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.
Extracorporeal membrane oxygenation (ECMO) is a last resort treatment for children with cardio-respiratory failure. Some of these patients will develop thrombocytopenia-associated multiple organ failure (TAMOF), which is sometimes managed with therapeutic plasma exchange (TPE). Our objective is to describe critically ill children on ECMO who underwent TPE for TAMOF. We conducted a single-center retrospective case series of seven children with congenital cardiac disease, requiring ECMO, diagnosed with TAMOF, and treated with TPE between 12/2023 and 6/2024. A centrifugation-based apheresis instrument was used to process 1.5 total blood volume. One packed red blood cell was used to prime the apheresis circuit. Systemic bivalirudin was used for anticoagulation. Seven patients (median age: 55 days, median weight: 4.0 kg, median bypass time: 172 min, 100% VA ECMO, 85% central cannulation, 100% bivalirudin) underwent a total of 30 TPE sessions. The median number of sessions per patient was 3, with a median time to first session of 27.3 h after cannulation. Plasma was used as the replacement fluid in all sessions, with a median volume of 168 mL/kg. The median platelet count increased from 45 × 109/L (38; 54) pre-TPE to 64 (IQR: 45; 75, p < 0.001) post-TPE, despite no platelet transfusions during TPE. The modified organ severity index decreased significantly from 13 to 12 (p < 0.001). The mortality rate was 71%. TPE may improve platelet counts and reduce organ severity scores in critically ill children with TAMOF on ECMO.
Double filtration plasmapheresis (DFPP) is a promising method for removing environmental toxins, but comparative data on toxin-specific removal patterns remain limited. This study investigates the removal effectiveness of various pollutants in patients with hyperlipoproteinemia(a) undergoing DFPP. We retrospectively analyzed procedures performed using the Inuspheresis System with two filters with differing pore sizes. We assessed the clearance of heavy metals, volatile organic compounds, and organic pollutants by calculating the “redistribution ratio” (RR) and the percentage of captured analyte (CA). Analytes with large volumes of distribution and low protein binding, such as toluene, methyl isobutyl ketone, and barium, showed high rebound (RR: 1.95, 1.31, and 1.97, respectively), suggesting redistribution from peripheral compartments. Moderate rebound was observed for partially protein-bound toxins, including PCB 153 (0.76), PCB 138 (0.74), and hexachlorobenzene (0.66). Low or negative RRs were seen with arsenic (−0.49), mercury (−0.05), and cobalt (0.08), likely reflecting limited redistribution. High CA values were recorded for lipophilic, protein-bound toxins such as PCBs and p,p′-DDE. Herein, we demonstrate that DFPP is effective in removing environmental toxins from the human body. The pharmacokinetic properties of each compound are key determinants of DFPP effectiveness and may help guide the development of personalized detoxification strategies to optimize its clinical use.
In a resource-constrained setting, maximizing plateletpheresis efficiency is critical. We believe leveraging advanced apheresis device software to enhance platelet yield, reduce consumables, and shorten procedure times offers significant advantages. This study compared Haemonetics, Trima, and Optia apheresis devices, analyzing donor and machine parameters. It also assessed how high-yield collections and recent software updates on Trima and Haemonetics devices impact donor safety. The goal was to find the best practices for optimizing both donor safety and platelet collection. Analyzing 900 procedures (300 per device), Trima and Optia yielded significantly more platelets (9 × 1011) in less time compared to Haemonetics (5.7 × 1011) (p < 0.05). Trima collected10–12 × 1011 platelets from significantly more donors with lower pre-donation counts than Optia (p < 0.05). Optia led to the fewest adverse events (0.7%). Donor weight was significantly higher for yields > 9 × 1011 on Optia and Trima (p < 0.05). Haemonetics' 3.6–3.8 × 1011 yield group had significantly lower session time, donor weight, and presession platelet counts (p < 0.05). Software updates (200 sessions/device) significantly boosted Trima's yields to 14.8 × 1011 while reducing adverse events (1% vs. 2.3% pre-update). Haemonetics also saw improved yields and fewer adverse events (1% vs. 4.3%), though its overall yield remained lower (6.3 × 1011, p < 0.05). Both maintained safe post-procedure platelet counts (> 130 000/μL). However, Trima's predicted yields for very high collections (> 12 × 1011) significantly differed from lab-determined yields. Trima and Optia provide better platelet collection efficiency than Haemonetics. Software updates improved both Trima and Haemonetics' performance and safety; however, Trima's high-yield predictions need refining. Optimal settings, updated software, and careful donor selection are essential for maximizing platelet yield and donor safety in resource-limited areas.
Therapeutic plasma exchange (TPE) is used to lower triglyceride levels in patients with severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP). However, evidence supporting the effectiveness of TPE in preventing end-organ damage remains limited. This retrospective cohort study was conducted using the TriNetX database to evaluate adults with acute pancreatitis, triglyceride levels > 1000 mg/dL, and “worrisome criteria”, defined as clinical indicators of disease severity such as fever, leukocytosis, elevated lactate, or signs of shock. Patients receiving TPE within 3 days of diagnosis were compared with patients with no TPE within 30 days. Outcomes included triglyceride reduction to < 500 mg/dL, ICU admission, end-organ damage, and mortality. Of 14 188 patients with HTG-AP, 3% (n = 419) received TPE; 97% (n = 13 237) were treated without TPE. After 1:1 propensity-score matching, 2 well-matched, 412-patient cohorts were created. More patients in the TPE cohort had a reduction in triglyceride levels to < 500 mg/dL at 1 week (81% vs. 40%, p < 0.001) and 1 month (86% vs. 48%, p < 0.001). However, the TPE cohort also had higher ICU admission rates (39% vs. 19%, p < 0.001). No significant differences in organ failure rates were observed at 1 week (4.4% vs. 3.3%, p = 0.47) or 1 month (5.8% vs. 5.0%, p = 0.71). Similarly, 30-day (4.4% vs. 6.3%, p = 0.21) and 3-month (5.3% vs. 7.8%, p = 0.16) all-cause mortality were comparable between the cohorts. In patients with HTG-AP, use of TPE within 3 days of diagnosis reduces triglyceride levels effectively but does not significantly reduce the risk of end-organ damage or mortality. TPE is associated with increased ICU care requirements, which may reflect protocolized ICU admission.
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：