scholarly journals Therapeutic plasma exchange (TPE) as a plausible rescue therapy in severe vaccine-induced immune thrombotic thrombocytopenia

2021 ◽  
pp. 103174
Author(s):  
Gail Rock ◽  
Viktoria Weber ◽  
Bernd Stegmayr
Keyword(s):  
Plasma Exchange ◽  
Rescue Therapy ◽  
Therapeutic Plasma Exchange

scholarly journals Life-threatening COVID-19 presenting as stroke with antiphospholipid antibodies and low ADAMTS-13 activity, and the role of therapeutic plasma exchange: A case series

2020 ◽  
Vol 8 ◽  
pp. 2050313X2096408
Author(s):  
Abdulrahman Alharthy ◽  
Fahad Faqihi ◽  
Abdullah Balhamar ◽  
Ziad A Memish ◽  
Dimitrios Karakitsos
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Plasma Exchange ◽  
Plasma Volume ◽  
Antiphospholipid Antibodies ◽  
Rescue Therapy ◽  
Antiviral Treatment ◽  
Case Series ◽  
Therapeutic Plasma Exchange ◽  
Life Threatening

We present a case series of three patients with COVID-19 who were admitted to our intensive care unit due to acute respiratory distress syndrome, brain infarction, pulmonary embolism, and antiphospholipid antibodies. We applied therapeutic plasma exchange on all cases. On intensive care unit admission, all patients had low (<10) Glasgow Coma Scale, and central nervous imaging showed multiple brain infarctions. COVID-19 was confirmed by reverse transcriptase polymerase chain reaction assays. Patients underwent rescue therapeutic plasma exchange using the Spectra OptiaTM Apheresis System (Terumo BCT Inc., USA), which operates with acid-citrate dextrose anticoagulant as per Kidney Disease Improving Global Outcomes 2019 guidelines. A dose of 1.5 plasma volume was used for the first dose and then 1 plasma volume daily for a total of five doses. Plasma was replaced with Octaplas LG® (Octapharma AG, USA), which is an artificial fresh frozen plasma product that has undergone viral inactivation by prion reduction technology. We administered ARDS-net/prone positioning ventilation, empiric antiviral treatment, therapeutic anticoagulation, and intensive care unit supportive care. Laboratory tests showed lymphocytopenia; elevated levels of D-dimer, fibrinogen, total bilirubin, C-reactive protein, lactate dehydrogenase, and ferritin; as well as low levels of ADAMTS-13 activity and antibody. Serology tests depicted positive IgM and IgG antiphospholipid antibodies (anti-cardiolipin and anti-β2-glycoprotein I antibodies). No side effects of therapeutic plasma exchange were recorded. After the completion of therapeutic plasma exchange, patients improved clinically and gradually recovered neurologically (after 27–32 days). To conclude, in life-threatening COVID-19, especially when immune dysregulation features such as antiphospholipid antibodies exist, therapeutic plasma exchange could be an effective rescue therapy.

scholarly journals Using therapeutic plasma exchange as a rescue therapy in CoVID-19 patients: a case series

2020 ◽  
Author(s):  
Seyed Hasan Adeli ◽  
Akram Asghari ◽  
Reihane Tabarraii ◽  
Rasoul Shajari ◽  
Sara Afshari ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Rescue Therapy ◽  
Case Series ◽  
Therapeutic Plasma Exchange

Prognostic indicators of improvement with therapeutic plasma exchange in pediatric demyelination

Neurology ◽  
2019 ◽  
Vol 93 (22) ◽  
pp. e2065-e2073 ◽  
Author(s):  
Andrea Savransky ◽  
Adrian Rubstein ◽  
Marina Huaman Rios ◽  
Silvana L. Vergel ◽  
Mabel Castro Velasquez ◽  
...  
Keyword(s):  
Adverse Events ◽  
Plasma Exchange ◽  
Rescue Therapy ◽  
Age At Onset ◽  
Water Channel ◽  
Visual Outcome ◽  
Therapeutic Plasma Exchange ◽  
Functional Improvement ◽  
Prognostic Indicators ◽  
Therapeutic Window

ObjectivesTo determine the safety and clinical benefit of therapeutic plasma exchange (TPE) as rescue therapy in children with acute inflammatory demyelinating CNS syndromes and to identify baseline prognostic indicators of treatment improvement.MethodsThis single-center retrospective pediatric cohort included all consecutive patients admitted to our hospital over the period from 2003 to 2017 because of a steroid-refractory acute CNS event presumed to be inflammatory who required TPE. Functional status assessment to identify improvement included the following performance category scales: visual outcome, bladder control, gait, and Expanded Disability Status Scale (EDSS). These assessments were performed before and after TPE in every patient.ResultsSixty-five children requiring TPE to treat 78 CNS attacks were included for analysis. Median age at TPE was 10.5 years (1.9–18 years); 45% were girls. Seropositivity (aquaporin-4 water channel–immunoglobulin G [IgG] or myelin oligodendrocyte glycoprotein–IgG) was found in 20 of 42 (48%) patients. Attack phenotypes leading to TPE were optic neuritis (ON) in 42%, longitudinally extensive transverse myelitis (LETM) in 31%, ON + LETM in 15%, and other combined syndromes in 11%. Overall, moderate to marked neurologic improvement was observed in 72% of children at the end of TPE and in 88.5% at 6 months of follow-up. Lower baseline scores on the EDSS, visual outcome, and gait scales were found to be independent prognostic indicators of treatment benefit. Sex, age at onset and at TPE, attack phenotype, disease duration, and time from attack onset to TPE initiation were not significantly associated with treatment outcome. Adverse events were observed in 31 of 524 (5.9%) procedures, being severe in 4.ConclusionsTPE was an effective rescue therapy associated with functional improvement. No therapeutic window for TPE initiation was identified in this pediatric cohort. Overall frequency of adverse events was low; however, serious events should be anticipated and avoided.Classification of evidenceThis study provides Class IV evidence that for children with acute inflammatory demyelinating CNS syndromes, TPE leads to functional improvement.

Therapeutic Plasma Exchange Application in Children Requires Individual Decision

2020 ◽  
Author(s):  
Gürkan Atay ◽  
Demet Demirkol
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Demyelinating Disease ◽  
Pediatric Intensive Care ◽  
Therapeutic Plasma Exchange ◽  
Transplantation Rejection ◽  
Access Problems ◽  
Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

Therapeutic plasma exchange in intensive care and intensive nephrology

2018 ◽  
Vol 20 (4) ◽  
pp. 394-403
Author(s):  
M. S. Vetsheva ◽  
◽  
K.E Loss . ◽  
O.L. Podkorytova ◽  
E.V. Lebedkov ◽  
...  
Keyword(s):  
Intensive Care ◽  
Plasma Exchange ◽  
Therapeutic Plasma Exchange

Therapeutic plasma exchange in a single center: Ibni Sina experience

2004 ◽  
Vol 30 (3) ◽  
pp. 181-184 ◽  
Author(s):  
Önder Arslan ◽  
Mutlu Arat ◽  
Ibrahim Tek ◽  
Erol Ayyildiz ◽  
Osman Ilhan
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Single Center
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