Kawasaki disease (KD) is an acute inflammatory disorder in children. The important complication of coronary artery aneurysms occurs in treatment-resistant patients. Therapeutic plasma exchange (TPE) has been effective for some refractory KD. Here, we investigated the effectiveness of TPE and how the glucocorticoid amplifying enzyme, 11beta-hydroxysteroid dehydrogenase 1, is involved in the resolution of inflammation in refractory KD.
RETRACTION: RR. Sinha, “ Beyond Donation: Rethinking Long-Term Support Systems for Hematopoietic Stem Cell Donors,” Journal of Clinical Apheresis 40, no. 5 (2025): e70055. https://doi.org/10.1002/jca.70055.
The above article, published online on 07 September 2025 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Jeffrey L. Winters; and Wiley Periodicals, LLC. A review by the journal found that four out of five references included in the letter to the editor were either incorrect or nonexistent.
The editors have determined that the large proportion of incorrect references constitutes a major error and leaves significant portions of the letter unsubstantiated. A correction for these errors was not considered appropriate. This retraction has been agreed to because the errors in the references fundamentally compromise the content and conclusions of the letter. The author was informed of the retraction.
Naphthalene toxicity is a rare but serious cause of methemoglobinemia and hemolysis, particularly in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, in whom methylene blue is contraindicated. We present a case of a 6-year-old girl with a family history of G6PD deficiency who developed cyanosis, jaundice, dark urine, and an oxygen saturation of 50% after ingesting a mothball. Laboratory findings confirmed hemolytic anemia with suspected methemoglobinemia. Methylene blue was avoided, and initial treatment with high-flow oxygen, ascorbic acid, and N-acetylcysteine failed to improve her condition. Red blood cell exchange (RCE) was performed, leading to rapid normalization of oxygen saturation and resolution of hemolysis. G6PD deficiency was later confirmed by enzyme assay. We concluded that in G6PD-deficient children with naphthalene-induced methemoglobinemia, RCE provides an effective alternative to methylene blue, resulting in rapid recovery.
Individuals with sickle cell disease (SCD) often require central venous catheter (CVC) use; however, this is associated with a high incidence of venous thromboembolism (VTE). We conducted a pilot randomized controlled trial (RCT) to assess if it is feasible and safe to conduct an adequately powered RCT comparing rivaroxaban to placebo as thromboprophylaxis in adult SCD participants with CVC. In this pilot investigator-initiated, double-blinded, multi-center RCT, we assessed feasibility outcomes to explore if a full RCT is possible, and also exploratory outcomes of thrombosis and bleeding. THIS pilot trial was closed prematurely due to slow recruitment, lack of funding, and non-feasibility of the complete trial. Of 21 participants who met eligibility criteria, 4 were recruited into the study. Adherence to study procedures was 100% and loss to follow-up was 0%. One participant was noted to have a VTE during follow-up, but of unknown chronicity. Another participant developed a new VTE post-randomization, but prior to starting study drug. No major or clinically relevant bleeding events occurred during study follow-up. Challenges in running the study were largely due to a limited eligible population, and low participation interest in study involvement.
Trial Registration: ClinicalTrials.gov identifier: NCT05033314
The American Society for Apheresis (ASFA) Attending Physician Subcommittee of the Physicians' Committee performed an annual review of articles published in 2024 related to apheresis medicine. The 10 seminal apheresis articles selected by the subcommittee members are summarized in this review. PubMed was used to identify manuscripts published in 2024 in four areas of interest: donor apheresis, therapeutic apheresis, apheresis education, and apheresis for cellular therapy. Only full length, peer-reviewed manuscripts in English with data from human subjects were included. Case reports, review articles, and meta-analyses were excluded. Articles were considered seminal if they met at least one of the following previously established criteria: novel finding(s), practice-altering outcomes, international in scope, randomized-controlled trial, relevant to current clinical practice, and/or provide evidence for category III or IV indications based on the ASFA 9th special issue of the Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach.
Autologous stem cell transplantation (ASCT) requires efficient collection of peripheral blood stem cells. At London Health Sciences Centre (LHSC), high-risk multiple myeloma patients are routinely booked for three-day apheresis collections to meet higher CD34+ cell count targets, though many do not require all scheduled days, leading to resource inefficiencies. A quality improvement initiative was implemented to reduce unnecessary apheresis sessions through two interventions: (1) lowering CD34+ cell count target thresholds (from 6 × 106 to 5 × 106 cells/kg for tandem collections and from 3 × 106 to 2.5 × 106 for single collections), and (2) increasing total blood volume (TBV) processed from 3× to 4× for patients within certain target thresholds. Two Plan-Do-Study-Act (PDSA) cycles were conducted between March 2024 and March 2025 involving 76 patients. Outcome measures included collection days saved and cost savings, and post-transplant engraftment times served as a balancing measure. A total of 39.4% of patients avoided at least one collection day due to these interventions. Third-day collection usage in high-risk myeloma patients decreased from 25% to 5.9%. Mean collection days fell significantly in this group (2.21–1.8; p = 0.0015), with total cost savings of CAD $72 734.97. No significant differences were observed in neutrophil or platelet engraftment times, confirming preserved clinical efficacy. Implementing lower CD34+ cell count targets and increased TBV processing significantly reduced apheresis sessions and costs without compromising engraftment outcomes. These changes have become the standard of care at LHSC and may serve as a feasible model for other transplant centers.
The American Society for Apheresis (ASFA) recommendations only mention using therapeutic plasma exchange (TPE) to treat drug-resistant thyroid storms. Double filtration plasmapheresis (DFPP) is a therapeutic apheresis procedure with the advantage of being semi-selective, making it possible to limit albumin losses and reduce the volume of replacement fluid. However, there have been no studies comparing the efficacy and tolerability of TPE and DFPP for this specific indication. We hereby report the observation of 2 patients treated for thyroid storms due to amiodarone-induced thyrotoxicosis who were each able to benefit from TPE as well as DFPP sessions, enabling us to compare the purification of free thyroid hormones and tolerance of these two treatments. TPE showed greater efficiency in removing thyroid hormones with the same tolerability as DFPP.
Antiphospholipid syndrome (APS) is characterized by the presence of antiphospholipid antibodies (aPL), macro- and micro-vascular thromboembolic complications. Lupus anticoagulant-hypoprothrombinemia (LAHPS) may confound the diagnosis and management of bleeding. Catastrophic APS has a category 1 indication for therapeutic plasma exchange (TPE). However, in patients with APS, LAHPS, and intracranial hemorrhage (ICH), TPE is not well described. A 47-year-old man with known APS anticoagulated on warfarin was transferred for diffuse spontaneous subdural hemorrhages (SDH) with somnolence. aPL levels were elevated on presentation; anti-β2-glycoprotein-I antibody (aβ2GPI) IgG was higher than the reportable range. Factor II activity level was 20% despite holding warfarin: concerning for LAHPS. TPE was initiated to minimize risk of thromboembolism while holding anticoagulation. Level of consciousness improved by the second TPE. An acute lacunar infarct was detected on MRI, but this may have occurred before initiating TPE. Measures of lupus anticoagulant and anticardiolipin (aCL) IgG decreased initially, but aβ2GPI IgG remained above the reportable range. Both aCL and aβ2GPI IgM titers increased initially but decreased by day 31. Factor II activity level improved but remained below normal. Serial imaging showed resolution of SDH without new infarction. In patients with APS and recurrent thromboembolic disease, assessment and treatment of ICH may be confounded by LAHPS. Reversal of anticoagulation is reserved for patients in extremis, and treatment of LAHPS has previously been associated with thrombosis. In this context, TPE may be considered in combination with steroids and rituximab to bridge overlapping thromboembolic and hemorrhagic risk.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：