The Efficiency of Blood Substitution

Wallerstein, Harry; Brodie, S. Steven

doi:10.1093/ajcp/18.11.857

Cited by 13 publications

(8 citation statements)

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“…19 However, during the active phase of disease, these components are likely to be resynthesized; thus, four to five sittings over 7 to 10 days are recommended for severe disease. 20 Comparatively, doublevolume exchange transfusion removes about 87% of intravascular components 21 over a very short period of 1 to 2 hours. Considering resynthesis of pathogenic plasma components, the observed early and sustained therapeutic effect after just one course of exchange transfusion is noteworthy.…”

Section: Discussionmentioning

confidence: 99%

Exchange Transfusion: A Low-Cost Alternative for Severe Childhood Guillain-Barré Syndrome

2006

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The high cost and nonavailability of plasmapheresis and intravenous immunoglobulin are prohibitive for the treatment of Guillain-Barré syndrome in resource-poor settings. Exchange transfusion can be an alternative therapy for severe disease in children. The effectiveness of exchange transfusion was evaluated in nine children (median age 6 years) with severe Guillain-Barré syndrome (functional disability score >/= 4). All patients had lower limb weakness for a median duration of 4 days (range 2-16 days). Upper limb weakness (n = 8), respiratory involvement (n = 7), pooling of oral secretions (n = 3), and facial palsy (n = 1) were other motor signs. Four children developed respiratory failure; three were ventilated. Other clinical features included leg pains, meningismus and Lasàgue's sign, backache, excessive sweating, and hemodynamic instability. Two children had albuminocytologic dissociation on cerebrospinal fluid analysis. Nerve conduction velocity testing was done in three patients; two had suggestive findings. One course of exchange transfusion could be performed in seven patients. Six children (86%) responded well with one or more of the following: a halt in progressive motor weakness, improvement in leg pains, meningismus, and straight-leg raising within 24 to 48 hours; one could be weaned off the ventilator by 60 hours. All had improvement in motor power of at least one muscle group by one grade within 3 to 7 days. Two patients died, whereas five (71% of the treatment group) were discharged and could walk independently by 4 months. Two untreated ones had died. Exchange transfusion seems to be a safe and effective alternative for severe Guillain-Barré syndrome. It should be offered whenever intravenous immunoglobulin or plasmapheresis is not available or affordable. Replacement of immunosaturated red cells, removal of activated T cells and monocytes, and transient thrombocytopenia are possible explanations for its effectiveness in addition to removal of pathogenic autoantibodies, immune complexes, cytokines, and complements.

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Section: Discussionmentioning

confidence: 99%

Exchange Transfusion: A Low-Cost Alternative for Severe Childhood Guillain-Barré Syndrome

2006

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“…8 In view of re-synthesis of pathogenic plasma factors (e.g., antibodies, complements, circulating immune complexes and cytokines) during active phase, one-stage removal is unlikely to explain the observed rapid, fast and consistent improvement. A course of double-volume ET 2 (120 ml/Kg) was performed on day 7 for severe radiculitis (evidenced by uncontrolled neck pain, worsening straight leg-raising) and progressive weakness.…”

Section: Case Reportmentioning

confidence: 99%

Exchange transfusion as an alternative therapy for recurrent severe Guillain-Barre Syndrome

Baranwal¹,

Parmar

2007

Indian J Pediatr

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“…This is one possible way ANH is performed in clinical practice. It corresponds to the 'intermittent substitution formulas' presented by Wallerstein et al (8) for blood substitution in the treatment of erythroblastosis fetalis. For homogeneous distribution of RBC throughout the body the following formula for this intermittent procedure has been described (17):…”

Section: Iterative Modelmentioning

confidence: 99%

“…Simultaneously it constitutes the mathematical basis for theoretical considerations concerning the efficacy of ANH in avoiding allogenic transfusions. This formula is a simplified version of the plasma exchange equations presented by Wallerstein et al (8) and Veall et al (9) for replacement transfusion as a form of treatment for hemolytic disease of the newborn. Although developed for another therapeutical concept these equations are related to the kinetics of the decline of hb during hemodilution.…”

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confidence: 99%

New mathematical model for the correct prediction of the exchangeable blood volume during acute normovolemic hemodilution

Meier¹,

Kleen²,

Häbler³

et al. 2002

Acta Anaesthesiol Scand

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The Efficiency of Blood Substitution

Cited by 13 publications

References 0 publications

Exchange Transfusion: A Low-Cost Alternative for Severe Childhood Guillain-Barré Syndrome

Exchange Transfusion: A Low-Cost Alternative for Severe Childhood Guillain-Barré Syndrome

Exchange transfusion as an alternative therapy for recurrent severe Guillain-Barre Syndrome

New mathematical model for the correct prediction of the exchangeable blood volume during acute normovolemic hemodilution

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