Therapeutic Plasma Exchange

Shumak, Kenneth H.; Rock, Gail

doi:10.1056/nejm198403223101206

Cited by 240 publications

(67 citation statements)

References 84 publications

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“…Anticoagulation with sodium citrate solution was responsible for 3% of side effects in all PE procedures 24 , like perioral tingling, trembling, dizziness and hypotension 24,25 . Hypocalcemia resulted in mild paresthesias and tremor in seven of our patients.Vasovagal attack with concomitant hypotension, true hypovolemia or fluid overload may also be complications of PE 25 . Hypotension occurred in seven of our 26 patients and was reversed by fluid replacement.…”

Section: Resultsmentioning

confidence: 99%

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Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients

Carandina-Maffeis

Nucci

Marques

et al. 2004

Arq. Neuro-Psiquiatr.

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-We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD ± 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD ± 35.2); median 100.5 (extremes of 55 and 215).The mean volume of plasma exchanged in each session was 2396 ml (SD ± 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.KEY WORDS: plasmapheresis, myasthenia gravis, therapeutics, acceptance, complications. Plasmaférese no tratamento da miastenia grave: estudo retrospectivo de 26 pacientes RESUMO -Analisamos a experiência do Hospital das Clínicas da Unicamp com plasmaferese: (PF) na miastania grave (MG). 17,8 % do total dos casos de MG submeteu-se a PF, 26 casos, 19 mulheres e sete homens. A idade média de início da MG foi 28 anos (extremos 11 e 69). O menor déficit clínico foi IIb (O & G) e IIIa (MGFA).A PF foi indicada no pré-operatório de timectomia em um caso e em sete devido a crise miastênica. Em 18 casos, com MG generalizada e sintomas bulbares ou com exacerbação de déficit prévio, a PF foi indicada como intervenção aguda. Em dois pacientes desse grupo ela foi indicada também em regime crônico de ciclos mensais. Os 26 pacientes submeteram-se a 44 ciclos e a 171 sessões de PF. O número médio de sessões em cada ciclo foi 3,9 (DP ± 1,4); mediana de 5, extremos 2 e 6. O tempo médio de cada sessão foi 106,5 minutos (DP ± 35,2); mediana de 100,5 (extremos 55 e 215).O volume médio de plasma trocado em cada sessão foi 2396 ml (DP ± 561); mediana 2225 (extremos 1512 e 4500). Efeitos colaterais foram reversíveis: hipotensão (sete casos), tremor ou parestesias leves (sete casos). Taxas de infecção e mortalidade devido a PF foram zero. A totalidade dos pacientes teve benefícios imediatos a cada ciclo de PF e usualmente receberam prednisona ou outro imunossupressor. Houve boa aceitação ao procedimento em 80,7% dos pacientes.

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Section: Resultsmentioning

confidence: 99%

“…Placement of the central catheter can be the cause of major complications associated with PE, such as pneumothorax, thrombosis or infection 24,25 . Microbiological culture of catheter's extremity was always negative in our patients.…”

Section: Resultsmentioning

confidence: 99%

Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients

Carandina-Maffeis

Nucci

Marques

et al. 2004

Arq. Neuro-Psiquiatr.

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“…Several studies have demonstrated the usefulness of plasmapheresis in treatment of patients with autoimmune manifestations [40]. This effect has in many cases been ascribed to the lowering of autoantibody titres.…”

Section: Discussionmentioning

confidence: 99%

Reduction in serum levels of antimitochondrial (M2) antibodies following immunoglobulin therapy in severe combined immunodeficient (SCID) mice reconstituted with lymphocytes from patients with primary biliary cirrhosis (PBC)

Abedi¹,

Hammarström

Broomé³

et al. 1996

Clinical and Experimental Immunology

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The effect of gammaglobulin treatment on autoantibody production was investigated in SCID mice reconstituted with human peripheral blood mononuclear cells (PBMC) obtained from patients with PBC. All reconstituted mice displayed the presence of human antimitochondrial antibodies (αM2Ab) of both IgG and IgM types before treatment with human immunoglobulin. Two weeks after i.p. injection of 20 ×106 PBMC into SCID mice, i.p. treatment with various preparations of human immunoglobulin was initiated. In control animals treated with saline, serum levels of human αM2Ab of the IgG type increased with time, peaking around 4 weeks after reconstitution. In contrast, human IgG autoantibodies rapidly decreased in all animals treated with human IgG. Treatment with a human IgM preparation had no effect on serum levels of αM2Ab of the IgG type. The results may suggest that the pronounced reduction of specific IgG autoantibodies was due to an increased catabolism of human IgG, including the autoantibodies, in the gammaglobulin‐treated mice. Although the production of human αM2Ab in reconstituted mice could be easily shown, PBC‐specific liver lesions or bile duct destruction were not observed, irrespective of treatment protocol.

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“…Plasma exchange will remove humoral inducers of glo merular injury and inflammatory mediators responsible for tissue injury such as complement components, fibrin ogen or other coagulation factors [17], while OKT3 pro duces a strong effect on the cell-mediated immune re sponse through an action on the CD3 complex which is an intrinsic part of the T cell receptor. The T cells become ineffectual, and within an hour are epsonized and re moved from the circulation into the reticuloendothelial system.…”

Section: Discussionmentioning

confidence: 99%

Study of Morphologic Risk Factors in Graft Biopsies from Patients with Living Related Donor Kidney Transplants

Moustafa¹,

Sobh²,

El-Sherif³

et al. 1996

Am J Nephrol

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In this work, 205 graft biopsies obtained from 161 living related donor kidney transplant recipients were blindly reevaluated by our nephropathologist, and individual lesions were evaluated semiquantitatively. Glomerular lesions included capillary thrombosis, cellular infiltrate, mesangial matrix thickening, glomerulonephritis and the presence of glomerular crescents. Tubulointerstitial lesions included tubular necrosis, tubulitis, tubular atrophy, interstitial hemorrhage, interstitial inflammatory cellular infiltrate and infarction. Vascular lesions included endovasculitis, arteriolar wall fibrinoid necrosis and intimal fibrosis. Graft outcome was assessed by looking for the changes in serum creatinine at 3 months postbiopsy and regularly every 3 months until 36 months thereafter. Other variables were considered including patient age, timing of biopsy posttransplantation, and type of immune suppression. Statistical analyses were performed to study the impact of each individual lesion on graft outcome as judged by changes in serum creatinine. Furthermore, models were constructed for short- and long-term graft outcome. Arteriolar wall fibrinoid necrosis, tubular necrosis, glomerular capillary thrombosis and increased mesangial matrix thickness were the most serious lesions affecting graft outcome.

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Therapeutic Plasma Exchange

Cited by 240 publications

References 84 publications

Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients

Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients

Reduction in serum levels of antimitochondrial (M2) antibodies following immunoglobulin therapy in severe combined immunodeficient (SCID) mice reconstituted with lymphocytes from patients with primary biliary cirrhosis (PBC)

Study of Morphologic Risk Factors in Graft Biopsies from Patients with Living Related Donor Kidney Transplants

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