Role Of Plasmapheresis Research Articles

The role of plasmapheresis in childhood guillain‐barré syndrome

Plasmapheresis has been advocated in the treatment of childhood Guillain-Barré syndrome under the assumption that the results of adult series can be extrapolated to children. To test this assumption, we retrospectively evaluated the medical charts of all children who were admitted to The Children's Hospital of Philadelphia between January 1984 and March 1989, with the diagnosis of Guillain-Barré syndrome. Of the 30 patients identified, 7 were excluded because they had mild disease. Of the remaining 23, 9 underwent plasmapheresis and 14 served as historic control subjects. The two groups were similar with respect to age, presenting symptoms, findings on initial physical examination, and antecedent illnesses at the time of diagnosis. The mean time to recover to Grade 2 (independent ambulation) was significantly shorter in the plasmapheresis-treated group, 24.0 +/- 25.4 days, compared to 60.2 +/- 43.6 days in control subjects (mean +/- 1 SD). Our results indicate that plasmapheresis diminishes morbidity in childhood Guillain-Barré syndrome by shortening the interval until recovery of independent ambulation.

Plasmapheresis in Childhood Guillain-Barre Syndrome

The role of plasmapheresis in childhood Guillain-Barre syndrome was examined by retrospective analysis of children admitted to the Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.

Role of plasmapheresis in primary biliary cirrhosis: L.B. Cohen, E.P. Ambinder, A.M. Wolke, et al. Gut 26:291–294, (March), 1985

Role of plasmapheresis in primary biliary cirrhosis: L.B. Cohen, E.P. Ambinder, A.M. Wolke, et al. Gut 26:291–294, (March), 1985

Role of plasmapheresis in primary biliary cirrhosis.

Five patients with primary biliary cirrhosis and prolonged cholestasis underwent intensive plasmapheresis. The indications for plasmapheresis included intractable pruritus or hypercholesterolemia and xanthomatous neuropathy. Patients noted a rapid improvement of pruritus and fatigue which was sustained as long as plasmapheresis was continued. Cholesterol levels were lowered an average of 10.3 mmol/l and xanthomata were reduced in three of four patients. Two patients with painful neuropathy caused by xanthomata experienced relief of this symptom. The liver and spleen size were not affected by plasmapheresis, and activities of aminotransferases, alkaline phosphatase and titres of mitochondrial antibody remained unchanged. We conclude that plasmapheresis has a role in the therapeutic management of patients with advanced primary biliary cirrhosis who are disabled by the complications of pruritus, xanthomatous neuropathy, or hypercholesterolemia with xanthoma formation.

Guillain‐Barré syndrome

Guillain‐Barré syndrome

Evidence for a Therapeutic Effect of Plasmapheresis in Patients with Systemic Lupus Erythematosus

Fourteen patients with active systemic lupus erythematosus (SLE) have been treated with plasmapheresis at a rate of two litres daily on three to four days per week, over a period of two to three weeks. Plasma was replaced isovolemically with either fresh frozen plasma or with human plasma protein fractions. Ten patients were receiving treatment with prednisone at the time of plasmapheresis, and four had received no prior treatment. Eight patients showed evidence of either clinical improvement or clinical and immunochemical improvement, at the time of plasmapheresis. In the three patients who showed high levels of circulating complexes before treatment, there was a sudden fall in the level of circulating immune complexes, which was quantitatively greater than could be explained by the amount removed. This suggests that in some patients with SLE, clearance of complexes by the mononuclear phagocytic system is initially blocked by high levels of circulating complexes and that one effect of plasmapheresis may be to relieve this blockade. Five patients showed a clinical response to plasmapheresis despite the fact that tests for immune complexes were negative. Three patients showed no response to plasmapheresis, and three were regarded as unevaluable. In a limited number of patients, who show a high level of circulating immune complexes, and whose condition is deteriorating despite treatment with corticosteroids, there may be an important therapeutic role for plasmapheresis.

Plasmapheresis in Crohn's disease.

6 patients with Crohn's disease for 1-14 years have been treated with plasmapheresis for periods of up to 6 months. The symptoms of the one newly diagnosed patient were controlled by plasmapheresis alone, and 5 steroid-dependent patients were able to reduce their steroid requirements. During the study period, 13 clinical relapses were managed without increasing steroid dosage. There was evidence of circulating soluble immune complexes in all the patients and these levels were lowered by plasmapheresis. A possible role of plasmapheresis in the management of Crohn's disease is discussed.