Plasma Exchange Research Articles

New tatt? We're ok with that! Relaxing the tattoo deferral for plasmapheresis donors maintains safety and increases donations.

Tattooing is one of the leading donor deferral reasons in Australia. Until September 2020, donors were deferred from all donation types for 4 months after a tattoo. At this time, our guideline changed such that donations of plasma for further manufacture were accepted immediately, provided the tattoo was administered in a licensed or regulated Australian establishment. We examined the effects of this change. Donors with a tattoo deferral in the 2 years before or after the guideline change were identified and followed up until 3 November 2022. Between the two periods, we compared blood-borne virus (BBV) incidence, donor return, and the number of donors and donations regained after deferral. The incidence of BBV infection in donors after a tattoo deferral was zero in both periods. To exceed a residual risk of 1 in 1 million for hepatitis C virus, 190 donors would need to be infected yearly from a tattoo. Donors returned to donate significantly faster after the change (median return 85 days compared with 278 days). An extra 187 donations per 10,000 person-years of observation were gained, yielding a total of 44,674 additional plasma donations nationally 0-4 months after getting a tattoo. Allowing plasma donations immediately post-tattoo resulted in a substantial donation gain with no adverse safety effect. Lifeblood subsequently reduced the deferral for transfusible component donations to 7 days for tattoos in Australian licensed/regulated establishments.

Complications of therapeutic plasma exchange: A retrospective, single-center study of 2505 procedures performed in 338 patients over 15 years.

Therapeutic plasma exchange (TPE) may involve complications. We aimed to review the demographic data, indications, technical information, and complications. Data for TPE procedures (TPEPs) performed between 2004 and 2018 were retrospectively. This study covered 2505 TPEPs performed on 338 patients; 55% of them were female (n = 186), and the median age was 36 years (range, 11-93 years). Most TPEPs were administered for hematological (40.6%) indications. The incidence of complications on the first procedure was 3.2% (n = 80); only 16 procedures (0.6%) were failed. The complication incidence was 19.8% (n = 497), with 789 total complications. Most of the complications were patient-related (90.4%), and the most of them were urticaria (29.1%), occlusion (3.2%), and faulty systems (1.01%), respectively. The use of only fresh frozen plasma as replacement fluid caused a higher complication rate (22.1%, p < 0.01). The number of TPEPs is increasing every day. Hematologic indications for TPE and the use of fresh frozen plasma may increase the risk of complications.

The Effect of Plasma Exchange on Recovery of Patients with Coronavirus Disease 2019 (COVID-19) Admitted to the Intensive Care Unit

Introduction: To evaluate the efficacy and safety of Plasma Exchange (PE) in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) positive pneumonia patients. Method: This study was a case series conducted at a referral hospital. Twenty SARS-CoV-2-positive patients had an oxygen saturation of 80-90%, and the respiratory rate above 30 per minute. These symptoms started 1 week after the onset of the disease. All patients had less than 90% oxygen saturation and needed respiratory support (oxygen therapy) treated with plasma exchange on 3-5 consecutive days during hospitalization. We followed the amount of oxygen saturation, which was in the form of increasing the patient's oxygen saturation above 90% without oxygen supply and above 92% without oxygen, improving shortness of breath and improving patients' clinical symptoms. Results: Our study included a total of 20 COVID-19 patients with an overall mean age of 48.9 ± 12.1 years (range: 39–58 years); 60% (n=12) were males, 34.5% of whom benefited from TPE sessions. On the third day after the treatment, shortness of breath improved in these patients. Oxygen saturation of any twenty patients increased before the procedure of plasma exchange. Clinical symptoms of all patients were decreasing shortness of breath and improving patients' clinical symptoms after the procedure. Conclusion: According to our observations, plasma exchange could not show a significant therapeutic effect in COVID-19 patients with severe lung involvement.

Anti-Glomerular Basement Membrane Antibody Disease: Clinicopathologic Profile and Outcomes

Background: Anti-glomerular basement membrane antibody disease is a rare autoimmune disease caused by antibodies to α3 chain of type 4 collagen. Patients presenting with severe renal involvement requiring dialysis have poor response to treatment. Materials and Methods: We conducted a retrospective and prospective study at Institute of Nephrology, Madras Medical College, Chennai, India by analyzing the data of patients with biopsy-proven anti-GBM antibody disease treated from January 2013 to December 2019. Results: There were 2,949 kidney biopsies in the study period and 92 showed crescentic glomerulonephritis (GN). Of those, 20 patients (10 males) had anti-GBM antibody disease. Mean age was 40.75 ± 14.75 years. Rapidly progressive renal failure was the most common mode of presentation (95%); five (25%) patients had diffuse alveolar hemorrhage (DAH) and nineteen patients (95%) required dialysis at presentation. Seven patients (35%) were positive for anti-neutrophil cytoplasmic antibody (anti-myeloperoxidase in six and anti-proteinase 3 in one). Of the twelve patients (60%) who received immunosuppression (cyclophosphamide, steroids, and plasma exchange), two patients (10%) attained remission, and two patients (10%) expired due to sepsis. Crescentic GN was the predominant pathology in kidney biopsy in 19 patients (95%). Mesangial hypercellularity with deposition of IgA and C3 in mesangium was present in one patient. Conclusion: In our study, anti-GBM antibody disease accounted for 21.7% of crescentic GN. Majority of patients presented late, requiring dialysis. Patient survival was 90%, while renal survival was only 10%. One patient had co-occurrence of IgA nephropathy with anti-GBM antibody disease.

Positive Outcome in a Pregnancy with Anti-kell Alloimmunization Treated with Intravenous Immunglobulin and Therapeutic Plasma Exchange Despite Persistence of High Titre Antibody: A Case Report

Background: Few reports have been published about the current clinical management of anti-Kell alloimmunization in pregnancy; its low frequency of occurrence means that the few long series published have covered an extensive time period in which different treatment approaches have overlapped. The objective of the present paper is to present our experience in the clinical management of a pregnant woman who was positive for the anti-Kell antibody. Materials and Methods: The laboratory follow-up included the weekly measurement of the antibody titre, and identification of the paternal and fetal genotype. The clinical management included TPE and IVIG administration. Obstetric monitoring included ultrasonographic monitoring of the fetus. Case Description: We report a case of anti-Kell alloimmunization with high antibody titre at first observation. Testing for fetal DNA circulating in maternal blood confirmed positivity for KEL1 gene. The patient underwent fifteen sessions of TPE after 18 weeks of gestational age, followed by weekly IVIG infusion, which continued until 27 weeks of pregnancy. Anti-Kell titres were measured before and after each TPE session. The patient had no need for IUBT and delivered by cesarean section at 34 weeks of gestational age. Pregnancy resulted in a live birth with mild HDFN. Discussion: HDFN is a potentially lethal complication of alloimmunization, and IUBT is the standard treatment for severe fetal anemia. TPE and IVIG are two alternative treatment modalities described in the literature to avoid or postpone the need for IUBT transfusion. In the case reported, despite any substantial change in antibody titre, pregnancy resulted in a live birth. This result suggests that the use of TPE and IVIG in alloimmunization during pregnancy could be an effective treatment strategy.

Improvement of mechanical properties by cold plasma treatment of bonded surfaces

In nature, matter is found in solid, liquid or gaseous form. At very high temperatures, molecules can absorb an enormous amount of energy, causing them to move in a disordered way. With the absorbed energy, they can dissociate into atoms, and because of their disordered motion, these molecules or atoms can split into ions and electrons. Excessive heating of matter is therefore always accompanied by ionisation, leaving the medium electrically neutral. This ionised state is known as plasma. It is sometimes called the fourth state of matter. Plasmas are therefore mixtures of neutral and/or excited ions, electrons, atoms, radicals or demodules with an internal energy above the neutral state. Sources of plasma can be as follows: naturally occurring in the ionosphere; produced by nuclear reactions; generated by a hyperfrequency source; formed by direct heating followed by confinement in a region of space by a magnetic field; and produced by electrical discharges. Plasma is characterised by the state of its components: density, which is defined by the number of particles per unit volume; kinetic temperature; and degree of ionisation. Plasma can be thermal or out of thermal equilibrium, or 'cold plasma'. Cold plasma is formed, for example, when a gas passes through strong electric fields - electrons are dissociated from the molecules and the gas becomes electrically conductive and glows blue. The paper describes the equipment used to create cold plasma, which was used to treat different surfaces. After treatment, they were bonded with different adhesives and tested for tensile strenght. An improvement in the mechanical properties mentioned above was observed when the surfaces to be bonded were treated with cold plasma compared to surfaces bonded normally. When the impact of cold plasma treatment on elongation, or ε, is examined, it is found that for Fiber Wood samples, cold plasma treatment considerably boosts elongation, increasing it from 0.35% for untreated samples to 0.81% for samples treated with cold plasma. For samples that have been treated with cold plasma, the average value increases significantly from 0.03% to 0.63% when ArbofillFichte material is used. In addition, the application of cold plasma treatment to the surfaces results in an increase in the modulus of elasticity. For example, the modulus of elasticity doubles for Arbofill Fichte samples, going from 113.56MPa for untreated samples to 227.43MPa for cold plasma treated samples; for Fiber Wood, it increases from an average value of 789.52MPa for untreated samples to an average value of 931.62MPa for treated samples.

Efgartigimod in refractory autoimmune myasthenia gravis.

Efgartigimod, a neonatal Fc-receptor inhibitor, has recently been approved as treatment for myasthenia gravis (MG). In this retrospective cohort study, we aimed to systematically assess short- and long-term effectiveness of efgartigimod in patients with refractory MG. Sixteen patients with refractory autoimmune acetylcholine receptor MG were treated with efgartigimod. Data were collected from January 2021 to March 2023 on Myasthenia Gravis Activities of Daily Living (MG-ADL), Quantitative Myasthenia Gravis score (QMG), Myasthenia Gravis Composite score (MGC) and the 15-item revised version of the Myasthenia Gravis Quality of Life questionnaire (MG-QoL15r). A favorable outcome was seen in 56% of patients at the last measurement. Out of 16 patients, 50% were an MG-ADL responder after the first treatment cycle. After 4 weeks, a clinically meaningful improvement compared to baseline was seen on the MG-ADL, QMG, and MGC. There was a statistically significant improvement on the MGQoL15r from baseline to week 4. The improvement was maintained until the last measurement for the MGC and the MGQoL15r. At the last visit, all patients had discontinued 4-weekly dosages, shifting to administration frequencies of 1, 2, or 3 weeks. Drug doses could be decreased for prednisolone (n = 7), azathioprine (n = 2), and intravenous immunoglobulin (n = 9). Frequency of plasma exchange was decreased in nine patients. In patients with refractory MG, efgartigimod was effective for at least half of all patients. Patients required more frequent dosing compared to the ADAPT phase 3 trial. In 80% of the patients concurrent medication could be reduced or discontinued.

Derivation of dirac exchange interaction potential from quantum plasma kinetic theory

The Dirac exchange interaction is derived from recent quantum kinetic theory for collisionless plasmas. For this purpose, the kinetic equation is written in the semiclassical and long wavelength approximations. The validity of the model for real systems is worked out, in terms of temperature and density parameters. Within the region of applicability, the correlation potential energy is shown to be always smaller than the exchange contribution. From the moments of the quantum kinetic equations, macroscopic, hydrodynamic equations are found, for an electron-ion plasma. The Dirac exchange term is explicitly derived, in the case of a completely degenerate electron gas. These results show, within quantum kinetic theory for charged particle systems, a new view of the Dirac exchange interaction frequently used in density functional theory parametrization. Finally, a simpler form of the quantum plasma exchange kinetic theory is also found.

Patterns of disease-modifying therapy utilization before, during, and after pregnancy and postpartum relapses in women with multiple sclerosis

BackgroundPregnancy is a common consideration for people with multiple sclerosis (pwMS); MS onset is typically between 20 and 45 years of age, during potential child-bearing years. Pregnancy and postpartum care are a significant factor influencing disease-modifying therapy (DMT) selection for many pwMS. To date, few DMTs are considered safe to continue during pregnancy and real-world treatment patterns before, during, and after pregnancy remain uncharacterized. Evolving guidance is needed regarding how to optimize management of the pregnancy and postpartum periods considering the changing DMT landscape. This analysis in two large claims databases describes DMT utilization for the treatment of MS before, during, and after pregnancy and relapse patterns during pregnancy and postpartum. MethodsIn this retrospective, observational study, the US MarketScan Commercial and Medicaid claims database was assessed for female patients aged 18–55 years with ≥1 insurance claim submitted under the diagnosis code of MS from 01 January 2016–30 April 2021 and continuous enrollment eligibility from ≥6 months prior to pregnancy date (preconception) through 6 months of follow-up following delivery (postpartum period). Comorbid conditions were examined preconception and postpartum, including anxiety and depression. Moderate/severe relapse was defined as MS-related hospitalization, or an outpatient visit and one claim within 7 days of the visit with steroids or total plasma exchange. ResultsA total of 944 patients (mean [standard deviation] age, 32.4 [5.0] years) were eligible; 688 (73%) were commercially insured and 256 (27%) received Medicaid. Compared with commercially-insured patients, use of DMTs was lower among Medicaid patients at 6 months preconception (25.4% vs 40.4%; p < 0.001), with similar patterns observed both during pregnancy and postpartum. Overall, prevalence of DMT use declined sharply during pregnancy, from 36.3% of patients in the 6 months preconception to 17.9%, 5.3%, and 5.8% in trimesters 1, 2 and 3, respectively. Postpartum DMT utilization increased to 20.9% at 0–3 months and 24.4% at 4–6 months. Of all patients in the preconception period, the most frequently used DMTs were glatiramer acetate (14.3%), dimethyl fumarate (6.0%), interferon (5.2%), and natalizumab (4.9%). Due to small sample size, information was limited for anti-CD20s and alemtuzumab. The proportion of patients with any moderate/severe relapse declined over pregnancy (preconception, n = 82 [8.7%]; pregnancy, n = 25 [2.6%]), but increased postpartum (n = 94 [10.0%]). Of the 889 patients who stopped DMT during pregnancy, the risk of postpartum relapses was lower in the patients who resumed DMT postpartum (10/192) than in patients who did not (76/697) (5.2% vs 10.9%; odds ratio, 0.455 [95% confidence interval 0.216–0.860], p = 0.018). Cases of postpartum depression and anxiety were significantly lower in commercially-insured patients vs Medicaid patients (postpartum depression, 13.7% vs 27.0%, p < 0.01; postpartum anxiety, 16.3% vs 30.5%, p < 0.01). ConclusionDMT utilization declined sharply during pregnancy; it gradually increased postpartum but remained below pre-pregnancy use. The proportion of pwMS experiencing a moderate/severe relapse and number of relapses declined over pregnancy but increased postpartum. Reinitiation of DMT during the postpartum period was associated with lower risk of relapses, supporting a role for early reinitiation of DMT postpartum. Study supported byBiogen

Ultra-High Vacuum Cells Realized by Miniature Ion Pump Using High-Efficiency Plasma Source.

In recent years, there has been significant interest in quantum technology, characterized by the emergence of quantum computers boasting immense processing power, ultra-sensitive quantum sensors, and ultra-precise atomic clocks. Miniaturization of quantum devices using cold atoms necessitates the employment of an ultra-high vacuum miniature cell with a pressure of approximately 10-6 Pa or even lower. In this study, we developed an ultra-high vacuum cell realized by a miniature ion pump using a high-efficiency plasma source. Initially, an unsealed miniature ion pump was introduced into a vacuum chamber, after which the ion pump's discharge current, depending on vacuum pressures, was evaluated. Subsequently, a miniature vacuum cell was fabricated by hermetically sealing the miniature vacuum pump. The cell was successfully evacuated by a miniature ion pump down to an ultra-high vacuum region, which was derived by the measured discharge current. Our findings demonstrate the feasibility of achieving an ultra-high vacuum cell necessary for the operation of miniature quantum devices.

Plasma atomic layer etching of ruthenium by oxygen adsorption-removal cyclic process

Ruthenium (Ru) is a next-generation metal interconnect material, and the demand for precise etching is on the rise. This study explores anisotropic atomic layer etching (ALE) of Ru, utilizing various oxygen adsorption methods (O radical, oxygen plasma, or O2 molecule) and two types of plasma sources: inductively coupled plasma (ICP) and ion beam source. Through ICP ALE, an etch per cycle (EPC) of ∼ 1.5 Å/cycle was achieved using oxygen plasma for adsorption. For ion beam ALE, EPC values of ∼ 0.8 Å/cycle were obtained using oxygen radical, and ∼ 0.4 Å/cycle through physisorption using oxygen molecule without plasma generation. The higher EPC with the ICP ALE was attributed to spontaneous etching during oxygen adsorption during the oxygen plasma generation. Conversely, the lower EPC with ion beam ALE during oxygen adsorption using O2 molecule without plasma generation resulted from nonuniform oxidation of Ru during the adsorption step. Among the three ALE methods, optimal Ru ALE with 100 % ALE synergy was achieved with ion beam ALE, likely due to the absence of ion bombardment during oxygen adsorption and the precise Ar+ ion energy for removing RuOx formed on the surface.

Early clinical response and complications of therapeutic plasma exchange in central nervous system demyelinating diseases.

Appropriate treatment reduces the severity and duration of relapses in demyelinating diseases of Central Nervous System (CNS). If high-dose corticosteroids treatment fails, therapeutic plasma exchange (TPE) is considered as a rescue treatment. This study aimed to investigate early clinical response and complications of TPE and prognostic factors in CNS demyelinating relapses. This prospective observational study was designed in a tertiary center during one year. All adult patients diagnosed corticosteroid-resistant Multiple Sclerosis (MS), NeuroMyelitis Optica Spectrum Disorder (NMOSD), idiotypic Transverse Myelitis or Clinical Isolated Syndrome relapses, were eligible. Clinical response is defined based on Expanded Disability Status Scale (EDSS) at discharge. Clinical and laboratory complications recorded. Seventy-two patients were analyzed which 58.3% patients were female. MS was diagnosed for 61.1% of cases. Thirty-five patients (48.6%) responded and the mean differences of EDSS significantly decreased 0.60 score (CI95%:0.44-.77). Electrolyte imbalances and thrombocytopenia occurred in 80.6% and 55.6% of cases respectively and 40.3% of patients had systemic reactions. However, 26.4% patients experienced moderate to severe complications. In patients with moderate to severe disability, responders were younger (MD: 8.42years, CI95%: 1.67-15.17) and had lower EDSS score at admission (median:6, IQR: 5.5-6 against 7.5 IQR: 6.5-8). The risk of failure was higher in active progressive MS patients compared with RRMS patients (OR: 6.06, CI 95%:1.37-26.76). Patients with thrombocytopenia were hospitalized more than others (MD: 1.5 days, CI 95%: 0-3). Females were more prone to hypokalemia and systemic reactions (OR: 3.11, CI 95%:1.17-8.24 and OR: 6.67, CI 95%:2.14-20.81 respectively). The most common indication of TPE was corticosteroid-resistant severe MS relapses. About half of the patients presented an early clinical response. Lower disability, younger age and RRMS diagnosis are prognostic factors of better response. One out of four patients experienced moderate to severe complications, mainly electrolyte imbalances and systemic reactions. Appropriate interventions against these complications should be considered during TPE, especially in females.

Direct detection of monoterpenes in evacuated air atmospheres by glow discharge plasma source for mass spectrometry

Some compounds, including the monoterpenes, are difficult to be analyzed by chemical ionization mass spectrometry (CI-MS) mass spectrometry because of having distinct chemical features of unsaturated bonds in relatively large molecule, which is responsible for occurring fragmentation of molecular ions. A direct detection of monoterpenes, including monocyclic, bicyclic and oxygenated (acyclic), was carried out using a soft plasma ionization (SPI) source combined with a q-mass spectrometer (q-MS). Detectable signals for monoterpenes were examined in an ambient air discharge plasma when varying the discharge parameters, such as discharge pressure (0.4–3.0 kPa) and sample/carrier pressure ratio (R = 5–100%). Furthermore, to consider the ionization reactions in detail, nitrogen gas was also used as the discharge gas (carrier gas). Monoterpenes, including cross-linked bicyclic (α-pinene and β-pinene) and oxygenated (linalool, geraniol, nerol and eucalyptol), in which their simple spectrum patterns can be obtained with little or no fragmentation at an ambient air pressure of several kPa, has successfully conducted by the pulsed dc SPI-MS. To our knowledge, this is the first report demonstrating that the spectrum pattern of monoterpenes could be directly detected without any complicated fragmentation of analyte ions in the SPI source.

Improving the Power Efficiency of a Microwave Plasma Source by Using the Principle of a Variable-Impedance Waveguide

Microwave plasma sources are used in various applications, but inefficiency can limit their usefulness. Researchers have investigated a new approach with which to improve efficiency by using a waveguide with a special tuner. A standard waveguide was compared to one equipped with a stub tuner, which allows for the fine-tuning of the electrical properties. The experiment used a frequency of 2.45 GHz and tested input powers of 1 kW and 1.5 kW. Experiments showed that waveguides with tuners transferred power more efficiently, with fewer reflected and more transmitted microwaves. While peak temperatures remained similar, the tuned waveguide produced a hotter plasma flame (30–60 °C) at the same distance. Notably, increasing the input power further boosted the flame temperature by 300 °C. These findings suggest that stub tuners can significantly improve the efficiency of microwave plasma sources. This paves the way for more efficient plasma generation technologies and potentially allows for applications requiring even higher power.

Donor plasma VEGF-A as a biomarker for myocardial injury and primary graft dysfunction after heart transplantation

BackgroundVascular endothelial growth factor (VEGF)-A is an angiogenic and proinflammatory cytokine with profound effects on microvascular permeability and vasodilation. Several processes may induce VEGF-A expression in brain-dead organ donors. However, it remains unclear whether donor VEGF-A is linked to adverse outcomes after heart transplantation. MethodsWe examined plasma VEGF-A levels from 83 heart transplant donors as well as the clinical data of these donors and their respective recipients operated between 2010 and 2016. The donor plasma was analyzed using Luminex-based Multiplex and confirmed with a single-target ELISA. Based on donor VEGF-A plasma levels, the recipients were divided into three equal-sized groups (low VEGF <500 ng/L, n=28; moderate VEGF 500-3000 ng/L, n=28; and high VEGF >3000 ng/L, n=27). Biochemical and clinical parameters of myocardial injury as well as heart transplant and kidney function were followed-up for one year, while rejection episodes, development of cardiac allograft vasculopathy, and mortality were monitored for five years. ResultsBaseline parameters were comparable between the donor groups, except for age, where median ages of 40, 45, and 50 were observed for low, moderate, and high donor plasma VEGF levels groups, respectively, and therefore donor age was included as a confounding factor. High donor plasma VEGF-A levels were associated with pronounced myocardial injury (TnT and TnI), a higher inotrope score, and a higher incidence of primary graft dysfunction in the recipient after heart transplantation. Furthermore, recipients with allografts from donors with high plasma VEGF-A levels had a longer length of stay in the intensive care unit and the hospital, and an increased likelihood for prolonged renal replacement therapy. ConclusionsOur findings suggest that elevated donor plasma VEGF-A levels were associated with adverse outcomes in heart transplant recipients, particularly in terms of myocardial injury, primary graft dysfunction, and long-term renal complications. Donor VEGF-A may serve as a potential biomarker for predicting these adverse outcomes and identifying extended donor criteria.

The treatment strategies of autoimmune hemolytic anemia

Autoimmune hemolytic anemia (AIHA) is characterized by the accelerated destruction of erythrocytes due to the presence of antibodies and/or complement that bind to antigens on erythrocytes. It can be subdivided into warm, cold or mixed AIHA based on the type of autoantibody and the optimal temperature of antigen-antibody reaction. Glucocorticoid with or without rituximab is the first-line treatment of warm AIHA (wAIHA), and splenectomy was once the preferred second-line treatment for relapsed or refractory wAIHA. However, due to the various complications of splenectomy, rituximab has gradually become the preferred treatment for patients who have failed glucocorticoid therapy. Other available treatments including immunosuppressants and plasma exchange can be chosen. Rituximab with or without bendamustine is generally taken as the first-line regimen for cold autoimmune hemolytic anemia (cAIHA), while glucocorticoid and splenectomy are ineffective. Sutimlimab, a kind of complement inhibitor, has been approved for the treatment of cold agglutinin disease (CAD). In recent years, many new drugs have emerged as treatment options for AIHA. Emerging therapies, including B-cell-directed therapies, plasma cell-directed therapies, complement inhibitors, and phagocytosis inhibition, provide a new perspective for AIHA therapy, showing great potential for clinical applications.

The use of therapeutic plasma exchange in systemic loxoscelism induced treatment resistant hemolytic anemia: A case report

Brown recluse spider bites can lead to severe reactions such as skin necrosis,hemolytic anemia, and multiorgan failure, which can be life-threatening. Therapeutic plasma exchange has been reported to provide clinical benefit for such cases. In thisreport, we present a case of a brown recluse spider bite that was successfully treated with therapeutic plasma exchange and compare it with previous case reports.

The role of antibodies in small fiber neuropathy: a review of currently available evidence.

Small fiber neuropathy (SFN) is a peripheral nerve condition affecting thin myelinated Aδ and unmyelinated C-fibers, characterized by severe neuropathic pain and other sensory and autonomic symptoms. A variety of medical disorders can cause SFN; however, more than 50% of cases are idiopathic (iSFN). Some investigations suggest an autoimmune etiology, backed by evidence of the efficacy of IVIG and plasma exchange. Several studies suggest that autoantibodies directed against nervous system antigens may play a role in the development of neuropathic pain. For instance, patients with CASPR2 and LGI1 antibodies often complain of pain, and invitro and invivo studies support their pathogenicity. Other antibodies have been associated with SFN, including those against TS-HDS, FGFR3, and Plexin-D1, and new potential targets have been proposed. Finally, a few studies reported the onset of SFN after COVID-19 infection and vaccination, investigating the presence of potential antibody targets. Despite these overall findings, the pathogenic role has been demonstrated only for some autoantibodies, and the association with specific clinical phenotypes or response to immunotherapy remains to be clarified. The purpose of this review is to summarise known autoantibody targets involved in neuropathic pain, putative attractive autoantibody targets in iSFN patients, their potential as biomarkers of response to immunotherapy and their role in the development of iSFN.

Evaluation of the results of the patients who underwent plasmapheresis in the pediatric intensive care unit.

Therapeutic plasma exchange (TPE) is an extracorporeal treatment method that removes large molecular weight substances from plasma. In our study, we aimed to retrospectively examine the indications and procedural methods of the patients who had undergone TPE, and the complications that occurred during the procedure. Forty-one patients who were monitored in thePICU of Gazi Yaşargil Training and Research Hospital and had indications for TPE between 2017 and 2021 were included in the study. Laboratory parameters were checked before and after the TPE procedure. In addition to these, patients' diagnosis, weight, type of procedure and type of device, where the procedure was performed, duration of the procedure, amount of blood and plasma processed, complications, number of procedures, and death during the procedure or independent of the procedure were evaluated. The median age was 93.0 (14.0-167.0) months. Hemolytic uremic syndrome (HUS) was the most common TPE indication with nine patients. The most common complication related to TPE was fever (11 patients), while no complication was observed in 18 patients.When laboratory results were evaluated according to American Society for Apheresis (ASFA) categories, a significant improvement was observed in the values of platelet, AST, ALT, LDH, urea, and creatinine in ASFA1 after TPE. No significant improvement was observed in ASFA2 (p > 0.05). In ASFA3, a significant improvement was observed in INR, AST, ALT, LDH, total bilirubin, creatinine, pH, and lactate values after TPE (p < 0.05). Five patients died from ASFA1, one from ASFA2, and three patients from ASFA3. Since significant adjustments are observed in clinical and laboratory values in sepsis-MOF, which is in the ASFA3 category, we believe that it should be evaluated in the ASFA2 or ASFA1 category in the early treatment of these diseases. In addition, we think that MIS-C cases, which have not been in any category according to ASFA, should be included in the ASFA2 or ASFA3 category, considering our TPE results.

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) Initially Presenting as Septic Meningoencephalitis in a 16-Year-Old Male.

We describe a case of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in a 16-year-old patient who initially presented with clinical features of septic meningoencephalitis. This case outlines the importance of considering a diagnosis of MOGAD in patients who fail to improve with appropriate antimicrobial therapy or show a positive clinical response to glucocorticoids (often used in treatment of meningococcal meningitis). We emphasise the importance of recognising that an infectious prodrome can precede MOGAD. A 16-year-old male was admitted with vomiting, fever, headache, photophobia and altered mental state. He was treated for meningoencephalitis with initial clinical improvement. Lumbar puncture findings were suggestive of viral meningoencephalitis. During admission the patient went through several periods of transient clinical and biochemical improvement, alternating with periods of symptomatic relapse. On day 17 of admission, he was transferred to a tertiary centre for suspected autoimmune disseminated meningoencephalitis (ADEM) and two days later, he suffered a catastrophic neurological decline with new dysarthria, dysphagia, aphasia, horizontal nystagmus and facial paralysis. He made a remarkable neurological recovery after commencing treatment with IV immunoglobulin, IV methylprednisolone and plasma exchange, with complete resolution of symptoms. MOGAD can run a variable course and present soon after a central nervous system infection, making the diagnosis more challenging. Nonetheless, patients can achieve a full neurological recovery with early recognition, diagnosis and treatment of this rare entity. Autoimmune encephalitis can be preceded by an infectious prodrome which makes the diagnosis more challenging.Autoimmune encephalitis can run a subacute and fluctuating course with transient periods of symptomatic improvement preceding a rapid neurological decline.Glucocorticoids often used in treatment of patients with meningococcal meningitis may lead to transient symptomatic improvement in patients with autoimmune encephalitis, masking the diagnosis.MRI findings of demyelination in autoimmune encephalitis may lag behind clinical symptoms by days to weeks.