scholarly journals Plasma exchange therapy and COVID ‐19

2020 ◽  
Author(s):  
Viroj Wiwanitkit
Keyword(s):  
Plasma Exchange ◽  
Plasma Exchange Therapy

scholarly journals AB0444 THROMBOTIC MICROANGIOPATHY AND SJÖGREN SYNDROME, AN UNUSUAL ASSOCIATION. PRESENTATION OF CLINICAL CASE AND SYSTEMATIC REVIEW OF THE LITERATURE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1521.2-1521
Author(s):  
Y. Santamaria ◽  
M. Galvis ◽  
A. Vanegas
Keyword(s):  
Hospital Admission ◽  
Plasma Exchange ◽  
Thrombotic Microangiopathy ◽  
Clinical Case ◽  
Medical Literature ◽  
Sjogren Syndrome ◽  
Plasma Exchange Therapy ◽  
History Of ◽  
The Mean ◽  
Intravenous Steroids

Background:Thrombotic microangiopathy (TMA) is a clinicopathologic diagnosis defined as microangiopathic hemolytic anemia (MAHA) with associated features of thrombocytopenia and end-organ ischemia. Systemic lupus erythematosus, antiphospholipid antibody syndrome, and scleroderma, are within the autoimmune diseases, the more commonly associated with TMA. It has been considered that the association with Sjögren Syndrome (SS) is rare.Objectives:To describe one patient with TMA and SS, and to review all cases reported in the literature.Methods:We notified a clinical case of a patient with Sjögren’s syndrome and TMA. Then, we searched the medical literature finding a total of 17 cases reported with this association until 2019. Before the data obtained were tabulated by trained staff and descriptive, comparing groups and bivariate analysis was performed. The outcome of interest was the death of the patient. Stata 12.0 software was used.Results:A 26-years-old Colombian female presented with a 6-week history of petechiae in lower limbs, gingivorrhagia, menorrhagia and jaundice; and previous history of arthritis and xerostomia. On admission, in the context of severe thrombocytopenia and MAHA, MAT diagnosis was made. During hospitalization we confirm the diagnosis of SS with ANA, antiRo and salivary gland biopsy. The patient was treated with steroids (methylprednisolone 500 mg/day, 3 days), plasma exchange therapy (PLEX) and Cyclophosphamide (750 mg), with recovery of hemoglobin and platelet levels; however, the patient died due to a complication of the PLEX catheter removal procedure.A total of 18 patients diagnosed with de novo or prevalent Sjögren’s syndrome who had hospital admission with a diagnosis of TMA were included. The mean age was 54.55 years (Standard deviation (SD): 12.45) and 83.33% of the patients corresponded to the female gender.At admission, the mean of hemoglobin was 8.45 g/dL (SD: 2.55) and median platelets of 27250/mm3 (interquartile range (IQR) 10500 - 102000) were found. The most frequent clinical manifestations were central nervous system alterations (50%), followed by bleeding in the skin and renal failure (44.44%) and fever (27.78%). The most frequent antibodies found were anti-Ro (100%), anti-nuclear antibodies (80%) and anti-La (75%). The most frequently prescribed treatment was plasma exchange therapy (83.33%), intravenous steroids (61.11%), oral steroids (61.11%) and cyclophosphamide (27.78%). Of the total patients, 38.89% died and 27.7% had some relapse of TMA.In the group comparison analysis, differences were found in intravenous steroid (81.82% in those who lived vs. 28.57% in those who died p=0.039), use of PLEX (100% in those who survived vs. 57.14% in those who died p = 0.043), fever (9.09% in those who survived and 57.14% in those who died, p = 0.047), admission hemoglobin (7.65 g/dL in those who lived vs. 10.22 g/dL in those who died, p = 0.05), final platelets (148,000 in which who lived and 39,000 in those who died p = 0.02). Then, in the logistic regression analysis, an association was found between mortality and use of intravenous steroids (OR: 0.08, 95% CI 0.009 - 0.83, p = 0.35) and fever at admission (OR: 13.33 95% CI: 1.04 - 169.55, p = 0.046).Conclusion:While the association between TMA and SS is uncommon, so far 18 cases have been reported in the world medical literature. It is typically a condition of women age close to 50 years. The most frequent manifestations are neurological. Among the variables evaluated, only the use of endovenous steroids was associated with a decrease in the probability of mortality; on the contrary, the presence of fever at hospital admission increased the probability of death. The results should be evaluated with caution, since, due to the limited availability of information, they may not be generalizable to clinical practice. More information on this should be obtained in the future.Disclosure of Interests:None declared

Blood plasma thermal behavior and protein oxidation as indicators of multiple sclerosis clinical status and plasma exchange therapy progression

2019 ◽  
Vol 671 ◽  
pp. 193-199 ◽  
Author(s):  
Boris Tenchov ◽  
Rumiana Koynova ◽  
Borislava Antonova ◽  
Stella Zaharinova ◽  
Silviya Abarova ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Thermal Behavior ◽  
Blood Plasma ◽  
Plasma Exchange ◽  
Protein Oxidation ◽  
Clinical Status ◽  
Plasma Exchange Therapy

scholarly journals Plasma Exchange Therapy in Patients with Complex Regional Pain Syndrome

2015 ◽  
Vol 18;4 (4;18) ◽  
pp. 383-394
Author(s):  
Guillermo M. Alexander
Keyword(s):  
Maintenance Therapy ◽  
Plasma Exchange ◽  
Complex Regional Pain Syndrome ◽  
Clinical Presentation ◽  
Short Form ◽  
Pain Syndrome ◽  
Small Fiber Neuropathy ◽  
Plasma Exchange Therapy ◽  
Small Fiber ◽  
Drexel University

Background: Complex regional pain syndrome (CRPS) is a severe chronic pain condition that most often develops following trauma. Some investigators have postulated CRPS to be a post-traumatic neuralgia associated with distal degeneration of small-diameter peripheral axons. Intravenous immunoglobulin treatment (IVIG) has been shown to be efficacious in the treatment of painful polyneuropathies. Some CRPS patients have been reported to respond to IVIG. Based on a recent hypothesis proposing an autoimmune etiology for CRPS, we decided to offer plasma exchange therapy (PE) to CRPS patients with a clinical presentation suggestive of a small fiber neuropathy. Objectives: To evaluate the efficacy of PE in a group of CRPS patients with a clinical presentation suggestive of a small fiber neuropathy that were either non-responders or poor responders to their current treatment. Study Design: This is a retrospective case series study of CRPS patients that met the Budapest diagnostic criteria for CRPS and received PE as treatment for their illness between September 2012 and June 2014. Approval for this review was granted by the Drexel University Institutional Review Board. Setting: Drexel University College of Medicine pain clinic Methods: Thirty-three CRPS patients that received PE treatment were retrospectively studied. The workup for these patients consisted of a complete medical and pain evaluation, the completion of the short-form McGill questionnaire, quantitative sensory testing (QST), and skin punch biopsy. The PE protocol was as follows: all patients had a series of PE therapies (range 5 to 11 with a mean of 7.2) performed over a 2 to 3 week period. Following the PE series, the patients had a pain evaluation and completed the short-form McGill questionnaire. Patients that responded to PE were offered maintenance therapy consisting of either weekly PE or other immune modulating agents. In these patients, their pain was evaluated during the maintenance phase. Results: Thirty of the 33 patients demonstrated significant (P < 0.01) median pain reduction of 64% following the initial series of PE. Three patients demonstrated no improvement. Twenty-four patients are receiving maintenance therapy, the pain reduction in these patients following the initial PE series has been maintained with either weekly PE (n = 15), oral immune modulating agents (n = 8), or IVIG (n = 1). The remaining 6 patients are not receiving maintenance therapy and their pain has returned to pre-treatment levels. In addition, this study suggests that patients with the greatest loss of small fibers and the greatest temperature sensory deficits are most likey to benefit from PE therapy. Limitations: The major limitation of this study is its retrospective nature which includes nonrandomization, non-blinding, and an uncontrolled design. Conclusions: This study shows that PE is effective in a subset of patients with severe long-standing CRPS and that the reduction in pain following the initial series of PE treatments can be maintained on a weekly PE schedule, IVIG, or with other immune modulating drugs. Large, randomized, placebo controlled studies may be required to confirm and expand these results. Such studies may lead to new therapies for this severe life-altering condition. Key words: Complex regional pain syndrome, small fiber neuropathy, plasma exchange, skin punch biopsies, immune modulating therapies

Effect of Plasma Exchange Therapy on Circulating Fibronectin in Burned Patients

1985 ◽  
Vol 6 (3) ◽  
pp. 239-242 ◽  
Author(s):  
Marek Dobke ◽  
John L. Hunt ◽  
Gary F. Purdue ◽  
Charles R. Baxter
Keyword(s):  
Plasma Exchange ◽  
Plasma Exchange Therapy

Plasma exchange therapy for solar urticaria

1996 ◽  
Vol 134 (6) ◽  
pp. 1093-1097 ◽  
Author(s):  
P. COLLINS ◽  
R. AHAMAT ◽  
C. GREEN ◽  
J. FERGUSON
Keyword(s):  
Plasma Exchange ◽  
Plasma Exchange Therapy ◽  
Solar Urticaria

Hemostatic Changes After Plasma Exchange Therapy For Fulminant Hepatic Failure

1981 ◽  
Author(s):  
N Takata ◽  
S Kusumi ◽  
K Fujimura ◽  
A Kuramoto
Keyword(s):  
Plasma Exchange ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Enzyme Inhibitor ◽  
Life Time ◽  
Hepatic Necrosis ◽  
Plasma Exchange Therapy ◽  
Post Transfusion Hepatitis ◽  
Bedside Diagnosis ◽  
And Control

Although it is well known that fulminant hepatic failure (FHF)might be often complicated with disseminated intravascular coagulation (DIC), its bedside diagnosis and control are rather confused. Hemostatic change after replacement therapy might be helpful to distinguish wheather the abnormal clotting tests are owing to the defects of protein synthesis or to excessive consumption. A 38-year-old woman with relapse of acute myeloblastic leukemia and FHF(post-transfusion hepatitis, type of non-A,non-B) received 2 courses of plasma exchange therapy (4 and 3L) using Hemonetics M-30 with 6,000 U/day of heparin sodium continuous i.v. and died on 4th hospital day. Postmortem necropsy revealed massive hepatic necrosis and fibrin thrombi in kidneys. Before the beginning of plasma exchange, results of bedside tests were as follow;platelets 44×109/l(decreased from 240 within a week ), PT over 90", aPTT 26", fibrinogen 120 mg/dl and serum FDP 10 mcg/ml. Serial observations of hemostatic parameters 1, 4, 8 and 12 hours after the end of exchange therapy disclosed that apparent half life time of each factors were remarkably shortened. For example, T 1/2 of factor I, E, VE, XI, antithrombin EE (AT IE) and alpha-2 plasmin inhibitor(AP) were 4, 14.5, 1-5, 4.7, 15 and 2.6 hours, respectively. In crossed immunoelectrophoresis of AT III and AP, patient plasma showed abnormal peaks of each protein which were considered to be enzyme-inhibitor complexes. Plasminogen was not detected before therapy(0 % by S-2251 and less than 5 % by Rocket IEP) in spite of AP remaining (16 % by S-2251, 25 % by Rocket IEP) and FDP was elevated to 80 mcg/ml at 4 hours after exchange. These findings indicated that, in some case of FHF, FDP did not increase because of absence of plasminogen even if accompanied with DIC.

Efficacy of plasma exchange therapy for Kawasaki disease intractable to intravenous gamma-globulin

2004 ◽  
Vol 14 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Masaaki Mori ◽  
Tomoyuki Imagawa ◽  
Shigeki Katakura ◽  
Takako Miyamae ◽  
Ken-ichi Okuyama ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Plasma Exchange ◽  
Gamma Globulin ◽  
Plasma Exchange Therapy ◽  
Intravenous Gamma Globulin
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