Plasmaféresis terapéutica. Análisis de 2 años en el Instituto de Hematología e Inmunología / Therapeutic plasmapheresis. Two-year analysis at the Institute of Hematology and Immunology

La plasmaféresis terapéutica es un procedimiento extracorpóreo en el que, a partir de la extracción de sangre total, se separa el plasma del resto de los componentes celulares con el objetivo de disminuir o eliminar determinadas sustancias patológicas que intervienen en la fisiopatología de la enfermedad. En la actualidad, es el procedimiento de aféresis más frecuentemente usado en la medicina clínica. Se mencionan los avances fundamentales en sus indicaciones, métodos y soluciones de reposición, y se evalúan las indicaciones de plasmaféresis realizadas en el Instituto de Hematología e Inmunología en el período comprendido entre enero de 2009 y diciembre de 2010. Se evaluaron 295 plasmaféresis realizadas a 35 pacientes con 9 enfermedades o condiciones asociadas con ellas; el 60 por ciento correspondieron con la categoría I de la Asociación Americana de Aféresis (ASFA) y el proceder mostró efectividad en el 88,6 por ciento de los casos. El volumen de recambio osciló entre 750 y 2 400 mL y la solución de reposición más empleada fue la solución salina, seguida del plasma fresco congelado y la albúmina. En el 4,06 por ciento de los casos se evidenció alguna reacción adversa relacionada con el proceder, pero estas fueron leves y de fácil control. La plasmaféresis es un proceder con enormes beneficios terapéuticos cuando se utiliza en enfermedades en las que ha demostrado su eficacia

Therapeutic plasma exchange is an extracorporeal procedure in which, after removing the whole blood, plasma is separated from other cellular components with the aim of reducing or eliminating pathological substances involved in the pathophysiology of the disease. Today, apheresis procedure is the most frequently used in clinical medicine. In this paper, we mention fundamental advances in their indications, methods and replacement solutions. We evaluate indications of plasmapheresis, which were performed at the Institute of Hematology and Immunology from January 2009 to December 2010. There were evaluated 295 plasmapheresis performed in 35 patients with 9 diseases or conditions associated with them. 60 percent matched Class I of the American Association of Apheresis (ASFA) and this procedure was effective in 88.6 percent of cases. The exchange volume ranged from 750 to 2 400 mL and the most common replacement solution was saline solution, followed by fresh frozen plasma and albumin. 4.06 percent of these patients had some adverse reactions related to the proceeding, but these were mild and easily controlled. Plasmapheresis is a procedure with enormous therapeutic benefits when used in diseases, which have proven its effectiveness

Analysis of the Adverse Effects Associated with Therapeutic Plasmapheresis / 대한수혈학회지

BACKGROUND: Although therapeutic plasmapheresis (TP) is a useful procedure in removing pathogenic antibodies and toxic substances from the patient, adverse reactions could arise from the use of replacement fluids and anticoagulants. Comprehensive analysis on those adverse effects had been rarely reported in Korea. METHODS: We retrospectively investigated the clinical records and the TP records from 3,962 TP sessions for 581 patients between January 1995 and October 2008 at Asan Medical Center, and we analyzed the adverse reactions related to TP. RESULTS: Adverse reactions were seen in 142 patients (24.4%) in 348 TP procedures (8.8%). Citrate toxicity was most frequently seen in 83 procedures (23.9%) followed by chills in 72 procedures (20.7%), allergic reactions in 69 procedures (19.8%) and hypotension in 60 procedures (17.2%). Citrate toxicity, chills and allergic reactions were seen more frequently in the TP procedures using FFP than in the TP procedures using albumin (P=0.001). The prevalence of citrate toxicity was significantly lower in the cases where calcium gluconate was administered (P<0.001), while it was significantly higher in the patients whose hematocrit was below 28.5% (P<0.001). In terms of severity, the mild, moderate and severe adverse reactions were 36.8%, 56.3% and 6.9%, respectively. CONCLUSION: TP is a relatively safe method of treatment, but it is important to predict and prevent adverse reactions and to respond appropriately to these adverse reactions.

A Living Donor Liver Transplantation after Therapeutic Plasmapheresis in a Patient with Positive HLA Crossmatch / 대한수혈학회지

A positive HLA crossmatch in cadevaric liver transplantation is relatively acceptable, but in living donor liver transplantation (LDLT) using relatively small sized grafts, the rejection rates were higher in positive crossmatchcases than in negative cases, as described in several previous reports. We report a case of LDLT performed with therapeutic plasmapheresis, in a recipient with a positive HLA crossmatch to donor before transplantation. The patient was a 56-year-old male patient with liver cirrhosis (UNOS status IIA, MELD score 28) caused by chronic hepatitis B. The HLA crossmatch results were 1:2 and 1:8 positive for NIH-CDC (complement dependent cytotoxicity) and AHG-CDC, respectively. The flow cytometric crossmatch (FCXM) was also positive (T-MFI ratio 9.0 and B-MFI ratio 3.4). With 5 cycles of preoperative therapeutic plasmapheresis, the HLA crossmatch converted to negative and liver transplantation was performed. The liver function of the patient was well maintained for 5 months, without any sign of hyperacute or acute rejection. However, the patient eventually died from suddenly occurred infection-associated hemophagocytic syndrome at 5 months after surgery. Therapeutic plasmapheresis can be considered as one of therapeutic options for LDLT patients with a positive HLA crossmatch to donor.