Rheopheresis for sudden hearing loss (SHL)

Rheopheresis has met an increasing interest and application in different disease conditions affecting microcirculation. Its last applications are for the management of Macular and Cochlear disorders. The sudden hearing loss syndrome is a condition that affects 20 out of 100,000 persons per year, reduces the patient's social interaction and quality of life. It is associated with vascular and coagulation risk factors and it is considered as a result of local hypoperfusion secondary both to inflammatory and dysimmune conditions determining inadequate NO release and endothelial dysfunction. Rheopheresis treatment is a new approach which brings to satisfactory clinical results. Cascade filtration, heparin induced lipid precipitation and conventional plasma exchange are equally effective, and only 2 sessions are required for producing long lasting benefits. Our experience is with 60 patients, 90% of which getting from partial to complete recovery after treatment as measured by pure tone audiometry.     

Cascade filtration: clinical application in 26 patients with immune complex and IgM mediated diseases

A new technique which allows lymphocytapheresis to be combined with cascade filtration (CF) is described in this paper. This therapeutical approach was applied for the treatment of patients affected by necrotizing vasculitis (1), inflammatory myopathies (5), Cryoglobulinemia (5), immune complex polyneuropathies (7), rheumatoid arthritis (3) and psoriasis (3 patients). Two cases of Waldenstrom's macroglobulinemia were also treated after the onset of the hyperviscosity syndrome. 78 procedures have been performed without any untoward effect. From a clinical point of view all patients had some improvement following treatment, thereby confirming not only the clinical safety of this therapeutical approach but also its effectiveness at least in the management of diseases which usually respond to plasma exchange treatment. Laboratory investigations showed that with CF it is possible to selectively remove IgM, immune complexes, fibrinogen, lipoproteins and high molecular weight plasma components, sparing most albumin and IgG globulins (85 and 71%, respectively).     

Cord blood (CB) stem cells for wound repair. Preliminary report of 2 cases.

In 2 patients, to promote skin wound/lesion repair we used fibrin-platelet glue combined with HLA compatible (2 mismatches accepted) buffy coats containing CD 34+ cord blood cells. The fibrin platelet glue was prepared with autologous apheresis platelets and cryoprecipitate. The original product was divided into 3 and 4 aliquots respectively for a correspondent number of applications. At each application, the margins of the lesion were infiltrated with 3 ml of cord blood buffy coat, containing 30 x 10(3) CD 34+ cells. No graft versus tissue reaction was seen in our patients in a follow-up of 3-7 months. The level of improvement, scored arbitrarily from 0 to 4, was 3 and 4, respectively. Our conclusion is that the use of cord blood cells along with fibrin platelet glue is of clinical interest.     

Collection of peripheral blood hematopoietic progenitors (PBHP) from patients with severe aplastic anemia (SAA) after prolonged administration of granulocyte colony-stimulating factor

The aim of this study was to test whether prolonged administration of granulocyte colony-stimulating factor (G-CSF) would allow the collection by leukapheresis of PBHP in patients with SAA. For this purpose, nine SAA patients, 7 to 46 years old, six of whom were enrolled at diagnosis of their disease and three after previous immunosuppression had failed, were treated with antilymphocyte globulin (ALG) (day 1 to 5), cyclosporin A (5 mg/kg/d orally) (day 6 to 90) and G-CSF 5 micrograms/kg/d (day 6 to 90). A total of 40 leukaphereses were performed, (range 2 to 7 per patient), between days +10 and +168 from G- CSF treatment. White blood cell count at the time of harvest ranged from 1.2 to 18.1 x 10(9)/L. Results can be summarized as follows: the median number of cells collected per patient was 5.0 x 10(8)/kg (range 2.6 to 18.7), the median number of CD34+ cells was 1.8 x 10(6)/kg (range 0.27 to 3.8) and the median number of colony-forming units granulocyte-macrophage (CFU-GM) was 3.9 x 10(4)/kg (range 0 to 39). Twenty leukaphereses performed between days +33 and +77 of G-CSF treatment grew granulocyte macrophages and erythroid colonies in vitro. No colony growth was obtained from 20 leukaphereses performed before day +33 or after day +80. In six patients the total number of CFU-GM recovered were in the range described for autologous peripheral blood stem cell grafts. (2.6 to 39 x 10(4)/kg). In conclusion, this study suggests that circulating hematopoietic progenitors can be recovered after ALG priming and after at least 1 month of G-CSF treatment in a proportion of patients with SAA. Whether these cells will be suitable for autologous transplantation remains to be determined.     

Biochemical and clinical evaluation of a new cellulose diacetate secondary filter for cascade filtration

We have performed 24 cascade filtration treatments in 8 patients with hyperviscosity syndrome (2 cases), essential mixed cryoglobulinemia, post-hepatitic cryoglobulinemia, Sjogrens disease, rheumatoid vasculitis, Miller-Fisher syndrome and chronic dysimmune polyneuropathy. New cellulose diacetate filters were employed, giving a satisfactory performance. At 1.5 L plasma treatment, the rejection rate for macromolecular plasma components was close to 90%, whereas albumin recovery was close to 70%. Treatments were clinically effective, confirming that cascade filtration is an alternative to conventional plasma exchange in patients with IgM or immune complex mediated diseases.     

Single-donor platelet concentrates produced along with packed red blood cells with the haemonetics MCS 3p: Preliminary results

There has been an increasing interest in recent years over the qualitative superiority of single-donor platelets in the management of hemato-oncologic patients. The reasonable desire of both patients and physicians to limit the risks of transfusion along with the need for limiting the costs involved in this kind of therapy have led to application of multicomponent donations both in terms of double platelet concentrates and double products such as red blood cells (RBC) and platelets from the same donor. Single donor platelets and RBC have been collected in a semi-automated mode and only the very recent introduction of the Haemonetics MCS 3p with its SDP/RBC protocol provides a totally closed-system automated protocol for this combined collection. Twenty procedures have been carried out so far at our unit. In a mean of 87 minutes (6–7 passes), a mean of 3.1 × 10¹¹ platelets were collected along with ～220 mL of packed RBC. The leukocyte contamination of the platelet product was in the range of 0.4–1.1 × 10⁷ (99% lymphocytes), and the quality of platelets was very satisfactory as measured by the hypotonic shock response, aggregation induced by ADP, collagen and ristocetin, morphology score, and membrane glycoproteins modifications. Equally satisfactory was the quality of the RBC concentrate, suspended in 80 mL of SAG-M, with a total hemoglobin (Hb) content approaching 55 g as compared to the normal Hb content of a standard RBC concentrate that is approximately 62 g. No adverse effect has complicated the 20 procedures carried out so far, and the donors' evaluation of the procedure was favorable, except for the length of the procedure.     

Plasma Exchange as a Therapy for Guillain-Barré Syndrome with Immune Complexes

Small volume plasma exchange (PE) was evaluated in 6 patients with acute Guillain-Barré syndrome (GBS) and in 1 with its chronic relapsing type. Patients were treated during the onset or progression of their neurologic involvement and no other combined therapy was provided. 6 of our patients had clear benefit following the first session. Two procedures on alternate days were carried out in 4 patients while a third procedure was performed in 3 due to insufficient exchange or to equivocal improvement. After PE, patients showed moderate to marked improvement in motor strength, in their ventilatory function and in their sensory symptoms, which improved definitely but more slowly than motility. Each patient showed, prior to therapy, high levels of immune complexes; their level was clearly reduced by PE and clinical results correlated with this removal. No relapse was observed during 5–15 months of appropriate follow-up.