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Blood adsorption, one of the blood purification, can be classified into hemoperfusion and immunoadsorption.In recent years, double plasma molecular adsorption, a combined adsorption, has also been widely used in clinical practice.Based on adsorption, the toxins in blood of patients can be efficiently removed by hemoadsorbents.There are two kinds of adsorbents commonly used in hemoperfusion: carbon and resin, and two types of adsorbents in immunoadsorption: biological affinity and physicochemical affinity.Adsorption has been widely applied in clinical practice, involving in sepsis, organ transplantation, systemic lupus erythematosus, liver failure, autoimmune diseases and so on.The review described the application of blood adsorption in clinical practice.
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Objective To investigate the treatment on de novo donor specific antibody (dnDSA) mediated acute rejection after lung transplantation. Methods Clinical data of 1 recipient with antibody-mediated rejection (AMR) early after lung transplantation was retrospectively analyzed. The process of diagnosis and treatment were assessed. Results The recipient underwent right lung transplantation due to systemic sclerosis-associated end-stage interstitial lung disease. Preoperatively, classⅠ panel reactive antibody (PRA) was positive (11%). No pretreatment was given before transplantation. Antithymocyte globulin induction therapy was delivered on the day of transplantation and postoperatively. The recipient was properly recovered early after transplantation. Chest tightness and shortness of breath occurred at postoperative 13 d, which were progressively worsened and rapidly progressed into type Ⅰ respiratory failure. Class Ⅰ PRA was increased to 58%, and dnDSA was observed at the loci of A24: 02. The mean fluorescence intensity (MFI) was 2 110. According to the guidelines of International Society for Heart and Lung Transplantation, the recipient was diagnosed as possible AMR. After comprehensive treatment including plasmapheresis, protein A immunoadsorption, glucocorticoid pulse, rituximab and immunoglobulin intravenous drip, the PRA and DSA levels were gradually decreased, and the MFI of DSA was 0 at postoperative 20 d. Clinical condition of the recipient was gradually improved. The dyspnea was healed, shortness of breath was eased, respiratory failure was treated, and pulmonary effusion was gradually absorbed. At postoperative 45 d, the recipient was discharged after full recovery. During 1-year follow-up, the recipient was physically stable and obtained normal quality of life. Class Ⅰ PRA was 5%, and class Ⅱ PRA was negative. No DSA was noted. Conclusions Based on traditional drug therapy, supplement of protein A immunoadsorption therapy may effectively eliminate DSA from the circulating blood of the recipient and mitigate the damage of target organs. Ideal short- and long-term prognosis may be achieved. Traditional drug therapy combined with immunoadsorption may yield ideal efficacy in treating AMR after lung transplantation.
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Staphylococcal protein A (SPA) has a high affinity for human immunoglobulin, and SPA immunoadsorption can specifically reduce the titer of autoantibodies and quickly relieve the clinical symptoms of myasthenia gravis (MG). Recent studies have suggested that immunoadsorption has better clinical efficacy and a lower incidence of adverse reactions than plasma exchange. A case of refractory MG with poor response to corticosteroids, intravenous immunoglobulins and immunosuppressive therapy was reported. The patient had low immune function and progressive pulmonary infection in the later stage of the disease. Respiratory muscle weakness was relieved quickly after four times of immunoadsorption therapy. The value of immunoadsorption in the treatment of refractory MG was explored with literature review.
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In order to further standardize the clinical technical operation of blood purification related to organ transplantation, experts in the fields of organ transplantation and nephrology organized by Branch of Organ Transplantation of Chinese Medical Association have formulated this specification from the perspectives of technical operation specifications of vascular access, hemodialysis, peritoneal dialysis, hemofiltration, plasma exchange and immunoadsorption.
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Shiga toxin-producing Escherichia coli (STEC) that causes a prodromal hemorrhagic enteritis is the main cause of hemolytic uremic syndrome (HUS) particularly in pediatric patients. It is characterized by acute kidney injury with microangiopathic hemolytic anemia and thrombocytopenia. The kidney and brain are the two major target organs, and neurological involvement is the most frequent cause of mortality. The time delay between bloody diarrhea and neurological symptoms ranges from few days to a month. Neurological disorders include disturbances in cognitive functions, focal neurological signs, epileptic seizures, myoclonus and neuropsychiatric symptoms. Cerebral magnetic resonance imaging reveals various patterns of hyperintensities distributed through cerebral matter or may be totally normal even the patient has severe neurological involvement. Electroencephalography usually show generalized or focal slowing of the background activity, spikes or sharp waves despite being normal in around 20% of patients. We present here an adult male patient referred to our center with requirement of hemodialysis due to diarrhea-associated HUS complicated by acute kidney injury. Later during the course of plasma exchange therapy the patient developed an isolated abducens nerve palsy. Complete renal recovery was achieved by plasma exchange therapy but abducens palsy remedied rescue introduction of immunoglobulin G (IgG) depletion by immunoadsorption
Escherichia coli, productor de toxina Shiga (STEC), que causa una enteritis hemorrágica en fase prodrómica, es la principal causa del síndrome urémico hemolítico (SUH), particularmente, en pacientes pediátricos. Se caracteriza por una lesión renal aguda con anemia hemolítica microangiopática y trombocitopenia. El riñón y el cerebro son los dos órganos principales a los que ataca, y la afectación neurológica es la causa más frecuente de mortalidad. El tiempo que transcurre entre la aparición de diarrea sanguinolenta y los síntomas neurológicos varía entre pocos días y un mes. Los trastornos neurológicos incluyen alteraciones en las funciones cognitivas, signos neurológicos focales, ataques epilépticos, mioclonías y síntomas neuropsiquiátricos. La resonancia magnética de cerebro revela varios patrones de hiperintensidades distribuidas a través de la materia cerebral o puede ser totalmente normal incluso si el paciente tiene un compromiso neurológico severo. El electroencefalograma generalmente muestra una disminución generalizada o focal de la actividad de fondo, picos u ondas agudas, a pesar de ser normal en alrededor del 20% de los pacientes. Presentamos un paciente adulto de sexo masculino, derivado a nuestro centro para ser tratado con hemodiálisis debido a SUH asociado a diarrea, complicado por insuficiencia renal aguda. Luego, durante el transcurso de la terapia de intercambio de plasma, el paciente desarrolló una parálisis ocular aislada del sexto par craneal. Se logró una recuperación renal completa por medio de la terapia de intercambio plasmático; no obstante, la parálisis del nervio motor ocular externo remedió la disminución de la inmunoglobulina G (IgG) mediante el tratamiento de rescate de inmunoadsorción
Subject(s)
Humans , Male , Adult , Ophthalmoplegia , Shiga Toxin/adverse effects , Shiga Toxin/toxicity , Renal Insufficiency , Shiga-Toxigenic Escherichia coli , Hemolytic-Uremic Syndrome , Nervous System DiseasesABSTRACT
In recent years, with the great development of knowledge in pathophysiology and the improvement of medical technologies and products,we have further deepened our understanding in the princi-ples and patterns of continuous blood purification(CBP)technology. Nowadays,experts both domestic and foreign have been advocating the application of a combined CBP,which means two or more different blood purification principles or techniques combine ( or integrate) together so we can achieve different blood purifi-cation purposes and relieve or cure diseases. This document introduced the main trend and advanced technolo-gies of CBP used in critical care medicine,such as double filtration plasmapheresis and immunoadsorption.
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Objective To study the clinical outcomes and safety of immunoadsorption therapy for refractory autoimmune disease in children.Methods Three boys who suffered of severe autoimmune disease-one boy suffered of severe dermatomyositis and pulmonary infection; one suffered of severe anaphylactoid purpura with alimentary tract hemorrhage and entero ablation for intestinal perforation ; other one suffered of systemic juvenile idiopathic arthritis and severe prosopo-cellular tissue infection,macrophage active syndrome,were treated with blood immunoadsorption by resin immunoadsorbent of HA280.Then evaluated the clinical outcome of 3 cases,including symptom improvement,change of serum immune globulin,complement,enzyme of liver and heart,autoantibody.Results After the treatment of immunoadsorption,the symptom of 3 cases improved obviously; the sensitivity of the corticosteroids increased; autoantibody of antinuclear antibody (ANA) and anti-cyclic citrullinated peptide antibody (CCP) changed to negative; C-reactive protein (CRP) dropped (P ＜ 0.05) ; descending scale of IgM,IgA,C3,C4 increased (P ＜ 0.05) ; the normal scale of immunoglobulin didn't changed (P ＞ 0.05) ; besides aspartate aminotransferase (AST) dropped in the case of dermatomyositis,the other enzyme of liver and heart didn't changed.Conclusions The body could be restored quickly by the treatment of immunoadsorption together with the drug; CRP in the blood could be removed by immunoadsorbent of resin; 1 or 2 times blood immunoadsorption could not change the level of enzyme,but it need to do more on severe cases,especially those with poor organ function; for the safe of the treatment of immunoadsorption for the young age,low weigh and severe cases,the operative procedure should be critical care.
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Objective To compare the treatment response of plasma exchange and immunoadsorption for children suffering from severe systemic lupus erythematosus (SLE),and then find the more advantageous treatment method.Methods Between March 2007 and March 2013,27 children with severe SLE were collected from the Department of Pediatric Nephrology and Rheumatology of Shengjing Hospital of China Medical University.Part of them about 11 children accepted plasma exchange treatment (plasma exchang group) and the others accepted immunoadsorption(immunoadsorption group).The clinical features,ANA,IgG,serum ions,the cost of treatment and the hospitalization time were reviewed,and the comparative analysis were performed in two groups.Results There were comparabilities between plasma exchange group and immunoadsorption group in age,gender,couse of disease and systemic lupus erythematosus disease activity index(SLEDAI) score before treatment.(1)In plasma exchang group,11 children were conducted 26 times treatment.The SLEDAI score significantly decreased after plasma exchange (19.00 ± 3.77 vs 5.34 ± 4.35,P ＜0.05),and the ANA and IgG significantly decreased as well[2 439.58 ± 1 430.56 vs 303.54 ± 169.32; (8.35 ± 5.67) g/L vs (4.04 ± 2.23) g/L,P ＜ 0.05].(2) There were 16 children in immunoadsorption group,they accepted immunoadsorption treatment about 44 times.The SLEDAI score after immunoadsorption significantly decreased (18.25 ± 4.62 vs 4.25 ± 2.23,P ＜ 0.05),and the ANA and IgG significantly decreased as well [2 560.39 ± 1 563.78 vs 289.62 ± 137.62 ; (9.98 ± 6.03) g/L vs (3.23 ± 1.37) g/L,P ＜0.05].(3) There were no statistical differences in the value of SLEDAI score,ANA and IgG after the treatment between two groups.(4) The concentrations of serum potassium,sodium and chlorine and calcium in the children treated by plasma exchange or immunoadsorption were consistent with the original.(5) The hospitalization expense in plasma exchange group was distinctly higher than that of immunoadsorption group (P ＜ 0.05).(6) There was no significant difference in the length of hospitalization between two groups [(33.6 ± 8.60) d vs (31.9 ± 14.6) d,P ＞ 0.05].Conclusion The treatment both plasma exchange and immunoadsorption were effective methods for the children with severe SLE.However,the cost of plasma exchange was much higher and had a great influence on the concentration of antihypertensive drugs.
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Objective To explore the effect of MICA-Ab expression on the prognosis of sensitized renal transplantation recipients.Methods A total of 51 sensitized recipients (PRA more than 20%) in our hospital from August 2007 to April 2010 were enrolled in the study.In these patients,29 cases received protein A immunoadsorption and detection of MICA-Ab was performed before and after protein A immunoadsorption.Other 22 patients received MICA-Ab detection when they were hospitalized.Associations of PRA,HLA-matches,acute rejection,and serum creatinine of postoperative week 1 and week 4 with MICA-Ab were analyzed retrospectively.Results Sixteen recipients (31.4%) had positive MICA-Ab expression but their acute rejection rate was not higher as compared to the patients with negative MICA-Ab expression.Recipients with PRA＞40% showed higher expression level of MICA-Ab than recipients with PRA≤40% (P≤0.05).HLA-match did not show influence on MICA-Ab expression.MICA-Ab positive group had no higher serum creatinine level than negative group in postoperative week 4.MICA-Ab level decreased significantly after protein A immunoadsorption.Conclusions MICA-Ab expression increases in the sensitive recipients but does not influence the prognosis.Protein Aimmunoadsorption can eliminate MICA-Ab effectively in sensitized recipients.
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Objective To investigate the removal effect of immunoadsorption (IA) on associated antibodies and the efficacy in late-onset myasthenia gravis (MG). Methods A total of 25 late-onset MG patients were randomly selected to enroll in this study. IA therapy was given to 10 patients (IA group), while immunoglobin (0.4 g·kg-1·d-1) was administrated to the other 15 patients for 5 days(Ig group). The titers of Titin antibody (Titin-ab), acetylcholine receptor antibody (AchR-ab) and presynaptic membrane antibody (PrsmR-ab) were detected before and after the treatment. Quantitive MG (QMG) score was assessed before and immediately after the entire course of treatment. The clinical efficacy, the duration of respiratory support and in-hospital were compared between two groups. The correlation between three antibodies and QMG score was also analyzed. Results Compared with that before treatment, the Titin-ab PIN values, the AchR-ab PIN values, and the PrsmR-ab P/N values of IA group were all decreased significantly after treatment (P<0.05, respectively). The P/N value of Titin-ab in IA group was decreased by 54.7%～3.5%, which was significantly higher than that in Ig group(19.9%±3.1%) (P<0.01). QMG score reduced by 42.4%± 4.2% and 23.8%±3.7% in IA group and Ig group respectively (P<0.01, respectively). Symptoms were effectively ameliorated by both treatments, but the effective power of IA group was higher than that of Ig group (70% vs 40%, P<0.05). Remission time of IA group was significantly shorter than that of Ig group [(5.38±0.42) d vs (8.4±1.54) d, P=0.008), so was the duration of in-hospital [(13.50±0.50) d vs (16.50±0.50) d, P<0.05). The number of respiratory support in IA group was less than that in Ig group (1/10 vs 6/15, P<0.05). By the Pearson correlation analysis, the decrease of Titin-ab showed a better longitudinal correlation with the decrease of QMG score than the other two antibodies (r=0.6315, P<0.01). Conclusion IA can rapidly and effectively clear the pathogenic antibodies of late-onset MG patients and its short-term clinical efficacy is better than immunoglobin.
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To estimate the protective effect of removing circulatory TNF-a immunoadsorpnon or Amberlite XAD-7 absorption respectively on endotoxin shock. Methods New Zealand white rabbits injected with lethal dose of endotoxin underwent hemoper-fusion through immunoadsorbent or Amberh'te XAD-7 respectively. Plasma TNF-a levels were detected, and the sorbent efficiency and survival rate were observed. Results After 2 hours hemoperfusion through immunoadsorbent or Amberlite XAD-7 respectively, plasma TNF levels were significandy lower than those in die control group, especially, die sorbent efficiency of immunoadsorp-tion was higher dian dial of Amberlite XAD-7 adsorption. Conclusion Compared widi die nonspecific Amberlite XAD-7 adsorption, immunoadsorption might be a specific and more effective therapy of endotoxin shock.