血浆置换治疗在儿科危重患者抢救中的经验

目的探讨血浆置换治疗在儿科危重症患者的应用价值和治疗方案。方法应用GAMBR0-PRISMA床旁血滤机和TPE2000膜式血浆分离器对15例危重症患儿（1岁10月～15岁，平均6．8岁）进行39次血浆置换治疗；以新鲜冰冻血浆作置换液，置换量为40-70ml／（kg·次），血泵速度为50～120ml／min，治疗时间2～3h／次：结果39次血浆置换治疗均顺利成功实施，无明显并发症出现；14例在治疗后临床症状及生化指标好转，5例痊愈。结论血浆置换可以应用于多种危重症儿科疾病，治疗方案需根据病情制定。     

双重滤过血浆置换治疗难治性重症肌无力的研究

目的探讨多次双重滤过血浆置换治疗难治性重症肌无力的方法、临床疗效和应用价值。方法23例难治性重症肌无力患者全部采用双重滤过血浆置换法治疗4次,3～4d置换1次,置换液为20％白蛋白50ml加706代血浆1000ml。治疗前及每次置换完成后第3天抽空腹血查乙酰胆碱受体抗体（AchR—Ab）,并根据临床绝对评分法评分和相对评分法判断临床疗效。结果痊愈1例,基本痊愈2例,显效9例,好转8例,无效3例,总有效率为86．96％。结论多次双重滤过血浆置换能有效降低血液中较高的AchR—Ab水平,对治疗难治性重症肌无力具有重要的临床价值。     

改良式肝素盐水密闭循环预冲在单重血浆置换中的应用研究

目的探讨单重血浆置换患者采用改良式肝素盐水密闭循环预冲的应用效果。方法选择2015年7月-2017年7月我院收治的需要进行2次单重血浆置换的患者30例,共进行单重血浆置换60例次,根据患者单重血浆置换日期进行编号,单号患者第1次先安排在观察组,第2次安排在对照组;双号的患者第1次安排在对照组、第2次安排在观察组。比较患者采用两种不同预冲方法对血浆滤过器及管路凝血及血浆置换后的效果。结果两组患者滤过器的滤过速度、血浆置换总时间、血浆滤过器及管路凝血及过敏反应的情况及血浆置换效果比较,差异有统计学意义(P0.01);且血浆置换前后出凝血时间(CT)比较,差异无统计学意义(P0.05)。结论改良式肝素盐水密闭循环预冲在单重血浆置换治疗中安全,血浆置换效果好,值得临床推广。     

血浆置换治疗酵米面中毒患者的护理

目的 探讨血浆置换治疗酵米面中毒患者的护理。方法 采用P2S血浆分离器、单腔或双腔导管，血透机或血泵，对12例酵米面中毒患者进行血浆置换，置换液用新鲜冰冻血浆、白蛋白、低分子右旋糖酐、电解质溶液等，血浆置换速度30—100ml／min,每次交换量500．3000ml，每天或隔天1次，平均4次，例。结果 血浆置换前后平均心率42次／min和78次／min，肌酸磷酸激酶平均478．5U／L和38U／L，α-羟丁酸脱氢酶平均235．8U／L和174．5U／L，AST平均89．6U／L和36．8U／L，ALT平均161U／L和38．8U／L。结论 血浆置换是治疗酵米面中毒的有效方法。     

股静脉插管在DFPP中的应用体会

选择性双重滤过膜式血浆置换疗法(简称DFPP)是指血液通过两种不同孔径的滤过膜，分离出致病的高分子量弃去，保留血浆白蛋白等生理性物质，以达到选择性去除或减少患者血液中致病物质的目的(如：自身抗体、免疫复合物、高粘度物质等)。它要求血流量达到100ml／min，二次循环血流速度150—200ml／min，开始2—3天一次，逐渐延长至5—7天一次，5—7次为一疗程。     

双重滤过血浆置换治疗难治性重症肌无力患者的护理

摘要：对３１例难治性重症肌无力患者采用双重滤过血浆置换（ＤＦＰＰ）治疗。结果痊愈５例，基本痊愈８例，显效１２例，好转４例，无效２例。提出治疗前做好心理护理及常规准备，治疗中建立有效的血管通路、密切观察病情变化、严格无菌操作、正确输入置换液、加温置换液等，是保证治疗效果的主要措施。关键词：重症肌无力；　血浆置换；　护理中图分类号：Ｒ４７３．７４　　文献标识码：Ｂ　　文章编号：１００１-４１５２（２００７）０５-００３０-０３     

双重滤过血浆置换治疗重度类风湿性关节炎合并尿毒症及肝硬化患者1例

双重滤过血浆置换（Double Filtration Plasmapheresis，DFPP）是适用于类风湿性关节炎等免疫性疾病患者的一种血液净化方法。解放军302医院肝衰竭治疗研究中心血液净化科为1例重度类风湿性关节炎合并尿毒症及肝硬化患者实施双重滤过血浆置换治疗，取得很好疗效。现报告如下。     

改良式追加预冲在双重血浆置换病人中的运用

[目的]探讨双重血浆置换病人在传统机器全自动预冲基础上采用改良式追加预冲方法的应用效果。[方法]选择2018年1月-2018年12月在我院行双重血浆置换28例病人,共行双重血浆置换71例次,排除最后一次治疗,组成70例次双重血浆置换病例资料。根据病人双重血浆置换顺序排列单号、双号分为两组,每组35例次,单号为对照组(行传统预冲方法),双号为观察组(行传统预冲基础上追加预冲方法)。比较两组预冲方法后双重血浆置换血浆滤过器残余气泡、滤过器及管路凝血情况、病人变态反应的发生、二级滤过器跨膜压(TMP)检测以及静脉双腔留置导管口渗血情况。[结果]两组病人血浆滤过器的残余气泡、滤过器及管路凝血情况、病人变态反应的发生、二级滤过器TMP压力,比较差异有统计学意义(P<0.05);两组静脉双腔留置导管口渗血情况差异无统计学意义(P>0.05)。[结论]改良式追加预冲方法在双重血浆置换治疗中安全、简单、易操作、效果好。     

血浆置换治疗血栓性血小板减少性紫癜临床疗效的观察

目的观察血浆置换治疗血栓性血小板减少性紫癜的临床疗效。方法回顾分析2013年1月—2018年6月本院14例确诊为血栓性血小板减少性紫癜患者的临床特征及进行血浆置换治疗后的疾病转归情况,分析血浆置换治疗过程中不良反应发生情况。结果 14例血栓性血小板减少性紫癜患者共进行了47次血浆置换,经过血浆置换治疗后10例患者病情好转恢复出院,血浆置换治疗血栓性血小板减少性紫癜患者的总有效率为71.4%。47次血浆置换术中共发生了3次不良反应,其不良反应发生率为6.4%。结论血浆置换是治疗血栓性血小板减少性紫癜的有效方法,患者一旦确诊或高度怀疑为血栓性血小板减少性紫癜时需尽早开始血浆置换治疗。     

双重膜式血浆置换治疗高脂血症患者的观察及护理

1999年12月～2004年2月,我们对204例高脂血症患者行双重膜式血浆置换(DFPP)。术中严密观察,术后精心护理,效果满意。现报告如下。1临床资料本组204例,男145例,女59例,31～72岁,平均51.5±20.5岁。2方法使用全自动血浆置换机行DFPP治疗,膜材料均为一次性使用。患者取平卧位,取一侧肘正中静脉-大隐静脉穿刺作为血管通路,以20%白蛋白10～20g、5%葡萄糖液500ml作为置换液。调整血流量为30～100ml/min,置换血浆2500～4000ml/次。3护理3.1严格遵守操作规程针对全自动血浆置换机各部位感应性强的特点,机器自动预冲时,根据医嘱设定各种治疗参数,…     

Therapeutic plasma exchange for the treatment of anti-NMDA receptor encephalitis

Anti-N-methyl-D-aspartate receptor (NMDA-R) encephalitis is thought to be one of the common paraneoplastic-associated encephalitides. Between February 2001 and February 2011, nine patients were diagnosed with this disorder at Columbia University Medical Center: eight females (mean age 23 years) and one male (3 years of age). Four female patients had ovarian teratomas, which were removed as part of their treatment. Therapeutic plasma exchange (TPE) was used as one of the treatment modalities in addition to immunosuppressive therapy, including corticosteroids, intravenous immunoglobulin (IVIG), and/or rituximab. A total of 56 TPE procedures were performed in these patients on alternate days (range, 5-14 procedures/patient). Approximately 1 plasma volume (PV) was processed for all patients; 5% albumin and 0.9% normal saline were used as replacement fluid. Complications occurred in 20% of TPE procedures; 9% were possibly due to underlying disease. The remaining 11% of complications were hypotensive episodes that rapidly responded to either a fluid bolus or a vasopressor treatment. One patient demonstrated immediate clinical improvement after three TPE treatments, and four patients had significant improvement at time of discharge from the hospital. Long-term follow-up showed that early initiation of TPE appears to be beneficial, and patients who received IVIG after TPE did better than those who received IVIG before TPE. However, the number of patients in this series is too small to provide statistically significant conclusions. Overall, TPE is a relatively safe treatment option in patients with anti-NMDA-R encephalitis. Further studies are needed to elucidate the benefit of TPE in this disease.     

Therapeutic plasma exchange for anticoagulant-refractory antiphospholipid syndrome with severe ischemic and necrotic skin lesions: A case series

Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by clinical findings including thrombosis and/or obstetric complication and laboratory findings, e.g. ≥1 positive antiphospholipid antibodies (aPL) (lupus anticoagulant, anticardiolipin IgG/IgM and/or anti-β2-glycoprotein IgG/IgM). A rare APS clinical entity is severe necrosis which is difficult to treat and often does not respond to anticoagulant therapy. Three consecutive patients with primary or secondary APS who presented with necrotic skin lesions secondary to APS were treated with therapeutic plasma exchange (TPE), glucocorticoids and low-molecular-weight heparin. All patients had a rapid-onset, either full or significant recovery of their APS-related necrotic lesions.Upon treatment, one patients showed resolution of lupus anticoagulant. Two patients had a decrease of at least 88 % in aPL titers after the initial treatment, and were kept on TPE maintenance every 5–6 weeks. None of the patients experienced significant side effects of the TPE. This is the first case series showing the clinical benefits of TPE in patients with ischemic and necrotic skin lesions due to severe anticoagulant-refractory vascular APS.     

Therapeutic plasma exchange in neuromyelitis optica: A case series

Neuromyelitis optica (NMO) is a relapsing inflammatory disease of the central nervous system that predominantly affects the spinal cord and optic nerves. The clinical hallmark of the disease is a step‐wise deterioration of visual and spinal cord function. This study reviews patients with steroid resistant relapsing NMO presenting for therapeutic plasma exchange (TPE) at our institution from December 2005 to December 2012. A total of five patients were treated with single volume TPE. Both subjective and objective clinical response to TPE was estimated by three different sources (the patient, a Transfusion Medicine physician, and the treating Neurologist) with the patient and Transfusion Medicine physician's final assessment of response made at the time of the last TPE in the series and the treating neurologist's assessment of response made at the time of the next neurological exam after the last TPE. A total of 17 TPE series were performed with the average course of therapy being three series (ranged 1–5) with five TPE (ranged 3–7) per series. All patients demonstrated improvement with each series of TPE and all procedures were well tolerated with only transient and well‐described reactions all of which were successfully resolved with minor or no sequelae. J. Clin. Apheresis 29:171–177, 2014. © 2013 Wiley Periodicals, Inc.     

Therapeutic plasma exchange in the treatment of neuroimmunologic disorders: review of 50 cases.

Therapeutic plasma exchange (TPE) has been used for the treatment of neurologic diseases in which autoimmunity plays a major role. We reviewed the medical records of our patients who had consecutively been treated by TPE between January 1998 and June 2000. Neurological indications included myasthenia gravis (30 patients), multiple sclerosis attack (6 patients with remitting-relapsing course and 3 patients with secondary progressive course), Guillain-Barrè syndrome (6 patients), paraproteinemic neuropathy (2 patients), and chronic inflammatory demyelinating neuropathy (CIDP), transverse myelitis due to systemic lupus erythematosus, acute disseminated encephalomyelitis in one patient each. Continuous flow cell separators were used for TPE. TPE was generally given every other day for all of the patients and one plasma volume was exchanged for each cycle. Although the patients with secondary progressive multiple sclerosis (3 patients) and paraproteinemic neuropathy (2 patients) did not show any improvement after TPE, other patients' targeted neurological deficits were improved by TPE. During the TPE procedures, no patient had any morbidity or mortality, and the complications were mild and manageable such as hypotension, hypocalcemia and mild anemia; three patients had septicemia due to the venous catheter used for TPE. TPE is an effective treatment in neurologic diseases in which autoimmunity plays an important role in pathogenesis, and it is safe when performed in experienced centers.     

Therapeutic plasma exchange rapidly improves cardiac allograft function in patients with presumed antibody‐mediated rejection

Background: Allograft dysfunction due to presumed antibody‐mediated rejection (pAMR) is one of the most serious complications of heart transplantation. Combination therapies of high‐dose steroids, intravenous immune globulin, and/or therapeutic plasma exchange (TPE) are often used in this setting. Methods: We performed a 9‐year retrospective review of all episodes of pAMR treated with TPE at our institution. pAMR diagnosis was based on clinical and pathologic findings. Left ventricular ejection fraction (LVEF) was measured at baseline, prior to initiation of TPE, and during the course of treatment. Results: There were 42 patients with 47 episodes of pAMR treated with TPE. The majority of episodes were treated with three TPE; however, eight required only two TPE and five episodes required >3 TPE. All episodes of pAMR had LVEF measured before and after the series of TPEs. The mean pre‐TPE LVEF was 38% compared with a post‐therapy mean LVEF of 50% (P < 0.0001). In 16 episodes of pAMR, for which LVEF was measured following each apheresis, there was significant improvement of allograft function after the first TPE (pre‐TPE mean LVEF of 31% and post‐first TPE mean LVEF of 37%; P = 0.02). Incremental and significant improvement in allograft function continued following each TPE. Changes in human leukocyte antigen‐donor specific antibodies and fibrinogen did not correlate with ejection fraction response. Conclusions: The rapid improvement in allograft function in our patients is most likely due to TPE as other pharmacologic interventions have longer onset. TPE should be considered a first‐line intervention in the setting of pAMR. J. Clin. Apheresis 29:316–321 2014. © 2014 Wiley Periodicals, Inc.     

Therapeutic plasma exchange in patients suffering from thrombotic microangiopathy after allogeneic bone marrow transplantation.

Thrombotic microangiopathy (TM) is a potentially fatal complication of allogeneic bone marrow transplantation (BMT). The underlying pathophysiology is thought to be generalized endothelial cell damage caused by several factors including conditioning treatment, cyclosporin A (CsA), or graft versus host disease (GVHD). In the present retrospective study, 6 patients suffering from Grade 2 BMT-TM at a mean of 62 days post BMT were treated by 3-15 daily sessions of therapeutic plasma exchange (TPE). In most sessions, cryosupernatant (CSN) of plasma, in some fresh frozen plasma (FFP) was used as the substitution fluid. All patients suffered from acute graft versus host disease (aGVHD) of the skin, which was treated by CsA. CsA was withdrawn in all patients. TPE caused a response in 4 of 6 patients evidenced by a decrease to Grade 0 (n = 3) or 1 (n = 1) BMT-TM. Only 1 patient had mild renal insufficiency which did not improve during TPE. While all patients were dependent on platelet transfusions at baseline, the platelet counts improved in 2 of 6 patients after the TPE course. One patient did not show any response to TPE with FFP, and his disease improved only after CSN was introduced as substitution fluid (Grade 0). Four patients were still alive 175-495 days post BMT, and 2 patients died about 2-3 weeks after the end of the TPE course, 1 from cachexia and 1 from systemic aspergillosis. In summary, in this pilot study, TPE positively influenced BMT-TM, especially if CSN was used as the substitution fluid.     

The use of therapeutic plasma exchange for treatment of acute polyradiculoneuropathy

The rationale for therapeutic plasma exchange (TPE) in acute polyradiculoneuropathy (APRN) is based on the presence of circulating antibodies which cause demyelination of the peripheral nerves. This study included 24 patients, most having a neurological defect of grade 4, classified into groups A and B. Group A was treated with immunosuppressive drugs only, while group B was treated by a combination of immunosuppressive drugs and TPE. The average volume of plasma removed during a single TPE procedure was 2.95 L, and totalled 21 L overall. The efficacy of the TPE treatment was assessed on the basis of changes in the neurological deficit grade, and in electrophysiological parameters. It was shown that improvements were significantly better and faster in patients treated by a combination of immunosuppressive drugs and TPE, and when TPE was started within the first 7 days after the onset of the disease.     

Therapeutic plasma exchange in pediatric patients with acute demyelinating syndromes of the central nervous system: A single-center experience

BackgroundTherapeutic plasma exchange (TPE) is an extracorporeal treatment that can be used in adult and pediatric patients with acute demyelinating syndromes of the central nervous system. In this study, the efficacy and safety of TPE was evaluated in 10 pediatric patients who underwent TPE that were unresponsive to corticosteroid treatment.MethodsRecords of 10 pediatric patients who underwent TPE in our pediatric intensive care unit (PICU) between May 2017 and June 2020 were used. Expanded Disability Status Scale (EDSS), Gait Scale (GS), and Visual Outcome Scale (VOS) were applied to the patients before and after TPE.ResultsOf the 10 patients who underwent TPE, five were diagnosed with multiple sclerosis (MS), three with transverse myelitis (TM), and two with acute disseminated encephalomyelitis (ADEM). The median age of the patients was 13.3 years (IQR 8-15), and the median day from symptom onset to onset of TPE was 12.5 days (IQR 7-28). A total of 104 TPE sessions were performed successfully. While no complications were encountered in three patients during the sessions, the most common complication was hypofibrinogenemia. The decrease in EDSS and GS scores was found to be consistent with the clinical response of the patients. There was no statistically significant decrease in the VOS.ConclusionsWith this study, we can say that TPE is a feasible, effective, and safe treatment modality in children with acute demyelinating syndromes of the central nervous system.     

Refractory thyrotoxicosis induced by iodinated contrast agents treated with therapeutic plasma exchange. A case report

Excess free iodide in the blood (ingested or injected) may cause thyrotoxicosis in patients at risk. Iodinated contrast solutions contain small amounts of free iodide and may be of significance for patients affected by Graves' disease, multinodular goiter or living in areas of iodine deficiency. Herein, we report a 57 elderly woman with a clinical history of multinodular goiter presented with a thyrotoxicosis induced by an iodinate contrast agent used during computed tomography scan. Because of the patient's resistance to conventional antithyroid drugs, she was treated with therapeutic plasma exchange (TPE). TPE is used in the treatment of several immunologic and nonimmunologic disorders. Temporary improvement after TPE in cases with thyrotoxicosis has been reported. In our patient's case, we observed an improvement in the thyroid hormone laboratory values as well as clinical findings. TPE can be an addition treatment when standard therapies for thyrotoxicosis fail providing the clinician with an adjuvant tool for rapid preparation of such a patient for thyroidectomy surgery.