Plasma exchange

The present standard of treatment for TTP is urgent plasma exchange (PEX). If PEX is unavailable, treatment with plasma infusion and glucocorticoids is indicated until PEX is available.34... 

The use of vincristine to treat thrombotic thrombocytopenic purpura has also been reported to be successful 14,18). This rare disease of sporadic thrombosis of small vessels with consequent intravascular hemolysis has been successfully treated recently with both plasma exchange and plasma infusion. However, there are obvious disadvantages to plasma infusion, including volume overload, transmission of infection, and cost and scarcity of plasma. Several patients have been successfully treated with vincristine alone or in association with plasma therapy. At present, however, this treatment should probably not be used alone because of the high success rate of plasma infusion and/or exchange. 

Perlmutter, S.J., Leitman, S.F., Garvey, M.A., Hamburger, S., Feldman, F., Leonard, H.L., and Swedo, S.F. (1999) Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet 354 1153-1158. 

FIGURE 14.1 Caudate size before and after plasma exchange in 14-year-old boy with OCD. 

Nicolson, R., Swedo, S.E., Lenane, M., Bedwell, J., Wudarsky, M., Gochman, P., Hamburger, S.D., and Rapoport, J.L. (2000) An open trial of plasma exchange in childhood-onset ohsessive-compulsive disorder without poststreptococcal exacerbations. / Am Acad Child Adolesc Psychiatry 39 1313-1315. 

Idiopathic thrombocytopenic purpura (ITP) Prednisone,1 vincristine, occasionally cyclophosphamide, mercaptopurine, or azathioprine commonly high-dose gamma globulin, plasma immunoadsorption or plasma exchange Usually good... 

The treatment of amiodarone-induced hyperthyroidism is difficult. It often does not respond to conventional therapy with carbimazole, methimazole, or radio-iodine. However, corticosteroids and the combination of methimazole with potassium perchlorate have been reported to be effective (52), even if amiodarone is continued (53). Other regimens that have been used include combinations of corticosteroids with carbimazole (54), corticosteroids and benzylthiouracil (55), or propylthiouracil (SEDA-15, 170). Potassium perchlorate has also been used (SEDA-21, 199). Other forms of treatment that have been successful have been plasma exchange and in very severe cases subtotal thyroidectomy (56) or total thyroidectomy (SEDA-15,170 SEDA-17, 220 57). 

Kollef MH, McCormack MT, Caras WE, Reddy VV, Bacon D. The fat overload syndrome successful treatment with plasma exchange. Ann Intern Med 1990 112(7) 545-6. 

Membrane plasmapheresis is also the first step for treatment of pathological plasma in the case of autoimmune diseases, as the patient retains his own red blood cells while his plasma is replaced by an albumin solution or fresh frozen plasma obtained from donors (plasma exchange therapy). Other more selective plasma purification techniques consist in eliminating pathologic immunoglobulins or LDL cholesterol familial hypercholesterolemia, either by a secondary filtration, chemical adsorption or immunoadsorption. A description of various applications of plasmapheresis can be found in the book edited by Smit Sibinga and Rater [15]. 

Figure 18.8 Hollow-fiber plasma filter with its extracorporeal circuit for plasma exchange.

T7. Thanabalasingham, S., Thompson, G. R., Trayner, T. I., Myant, N. B., and Soutar, A. K., Effect of lipoprotein concentration and lecithin cholesterol acyltransferase activity on cholesterol esterification in human plasma after plasma exchange. Eur. J. Clin. Invest. 10, 45-48 (1980). 

Cher LM, Merory JM (1993) Miller Fisher syndrome mimicking stroke in immunosuppressed patient with rheumatoid arthritis responding to plasma exchange. J Clin Neurooph-thalmol 13 138-140... 

Dandona P, Marshall NH, Bidey SP, et al.Treatment of acute malignant exophthalmos with plasma exchange. In Stockigt JR, Nagataki S, eds. Thyroid research VIII. Canberra Australian Academy of Science, 1980 583-586. 

Ghnoer D, Etienne-Decerf J, Schrooyen M. Beneficial effects of intensive plasma exchange followed by immtmosuppressive therapy in severe Graves ophthalmopathy. Acta Endocrinol 1986 111 30. 

Lehmann HC, Hartung HP, Hetzel GR, Stuve O, Kieseier BC (2006) Plasma exchange in neuroimmunological disorders Part 1 Rado-nale and treatment of inflammatory cendal nervous system disorders. Arch Neurol 63 930-935. 

Raphael JC, Chevret S, Hughes RA, Annane D (2002) Plasma exchange for Guillain-Bane syndrome. Cochrane Database Syst Rev CD001798. 

Plasmapheresis This procedure is a further development of blood exchange (M.J. Lepore et at, 1967). The patient s plasma is separated by centrifugation or other appropriate techniques and discarded, so that the protein-bound and fat-soluble toxins circulating in the plasma are removed. This plasma volume is replaced by fresh plasma. At the same time, the separated corpuscular components of the patient s blood are reinfused. Serious complications may arise from the transmission of viral hepatitis and the occurrence of transfusion-related lung disorders (ARDS). Nevertheless, the method involved is simple and has been carried out successfully in individual cases (87, 91) even as plasma exchange with the administration of a high plasma volmne (1.3 1/hr over 8 hours). It has proved to be much more successful when the serum (ca. 31... 

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