No abstract available.
Plasma Exchange* ; Plasma*

No abstract available.
Plasma Exchange* ; Plasma* ; Seoul*

No abstract available.
Plasma Exchange* ; Plasma* ; Seoul*

Thyroid storm is a life-threatening condition with mortality rates reaching up to 20 to 30%. First-line treatment includes inhibition of thyroid hormone synthesis, prevention of release of preformed hormones, blocking of peripheral FT4 to FT3 conversion, enhancing hormone clearance, and definitive radioactive iodine ablation. However, in the presence of life-threatening adverse effects (e.g., agranulocytosis) and contraindications (e.g., fulminant hepatic failure), therapeutic plasma exchange (TPE) can be used to rapidly remove circulating thyroid hormones, antibodies, and cytokines in plasma; this is recommended by the American Society of Apheresis (ASFA) and the American Thyroid Association (ATA) as second-line treatment for thyroid storm. Here, we report a 49-year-old female with Graves' disease admitted in our emergency room for a 6-week history of fever, weight loss, jaundice, exertional dyspnea, palpitations, and diarrhea. Her initial thyroid hormone levels were: FT4 64.35 (NV 9.01-19.05 pmol/L), FT3 23.91 (NV: 2.89-4.88 pmol/L), and TSH 0.00000 (NV: 0.35-4.94 mIU/L) and we managed her as a case of thyroid storm (Burch-Wartofsky score 70) by initiating high dose propylthiouracil. However, her sensorium deteriorated and serum bilirubin continued to rise from 307.2 on admission to 561.6 umol/L on the 5th hospital day (NV: 3 - 22 umol/L). TPE was performed after consultation with the Division of Hematology. Over the treatment course, her thyroid hormones normalized: FT4 13.18 pmol/L, FT3 2.30 pmol/L. However, despite TPE, her symptoms worsened and she became comatose, had hypotension despite vasopressors and developed new-onset atrial fibrillation. She expired on her 7th hospital day from multiorgan failure. TPE is effective in decreasing circulating thyroid hormone levels. However, it had no effect on clinically important outcomes as our patient still deteriorated and eventually succumbed. We still wrote and submitted this case report since if only successful cases were reported, the true effectiveness rate of TPE could not be determined.Thyroid storm is a life-threatening condition with mortality rates reaching up to 20 to 30%. First-line treatment includes inhibition of thyroid hormone synthesis, prevention of release of preformed hormones, blocking of peripheral FT4 to FT3 conversion, enhancing hormone clearance, and definitive radioactive iodine ablation. However, in the presence of life-threatening adverse effects (e.g., agranulocytosis) and contraindications (e.g., fulminant hepatic failure), therapeutic plasma exchange (TPE) can be used to rapidly remove circulating thyroid hormones, antibodies, and cytokines in plasma; this is recommended by the American Society of Apheresis (ASFA) and the American Thyroid Association (ATA) as second-line treatment for thyroid storm. Here, we report a 49-year-old female with Graves' disease admitted in our emergency room for a 6-week history of fever, weight loss, jaundice, exertional dyspnea, palpitations, and diarrhea. Her initial thyroid hormone levels were: FT4 64.35 (NV 9.01-19.05 pmol/L), FT3 23.91 (NV: 2.89-4.88 pmol/L), and TSH 0.00000 (NV: 0.35-4.94 mIU/L) and we managed her as a case of thyroid storm (Burch-Wartofsky score 70) by initiating high dose propylthiouracil. However, her sensorium deteriorated and serum bilirubin continued to rise from 307.2 on admission to 561.6 umol/L on the 5th hospital day (NV: 3 - 22 umol/L). TPE was performed after consultation with the Division of Hematology. Over the treatment course, her thyroid hormones normalized: FT4 13.18 pmol/L, FT3 2.30 pmol/L. However, despite TPE, her symptoms worsened and she became comatose, had hypotension despite vasopressors and developed new-onset atrial fibrillation. She expired on her 7th hospital day from multiorgan failure. TPE is effective in decreasing circulating thyroid hormone levels. However, it had no effect on clinically important outcomes as our patient still deteriorated and eventually succumbed. We still wrote and submitted this case report since if only successful cases were reported, the true effectiveness rate of TPE could not be determined.

No abstract available.
Plasma Exchange* ; Plasma* ; Purpura, Thrombotic Thrombocytopenic*

Child ; Humans ; Plasma Exchange ; Thrombotic Microangiopathies ; therapy

We evaluated clinical effects and side effects of plasma exchange(PE) in patients with severe Guillain-Barre syndrome(GBS). Two plasma volumes were exchanged 3 times on an alternate-day base(total 6 plasma volumes) in eight patients with severe GBS. Exchange fluid used was fresh frozen plasma(FFP) or human albumin. Intervals taken for patients to walk with support were significantly shorter than eight control patients. GBS of the similar grades(p<0.05). Effects were not related to age, sex, or initial CSF protein levels. After PE, thrombocytopenia followed in all patients, most remarkably after the first PE. Degree of platelet reduction correlated significantly with the time taken for each PE and the plasma flow rate during PE. But they resolved spontaneously in all cases within 2 to 11 days after the last PE. Other side effects included urticaria, paresthesia dyspnea, hemorrhagic spots on the skin, and chilly sense, all of which were transient. These results suggest that PE could promote early improvement in severe GBS with relative safety, if performed early in the course of the illness.
Blood Platelets ; Dyspnea ; Guillain-Barre Syndrome* ; Humans ; Paresthesia ; Plasma Exchange* ; Plasma Volume ; Plasma* ; Skin ; Thrombocytopenia ; Urticaria

BACKGROUND: The Spectra Optia (SPO) is a novel continuous-flow centrifugal apheresis system based on the COBE Spectra (CSP) platform. There have been few attempts to validate the advantages of the SPO. We performed a retrospective study comparing the two cell separators for therapeutic plasma exchange (TPE) procedures in kidney transplant (KT) patients and seeing efficacy and safety. METHODS: We analyzed 720 TPE procedures performed between August 2012 and July 2014. Procedures included desensitization TPE before KT and TPE for the management of acute and chronic antibody-mediated graft rejection. Demographic characteristics, operational TPE variables, and laboratory data were analyzed. RESULTS: Demographic characteristics for the SPO (n=389) and CSP (n=331) groups did not differ significantly. The procedure time to exchange one plasma volume was 94.2+/-10.3 min in the SPO group and 100.4+/-11.2 min in the CSP group (P<0.001). The plasma removal efficiency (PRE) was 92.5+/-4.9% in the SPO group and 83.2+/-3.7% in the CSP group (P<0.001). There were no significant differences across the two apheresis systems for changes in hematologic parameters. CONCLUSIONS: Compared with the CSP, the SPO was associated with an improved PRE and a shorter procedure time to exchange one plasma volume. Our results in KT patients show that the SPO is superior to the CSP in TPE procedures.
Blood Component Removal ; Graft Rejection ; Humans ; Kidney ; Kidney Transplantation ; Plasma ; Plasma Exchange* ; Plasma Volume ; Retrospective Studies

It is well known that circulating antibodies are produced by plasma cells derived from B lymphocytes, and T lyphocytes are endowded with the capacity to regulate the type and intensity of virtually all immune responses. Therefore, the measurement of relative and absolute number of lymphocytes in the peripheral blood of myasthenia gravis patients could be of value. We have studied the distribution pattern of lymphocytes and helper/suppressor ratio in the peripheral blood of 28 myasthenic patients in comparison with 10 patients of other neurologic diseases as control by using immunobead method. There was no significant differences between 17 myasthenic patients who had taken only anticholinesterase and control. But in 17 patients who had taken steroid, Helper T lymphocyte was decreased significantly compared to control. Both T lymphocyte and B lymphocyte were also decreased significantly compared to 17 myasthenic patients who had taken only anticholinesterase without steroid therapy. In 3 patients who had undergone thymectomy, there was significant decreases of suppressor T lymphocyte. Plasma exhange as a treatment for myasthenia gravis is currently the subject of clinical interest and research. Clinical response and muscle power measured by using sphygmomanometer were followed in 2 patients in myasthenic crisis and in 4 patients with severe disease refractory to all other treatment modalities, received 4-6 cycles of plasma exchange with Hemonetics 30-S. 2 patients had a recurrence 1.5 and 6 months after first course of plasma exchange respectively, Therefore, they had to take a second course of plasma exchange. The satisfactory increment of muscle power was noticed in 5 out of 6 cases after fourth plasma exchange.
Antibodies ; B-Lymphocytes ; Humans ; Lymphocytes* ; Myasthenia Gravis* ; Plasma Cells ; Plasma Exchange* ; Plasma* ; Recurrence ; Sphygmomanometers ; Thymectomy

Catastrophic antiphospholipid syndrome (APS) is an accelerated subtype of APS that results in multiorgan failure. Although catastrophic APS represents about 0.8% of all APS cases, it is usually a life-threatening medical condition that requires high clinical awareness. Catastrophic APS has been managed by various therapies, including anticoagulation, corticosteroids, plasma exchange and IV immunoglobulin, but it still has a high mortality rate. A few cases treated by anticoagulation and steroids have been reported in Korea. In this paper, we report a case of catastrophic APS that improved after anticoagulation therapy alone. Thus, we consider hat our case shows another clinical aspect of catastrophic APS.
Adrenal Cortex Hormones ; Antiphospholipid Syndrome ; Immunoglobulins ; Korea ; Plasma Exchange ; Steroids