Journal of Clinical Apheresis最新文献

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.

D. Sahoo, A. Krishna, and A. Basavarajegowda, “ Transient Wavy Collection Trend in Hematopoietic Stem Cell Apheresis: A Rare and Underreported Occurrence,” Journal of Clinical Apheresis 40, no. 3 (2025): e70040, https://doi.org/10.1002/jca.70040.

We apologize for this error.

Thyroid storm is a life-threatening endocrine emergency with a mortality rate of up to 17%. Standard treatment includes antithyroid drugs (ATD), β-blockers, and glucocorticoids. However, some patients may require blood purification therapies, such as plasmapheresis, due to the ineffectiveness of standard treatments or contraindications like agranulocytosis. We report the case of a 38-year-old female with Graves' disease who was admitted for thyroid storm (Burch–Wartofsky score of 70) combined with encephalopathy, presenting with impaired consciousness, seizures, and leukopenia (1.82 × 10⁹/L). Due to contraindications for ATD, she was treated with double filtration plasmapheresis (DFPP). After three sessions, her anti-thyrotropin receptor antibodies (TRAb > 40–29.8 IU/L) and thyroid hormones (FT4 88.7–19.7 pmol/L) significantly decreased, and her consciousness improved. She was later transitioned successfully to oral ATD upon discharge. Plasmapheresis can rapidly remove thyroid hormones and autoantibodies, particularly useful in cases where ATD is ineffective or contraindicated. While international reports predominantly describe plasma exchange (PE), this case is the first to suggest the efficacy and safety of DFPP in treating thyroid storm with thyrotoxic encephalopathy. DFPP selectively removes large-molecule antibodies while minimizing the use of blood products and albumin loss. For severe thyroid storm patients, early plasmapheresis may improve prognosis; however, the optimal timing, modality, and dosing require further investigation.

Hyperchloremic metabolic acidosis is an underreported but common metabolic complication following therapeutic plasma exchange (TPE) with an albumin-saline solution, particularly when multiple TPE sessions are performed within a limited period. The risk of hyperchloremic metabolic acidosis may be the highest in patients with chronic kidney disease because of their limited acid excretion capacity. We prospectively collected data from all patients who received TPE at Amsterdam UMC between February 2023 and March 2025. We collected data on demographics, TPE-related parameters, and blood electrolyte concentrations. We investigated the effect of TPE on plasma sodium, chloride, and bicarbonate concentrations, the occurrence of adverse events, and the modulating role of kidney function. Data from 64 patients with 320 TPE sessions were included in the analysis. The mean age was 50 years, 55% of the patients were male and the mean eGFR was 35 mL/min/1.73 m². The effect of a single TPE on plasma electrolyte concentration was independent of kidney function. However, after multiple TPE sessions, a lower eGFR was associated with a greater increase in plasma chloride concentration (p < 0.001) and a larger decrease in plasma bicarbonate concentration (p < 0.001) despite oral bicarbonate supplementation and a lower baseline plasma bicarbonate concentration. Patients with a lower eGFR were more likely to experience adverse events during a TPE session (p = 0.004). Chronic kidney disease is a risk factor for developing hyperchloremic metabolic acidosis and adverse events during an intensive TPE cycle.