ABSTRACT
Six patients with prolonged acute courses of thrombotic microangiopathy are reviewed. These patients had in common courses of acute disease requiring plasma support for more than 3 months, with subsequent complete remission. Plasma support requirements may be prodigious, and the acute course may require more than 100 plasma exchanges before a stable remission is achieved. These patients appear to represent a subset of thrombotic microangiopathy distinct from the more common acute T.T.P. course, which resolves in 3-6 weeks, and the chronic relapsing pattern, which may have a short or prolonged acute course.
Subject(s)
Hemolytic-Uremic Syndrome/therapy , Plasma Exchange , Purpura, Thrombotic Thrombocytopenic/therapy , Adult , Child , Female , Hemolytic-Uremic Syndrome/complications , Humans , Infant, Newborn , Male , Middle Aged , Purpura, Thrombotic Thrombocytopenic/complicationsABSTRACT
Therapeutic applications using semiautomated blood cell separators have improved the clinical management of several disorders through cellular or plasma depletion, or by rapid erythrocyte or plasma replacement. Cytapheresis procedures may remove large numbers of platelets or leukocytes in proliferative disorders, or induce and maintain a lymphopenia in "autoimmune" diseases. Rapid reductions in circulating paraproteins, autoantibodies, and immune complexes can be achieved to augment longer-term cytotoxic or immunosuppressive therapy. Therapeutic apheresis is adjunctive or palliative, not curative, and is usually short-term rather than chronic. Familiarity with the evolving indications for intervention with apheresis is essential for maximal benefit and minimal risk to the patients recommended for therapy.
Subject(s)
Cell Separation , Leukapheresis , Plasmapheresis , Plateletpheresis , Erythrocyte Transfusion , Exchange Transfusion, Whole Blood/methods , Humans , Leukemia/therapy , Leukocytes , Lymphocyte Depletion , Plasma ExchangeSubject(s)
Leukapheresis , Leukemia/therapy , Acute Disease , Adult , Aged , Antineoplastic Agents/therapeutic use , Female , Humans , Leukemia/blood , Leukemia/mortality , Leukocyte Count , Male , Middle Aged , Prognosis , RiskABSTRACT
Four patients with thrombotic thrombocytopenic purpura (TTP) were treated by plasma-exchange transfusion, three of whom recovered completely. Because previous reports in the literature describing exchange transfusion as treatment for TTP have demonstrated variable success rates, particular attention was given to "dose" and frequency of plasma exchange. Evans blue dye studies established a measure of "dose" under conditions of varying efficiency. Serum LDH activity was found to be diminished by plasma exchange, and the rate of return of serum LDH activity reflected residual disease activity. The magnitude of LDH activity reduction correlated with the adequacy of dose of plasma exchange and was an indicator for the need of repeated daily exchanges. Failure to obtain a spontaneous increment in platelet count also suggested the need for additional exchanges and/or larger dose of exchange. There is a need for a standard expression of dose of plasma exchange. Utilizing these markers (LDH, platelet count), it may be possible to improve the survival in TTP if adequate dose and frequency of plasma exchange are used.
Subject(s)
Blood Transfusion , Plasma , Purpura, Thrombotic Thrombocytopenic/therapy , Adolescent , Adult , Evans Blue , Female , Humans , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Platelet CountABSTRACT
Acute thrombotic and hemorrhagic manifestations of thrombocytosis associated with myeloproliferative disorders may be life threatening. Conventional therapy with radioisotopes and/or cytotoxic drugs may require weeks for effective control of platelet counts. In five patients, plateletpheresis by discontinuous-flow (Haemonetics) or continuous-flow (Aminco Celltrifuge) centrifugation was used as a means of reducing platelet counts acutely. With each procedure, approximately 2-9 X 10(12) platelets were removed, resulting in decrements in platelet counts and relief of symptoms. Plateletpheresis is a useful and safe acute means of controlling platelet counts in myeloproliferative disorders.
Subject(s)
Plasmapheresis , Thrombocytosis/therapy , Adult , Aged , Female , Humans , Male , Middle AgedSubject(s)
Blood Cells , Cell Separation , Nursing Care , Acute Disease , Agglutinins , Anemia, Hemolytic/immunology , Anemia, Hemolytic/therapy , Autoantibodies , Cold Temperature , Female , Humans , Leukemia, Lymphoid/therapy , Leukemia, Myeloid/therapy , Male , Plasmapheresis , Polycythemia Vera/therapy , Waldenstrom Macroglobulinemia/therapyABSTRACT
Two patients with advanced lymphoma, chronic cold agglutinin disease refractory to conventional therapy and severe, progressive anemia were treated with exchange plasma transfusion. Both experienced significant reduction in titers. The first patient, in whom the procedure was done manually, died with widespread lymphoma without achieving apparent clinical benefit. The second patient was exchanged using the Aminco Celltrifuge, with improvement in in vitro compatibility tests and transfusion tolerance. The technical details of continuous-flow centrifugation exchange plasma transfusion are described.
