Journal of Clinical Apheresis最新文献

Transplantation remains the best option for patients with advanced-stage organ failure. In some patients, despite aggressive medical management with immunosuppressants, refractory/recurrent rejection occurs. This single-center retrospective study aims to analyze the role of ECP as an add-on therapy to treat acute cellular rejection (ACR) and/or antibody-mediated rejection (AMR) in non-lung organ transplantation. We identified five non-lung solid organ transplant (SOT) recipients refractory to standard anti-rejection interventions that received ECP therapy in the last 5 years: one liver transplant, two heart transplants, and two small bowel transplants. Baseline demographics, time to ECP initiation, clinical assessment, and biopsy results were analyzed. They received at least 6 months of ECP for biopsy-proven ACR and/or AMR. Graft function was assessed clinically after 6 months by biopsy and/or clinical functional assessment. Graft function improved in all five patients after 6 months of ECP therapy based on clinical functional evaluation and by biopsy in some patients. No complications or adverse events were reported. This study supports the potential for ECP as an adjunctive therapy in non-lung organ transplant recipients who are refractory to standard therapies and present with ACR and/or AMR. ECP has immunomodulating effect with minimal procedural risk. Prospective studies are warranted to confirm the beneficial effects of ECP in the setting of ACR and AMR post organ transplantation.

This report highlights the pivotal role of ophthalmologists in recommending therapeutic plasma exchange (TPE) for systemic disorders like Waldenström's macroglobulinemia (WM). A patient with suspected WM underwent ophthalmic evaluation, revealing peripheral retinal hemorrhages and Roth spots despite no visual complaints. Fundus imaging documented these changes, correlating with elevated IgM levels (86.32 g/L), indicative of hyperviscosity syndrome (HVS). Early retinal findings prompted TPE to mitigate HVS complications. Subsequent bone marrow biopsy confirmed WM with the MYD88 L265P mutation. This case underscores the importance of ophthalmologic insights in guiding hematologic interventions and improving outcomes.

Cold agglutinins are well recognized to complicate stem cell harvests. There is recognition that in both the collection, the processing, and reinfusion of the stem cells to the patient, the product could be exposed to lower temperatures, and this could affect the cold agglutinins within. There is little published evidence on peripheral blood stem cell (PBSC) collection in patients with cryoglobulinaemia. We would like to present a gentleman who has IgM myeloma and Type 1 cryoglobulinaemia. The patient was young and fit, and the plan was to consolidate his induction chemotherapy with an autologous stem cell transplant (ASCT).

We would like to discuss the challenges that we faced in this gentleman in trying to harvest stem cells to utilize for the purposes of performing an ASCT. These challenges occurred because of 1. progressive disease, causing an inevitable rise in cryoglobulin levels that prevented therapeutic plasma exchange and stem cell collection and 2. the myelosuppressive effects of the chemotherapeutic agent prohibiting an adequate stem cell dose required to proceed to transplant. We would like to describe the measures that we put in place in trying to collect PBSC in this patient, to utilize for the purposes of performing an ASCT.

This case report describes therapeutic plasma exchange as treatment for a rare instance of severe hypertriglyceridemia following high-dose intravenous lipid emulsion (ILE) therapy for bupivacaine-induced local anesthetic systemic toxicity (LAST). The patient received a cumulative ILE dose of 28.0 mL/kg to control seizures, exceeding the typical recommended maximum dose of 10 mL/kg. Clinical presentation included severe headache, visual disturbances, and photophobia, concerning for hyperviscosity syndrome. Laboratory findings revealed a markedly elevated serum triglyceride concentration (> 10 350 mg/dL). Therapeutic plasma exchange with plasma was successfully employed to rapidly reduce serum triglycerides and alleviate symptoms. This case highlights the potential for severe iatrogenic hypertriglyceridemia associated with high-dose ILE therapy for LAST and emphasizes the importance of close clinical monitoring and timely intervention.

Therapeutic plasma exchange (TPE) is widely used in the treatment of autoimmune diseases and hematological emergencies. It is also applied in transplant patients for the desensitization of anti-HLA (human leukocyte antigen) antibodies and the management of antibody-mediated rejection. This study aims to assess the epidemiology of therapeutic plasmapheresis and evaluate whether indications for plasmapheresis align with the guidelines of the American Society for Apheresis (ASFA) and investigate the associated adverse effects. This retrospective observational study was conducted in hospitals in Belo Horizonte, Minas Gerais, and included 85 patients who underwent 493 TPE sessions between April 2021 and December 2023. The median age was 43 years, and 60% of the patients were women. The most common indications for TPE were neuromyelitis optica (24%) and acute rejection following kidney transplantation (21%). The replacement fluids used were primarily albumin (84%) and plasma frozen 24 h after phlebotomy (16%). Adverse events were reported in 5.88% of patients, including hypotension, vasovagal reflex, and one case of facial edema and urticaria. No procedure-related deaths were observed. TPE sessions were conducted in accordance with the guidelines of the ASFA, with 50% of procedures classified as Category I. There was no significant association between adverse events and patient diagnoses. The study demonstrated that TPE is effective and safe, with predominant indications for neuromyelitis optica and kidney transplant rejection, following ASFA guidelines. Adverse events were rare and manageable.

Benchmarking in apheresis medicine focuses on the collection of hematopoietic cells, where specific key performance indicators have been recommended to be used as an internal quality control of processes. The aim of this study was to collect data regarding the number of therapeutic apheresis procedures performed in Catalonia, Spain, and to compare this data with those from other countries. A database was created to collect therapeutic apheresis procedures from 2019 to 2023 in Catalonia, Spain. Similar articles about this topic were obtained using Medical Subject Headings in PubMed. To compare therapeutic apheresis performance among countries, the incidence rate of therapeutic apheresis was calculated as the number of therapeutic apheresis procedures per 1000 people per year. In a 5-year period, 26 897 therapeutic apheresis were performed in a 7.6 million population with an incidence rate of therapeutic apheresis of 0.71 per 1000 people per year. The incidence rate varied by as much as 10.1 times among the studies, from 0.07 in a USA study to 0.71 in the present study. When only European studies were compared, the incidence rate varied by as much as 1.65 times among the studies, from 0.43 in a Norwegian study to 0.71 in the present study. We report for the first time the therapeutic apheresis activity performed in Catalonia, Spain. Moreover, the incidence rate of therapeutic apheresis, calculated as the number of therapeutic apheresis procedures performed per 1000 people per year, is an objective indicator, easy to calculate, that can help in benchmarking therapeutic apheresis utilization.