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Objective: To investigate the therapeutic effect of double filtration plasmapheresis (DFPP) on severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and its clinical significance. Methods: We retrospectively analyzed the clinical data from 9 patients with severe anti-NMDAR encephalitis confrmed by Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2014 to Mar. 2018. The 9 patients did not respond to methylprednisolone shock therapy. We collected the clinical manifestations, and examination results of laboratory, electroencephalogram and imaging, and analyzed the therapeutic effect of DFPP. Results: Nine anti-NMDAR encephalitis patients, including 5 females and 4 males, were admitted to neurology intensive care unit. Their ages were ranged from 15 to 69 years old, median age of onset was 37 years old, and average hospital stay was (33.2 ± 7.6) d. The main clinical symptoms were mental behavioral abnormalities (9 cases), autonomic dysfunction (9 cases), seizures (7 cases), central hypopnea (5 cases), and consciousness disorders (5 cases). One patient was complicated with ovarian teratoma. Nine patients were positive for anti-NMDAR antibodies in cerebrospinal fluid, and 7 patients were positive for anti-NMDAR antibodies in serum. All the 9 patients were examined by electroencephalogram, and 7 of them had abnormal findings, mainly with diffuse changes and abnormal slow waves. Brain magnetic resonance imaging showed that abnormal signals could be seen in the frontal lobe, parietal lobe, temporal lobe, hippocampus and other brain regions of 4 patients, and no abnormal signals were found in the other 5 patients. Nine patients were treated with DFPP after ineffective treatment with methylprednisolone, 5 of them recovered completely, and the other 4 cases had significantly improved residual symptoms. Conclusion: DFPP can be used as an alternative for patients with severe anti-NMDAR encephalitis who are not sensitive to glucocorticoid therapy. It has better clinical efficacy and it is not restricted by allogeneic plasma resources.
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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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Three dogs were evaluated for severe hyperproteinemia and hyperglobulinemia secondary to Leishmania infantum. Double filtration plasmapheresis (DFPP) was performed in two dogs at days 1, 2, and 6 after presentation. The third dog received DFPP at days 1 and 3 after presentation and eleven hemodialysis treatments. Significant reduction in serum total protein (p < 0.0001), alpha-1 (p = 0.023), alpha-2 (p = 0.018), gamma globulins (p = 0.0105), and a significant increase in albumin/globulin ratio (p = 0.0018) were found. DFPP may be a promising therapeutic technique for rapid resolution of signs of hyperproteinemia in dogs affected by L. infantum.
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Animales , Perros , Filtración , gammaglobulinas , Leishmania infantum , Leishmania , Plasmaféresis , Diálisis RenalRESUMEN
Objective To investigate the effect of double filtration plasmapheresis (DFPP) upon the removal of donor specific antibody (DSA) in highly sensitized recipients with renal transplantation. Methods Four highly sensitized recipients undergoing renal transplantation received 7 cycles of DFPP. Luminex technology was adopted to monitor the changes of DSA. Clinical efficacy, incidence of acute rejection and adverse reactions were observed. Results After DFPP, the DSA MFI [1036 (0-4113)] was significantly declined than that before treatment [6446 (2999-12905), Z= -2.503, P=0.012]. No hyperacute rejections occurred in four highly sensitized recipients undergoing renal transplantation.Acute rejection was noted in one case, which was mitigated by postoperative DFPP and adjustment of immunosuppressive agents. During postoperative follow-up, the function of transplant kidney was normal and no rejection reactions occurred. The level of albumin was decreased after DFPP. Conclusions DFPP can effectively remove the DSA in the recipients.It is an efficacious and safe approach to prevent the incidence of acute rejections in highly sensitized recipients after renal transplantation.
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Objective To observe the clinical efficacy and safety of double filtration plasmapheresis (DFPP)in eliminating blood group antibody in ABO﹣incompatible patients undergoing liver transplantation. Methods Eighteen recipients with ABO﹣incompatible liver transplantation in the General Hospital of Chinese People’s Armed Police from January 2012 to December 2014 were selected in the ABO﹣incompatibility group.The recipients with an antibody titer of anti﹣A or anti﹣B blood group >1∶16 were scheduled to undergo DFPP.Another 20 recipients eligible for blood transfusion were chosen into the control group.The changes in the antibody titer,blood biochemical parameters and the incidence of complications were observed in recipients with ABO﹣incompatible liver transplantation.The incidence of acute rejection and mortality rate between the ABO incompatibility group and control group were statistically compared. Results Among 18 patients,15 with an antibody titer of anti﹣A or anti﹣B blood group >1 ∶16 received DFPP.After DFPP,the mean antibody titer was significantly declined.Detection of blood biochemical parameters indicated that the level of fibrinogen was significantly decreased following DFPP (P =0.0001 ).Among 20 cases receiving DFPP,3 cases presented with hypotension,3 with hemorrhage,1 with nausea and vomiting,and 1 with coagulation in pipeline.All symptoms were alleviated after effective treatment.The incidence of acute rejection and mortality rate did not significantly differ between the ABO﹣incompatibility group and control group after DFPP (both P >0.05). Conclusions DFPP can safely and effectively reduce the level of blood group antibody,decrease the incidence of acute rejection after liver transplantation and enhance the success rate of liver transplantation.
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Objective To study how to use the machine of B.BRAUN's Diapact continuous renal replacement therapy (CRRT) to achieve multiple models of plasma treatment by analyzing the characteristics of the machine.Methods Based on the machine of B.BRAUN's Diapact CRRT,assisted by extra single pump,the pipeline connection of the machine was reformed and the appropriate parameter was reset.Results After the reconstruction,the new equipment could succeed in achieving special plasma treatment such as double filtration plasmpheresis (DFPP)and plasma adsorption (PA).Conclusions The reconstructed equipment can attain special plasma treatment.Compared with plasma exchange (PE),the equipment has some characteristics such as few syndromes and without external plasma.According to its safety and stability,this new method is suitable for clinical application.
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Background: Transplantation among ABO blood group incompatibility was considered an absolute contraindication until recent development of successful protocols. A living-donor across ABO barriers may provide another option for end-stage kidney disease patients. Objective: To report the first case of ABO-incompatible living-donor kidney transplantation (ABOi-LKT) in Thailand. Patients and method: The kidney transplantation across ABO barriers was performed following the Japanese recommended protocol. The kidney recipient was a thirty-four years old woman with blood group-O, whereas the kidney donor was her brother with blood group A. To reduce anti-donor (anti-blood group-A antibody) blood levels, the patient underwent double filtration plasmapheresis and received an intravenous anti-CD20 monoclonal antibody. A maintenance immunosuppressive regimen was similar to the one of ABO-compatible setting. Results: The kidney allograft had immediate good function. The transplantation was uneventful, and the patient went home within two weeks. Kidney allograft biopsies were performed on a protocol-driven basis at time-zero, the first and sixth month post-transplantation. Histologic studies showed unremarkable findings. The patient is now twelve months after transplantation and has achieved excellent kidney function. Conclusion: ABOi-LKT provides an alternative treatment for end-stage kidney disease patients. A multi-center study of ABOi-LKT in Thailand is ongoing, and this may change the national policy of organ donation in the near future.
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Objective To evaluate the efficacy of double filtration plasmapheresis (DFPP) in the treatment of patients with refractory rheumatoid arthritis (RA). Methods Eighty-two patients were randomly aesigned,42 to the DFPP group and 40 to the no-DFPP group. All patients previously experienced an incomplete response to 2-3 dis-ease-modifying antirheumatic drugs (DMARDs) and 1-2 nonsteroidal anti-inflammatory drugs (NSAIDs) or predni-sene. All patients received sulphasalazine (SASP,0.75 g three times daily) plus methotrexate (MTX, 10 mg orally once weekly). DFPP was performed once a week for 2-3 sessions. A total of 121 plasmapheresis procedures were per-formed in 42 patients. Control patients did not receive sham DFPP. The efficacy measures recorded one day after the final treatment and latest month in follow up for 12～24 months included the American College of Rheumatology 20% ,50% ,and 70% improvement criteria (ACR20, ACR50, and ACR70), the Health Assessment Questionnaire estimate of disability (HAQ); and the disease activity index. Results Patients in the DFPP group had ACR 20, ACR 50 and ACR 70 improvements of 100% ,92.9% and 81.0%,as compared with the patients in no-DFPP group 17.5% ,0,and 0 (P<0.001). Significant change from baseline was observed in HAQ scores in the DFPP group but not in the no-DFPP group (P<0.001). The changes from baseline in the disease activity scores were significantlygreater than in the no-DFPP group (P<0.001). Conclusion DFPP therapy significantly alters the signs and symp-toms of refractory RA. There are significant increases in physical function and improvement in quality of life.