Utilization of Post-centrifugal Plasma Filtration for Treatment of Hyperviscosity Syndrome due to Waldenstrom's Macroglobulinemia: A Case Report / 대한수혈학회지

Waldenstrom's macroglobulinemia is characterized by overproduction of immunoglobulin M (IgM), which can lead to development of a hyperviscosity syndrome. Plasmapheresis has been used to reduce plasma viscosity and IgM levels. However, plasmapheresis not only removes pathogenic substances but also the normal components in plasma. Post-centrifugal plasma filtration (PCPF) using a filter with an appropriate pore size has been shown to be effective for selective removal of macromolecules in plasma without requiring a replacement fluid. Here, we report on a patient with hyperviscosity syndrome due to Waldenstrom's macroglobulinemia, which was ameliorated by a single treatment of PCPF using an Evaflux 5A filter. After centrifugation, the separated plasma of the patient was subjected to membrane filtration for removal of IgM in the plasma. After PCPF, a 56.5% reduction in the IgM level (from 9,370 mg/dL to 4,080 mg/dL) was achieved, whereas the level of albumin showed a slight decrease, from 2.7 g/dL to 2.4 g/dL (11.1% reduction). The patient's symptoms were relieved and she was discharged on the seventh hospital day.

Efficacy of Therapeutic Plasma Exchange Using Post-Centrifugal Plasma Filtration / 대한진단검사의학회지

BACKGROUND: Therapeutic plasma exchange (TPE) removes pathogenic substances through a centrifugation or membrane filtration method. During the procedure for TPE, normal substances can be reduced with the removal of such pathogens. We evaluated a simple plasma exchange (SPE) and a modified technique called post-centrifugal plasma filtration (PCPF), and analyzed the degree of changes in substances between the two methods. METHODS: 14 chemical or serologic tests were performed on 129 samples from 16 patients and medical records were reviewed. Samples were divided into pre and post-apheresis measurements and delta values of pre and post-apheresis measurements were attained and compared for any statistical differences in the two methods. RESULTS: All post-apheresis concentrations were decreased compared to pre-apheresis levels in both methods. Two items revealed a statistical difference between the two methods. The IgG and rheumatoid factor, composed mainly of IgM, were reduced significantly in the SPE compared to the PCPF group (P=0.0009 P=0.02, respectively). CONCLUSIONS: Many factors, such as the size of the membrane pores and the patient's individual diagnosis played a very important role in the overall outcome of plasmapheresis. Although our study revealed a significant decrease in the IgG and RF in the SPE group, compared to the PCPF group, no other significance could be stated in the other substances measured. Therefore, such multivariable factors should be considered in the selection of the apheresis method.