scholarly journals A case of D alloimmunization in pregnancy: successfully treated solely with therapeutic plasma exchange (TPE)

2019 ◽  
Vol Volume 10 ◽  
pp. 251-253
Author(s):  
Fatemeh Tara ◽  
Asieh Maleki ◽  
Nayereh Taheri ◽  
Somayeh Moein Darbari
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
In Pregnancy

scholarly journals Therapeutic plasma exchange for the management of severe gestational hypertriglyceridaemic pancreatitis due to lipoprotein lipase mutation

2020 ◽  
Vol 2020 ◽  
Author(s):  
Albert S Kim ◽  
Rashida Hakeem ◽  
Azaliya Abdullah ◽  
Amanda J Hooper ◽  
Michel C Tchan ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Lipoprotein Lipase ◽  
Therapeutic Plasma Exchange ◽  
Placental Lactogen ◽  
Pharmacological Intervention ◽  
List Type ◽  
Hormonal Changes ◽  
Changes In Pregnancy ◽  
Preconception Counselling ◽  
In Pregnancy

Summary A 19-year-old female presented at 25-weeks gestation with pancreatitis. She was found to have significant hypertriglyceridaemia in context of an unconfirmed history of familial hypertriglyceridaemia. This was initially managed with fasting and insulin infusion and she was commenced on conventional interventions to lower triglycerides, including a fat-restricted diet, heparin, marine oil and gemfibrozil. Despite these measures, the triglyceride levels continued to increase as she progressed through the pregnancy, and it was postulated that she had an underlying lipoprotein lipase defect. Therefore, a multidisciplinary decision was made to commence therapeutic plasma exchange to prevent further episodes of pancreatitis. She underwent a total of 13 sessions of plasma exchange, and labour was induced at 37-weeks gestation in which a healthy female infant was delivered. There was a rapid and significant reduction in triglycerides in the 48 h post-delivery. Subsequent genetic testing of hypertriglyceridaemia genes revealed a missense mutation of the LPL gene. Fenofibrate and rosuvastatin was commenced to manage her hypertriglyceridaemia postpartum and the importance of preconception counselling for future pregnancies was discussed. Hormonal changes in pregnancy lead to an overall increase in plasma lipids to ensure adequate nutrient delivery to the fetus. These physiological changes become problematic, where a genetic abnormality in lipid metabolism exists and severe complications such as pancreatitis can arise. Available therapies for gestational hypertriglyceridaemia rely on augmentation of LPL activity. Where there is an underlying LPL defect, these therapies are ineffective and removal of triglyceride-rich lipoproteins via plasma exchange should be considered. Learning points: Hormonal changes in pregnancy, mediated by progesterone,oestrogen and human placental lactogen, lead to a two- to three-fold increase in serum triglyceride levels. Pharmacological intervention for management of gestational hypertriglyceridaemia rely on the augmentation of lipoprotein lipase (LPL) activity to enhance catabolism of triglyceride-rich lipoproteins. Genetic mutations affecting the LPL gene can lead to severe hypertriglyceridaemia. Therapeutic plasma exchange (TPE) is an effective intervention for the management of severe gestational hypertriglyceridaemia and should be considered in cases where there is an underlying LPL defect. Preconception counselling and discussion regarding contraception is of paramount importance in women with familial hypertriglyceridaemia.

Therapeutic plasma exchange for Graves’ disease in pregnancy

2021 ◽  
pp. 1753495X2110313
Author(s):  
Matthew Lumchee ◽  
Mimi Yue ◽  
Josephine Laurie ◽  
Adam Morton
Keyword(s):  
Plasma Exchange ◽  
Thyroid Function ◽  
Therapeutic Plasma Exchange ◽  
Graves Disease ◽  
Close Monitoring ◽  
Optimal Management ◽  
Rapid Control ◽  
Preconception Counselling ◽  
Definitive Management ◽  
In Pregnancy

Graves’ disease in pregnancy may be associated with maternal, fetal and neonatal complications, which are proportionate to the severity of hyperthyroidism. Optimal management is detailed preconception counselling, achievement of an euthyroid state prior to conception, and close monitoring of thyroid function and thyroid-stimulating antibodies together with judicious use of anti-thyroid medications during pregnancy. A case of Graves’ disease in pregnancy, complicated by pancytopenia, with a deterioration in thyroid function following cessation of thionamide therapy is described here. Therapeutic plasma exchange was subsequently used to achieve rapid control prior to thyroidectomy. Therapeutic plasma exchange is an effective treatment for hyperthyroidism where thionamides are ineffective or contraindicated, as a bridge to definitive management.

scholarly journals Hypertriglyceridemia-induced pancreatitis in pregnancy: case review on the role of therapeutic plasma exchange

2021 ◽  
Vol 2021 ◽  
Author(s):  
Sarah Ying Tse Tan ◽  
Swee Ping Teh ◽  
Manish Kaushik ◽  
Tze Tein Yong ◽  
Shivani Durai ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Case Reports ◽  
Therapeutic Plasma Exchange ◽  
Team Approach ◽  
High Morbidity ◽  
List Type ◽  
Low Fat ◽  
Management Options ◽  
Low Fat Diet ◽  
In Pregnancy

Summary Gestational hypertriglyceridemia-induced pancreatitis is associated with significant maternal and fetal morbidity and mortality. We report a case of gestational hypertriglyceridemia-induced pancreatitis in a primigravida at 31-weeks gestation, complicated by impending preterm labor and metabolic acidosis requiring hemodialysis. This was successfully managed with therapeutic plasma exchange (TPE), followed by i.v. insulin, low-fat diet, and omega-3. Triglyceride levels stabilized after TPE and the patient underwent an uncomplicated term delivery. In pregnancy, elevated estrogen and insulin resistance exacerbate hypertriglyceridemia. Management is challenging as risks and benefits of treatment options need to be weighed against fetal wellbeing. We discuss management options including a review of previous case reports detailing TPE use, dietary optimization, and delivery timing. This case emphasizes the importance of multidisciplinary care to optimize maternal and fetal outcomes. Learning points Gestational hypertriglyceridemia-induced pancreatitis has high morbidity. A multidisciplinary team approach is a key as maternal and fetal needs must be addressed. Rapid lowering of triglycerides is crucial and can be achieved successfully and safely with plasma exchange. A low-fat diet while ensuring adequate nutrition in pregnancy is important. Timing of delivery requires consideration of fetal maturity and risk of recurrent pancreatitis.

scholarly journals Therapeutic plasma exchange in pregnancy: A literature review

2021 ◽  
Vol 260 ◽  
pp. 29-36 ◽  
Author(s):  
M. Wind ◽  
A.G.A. Gaasbeek ◽  
L.E.M. Oosten ◽  
T.J. Rabelink ◽  
J.M.M. van Lith ◽  
...  
Keyword(s):  
Literature Review ◽  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
In Pregnancy

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
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