulin and other serum protein concentrations should be quantitated initially to eliminate poor-risk donors, and monitored at intervals during the course of plasmapheresis.

The impact of different intensities of regular donor plasmapheresis on humoral and cellular immunity, red cell and iron metabolism, and cardiovascular risk markers

“…Previous studies investigating serum protein levels under long‐term plasma donation have yielded conflicting results. Removal of 750–1600 ml of plasma per week caused significant decreases in IgG, mostly leveling off within the lower normal range [3–7,9]. Some of these studies also reported a significant drop in TSP [3,9] and albumin [3,4,9] levels.…”

“…A more recent trial of long‐term plasma donors reported an increased percentage of B cells and a decreased percentage of suppressor T cells and natural killer cells, measured by flow cytometry [9]. Previous studies had not detected any significant influence on lymphocyte count and function from intensive donor plasmapheresis [4].…”

“…The safety of long-term intensive donor plasmapheresis remains a controversial issue. Several trials -mainly performed in the United States of America (USA) -have shown that donor ability to restore lost plasma proteins is a major limiting factor in plasmapheresis [1][2][3][4][5][6][7][8][9]. A more recent trial of long-term plasma donors reported an increased percentage of B cells and a decreased percentage of suppressor T cells and natural killer cells, measured by flow cytometry [9].…”

Volume Limitations of Plasmapheresis

“…Salvaggio et al [21] harvested 2 x 800 ml of plasma per week for periods of more than 2 years from healthy, volunteer prison inmates and found a significant (p < 0.01) and chronic depression of the serum albumin level by 0.5-0.6 g%. Cohen and Oberman [3] removed 2 x 500 ml of plasma per week in a small-group program predominantly in volving medical or paramedical house staff members.…”

Volume Limitations of Plasmapheresis

“…Salvaggio et al [21] harvested 2 x 800 ml of plasma per week for periods of more than 2 years from healthy, volunteer prison inmates and found a significant (p < 0.01) and chronic depression of the serum albumin level by 0.5-0.6g%. Cohen and Oberman [3] removed 2 x 500 ml of plasma per week in a small-group program predominantly involving medical or paramedical house staff members.…”