Sanédy SA Simon, Marit S van Sandwijk, Rik H Olde Engberink
{"title":"Chronic Kidney Disease Is a Risk Factor for the Development of Hyperchloremic Metabolic Acidosis After Repeated Therapeutic Plasma Exchanges","authors":"Sanédy SA Simon, Marit S van Sandwijk, Rik H Olde Engberink","doi":"10.1002/jca.70059","DOIUrl":"10.1002/jca.70059","url":null,"abstract":"<p>Hyperchloremic metabolic acidosis is an underreported but common metabolic complication following therapeutic plasma exchange (TPE) with an albumin-saline solution, particularly when multiple TPE sessions are performed within a limited period. The risk of hyperchloremic metabolic acidosis may be the highest in patients with chronic kidney disease because of their limited acid excretion capacity. We prospectively collected data from all patients who received TPE at Amsterdam UMC between February 2023 and March 2025. We collected data on demographics, TPE-related parameters, and blood electrolyte concentrations. We investigated the effect of TPE on plasma sodium, chloride, and bicarbonate concentrations, the occurrence of adverse events, and the modulating role of kidney function. Data from 64 patients with 320 TPE sessions were included in the analysis. The mean age was 50 years, 55% of the patients were male and the mean eGFR was 35 mL/min/1.73 m<sup>2</sup>. The effect of a single TPE on plasma electrolyte concentration was independent of kidney function. However, after multiple TPE sessions, a lower eGFR was associated with a greater increase in plasma chloride concentration (<i>p</i> < 0.001) and a larger decrease in plasma bicarbonate concentration (<i>p <</i> 0.001) despite oral bicarbonate supplementation and a lower baseline plasma bicarbonate concentration. Patients with a lower eGFR were more likely to experience adverse events during a TPE session (<i>p</i> = 0.004). Chronic kidney disease is a risk factor for developing hyperchloremic metabolic acidosis and adverse events during an intensive TPE cycle.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sonia Labarinas, Kalpana Norbisrath, Ibeh Nnaemeka, Yu Bai, Hlaing Tint, Dana Johnson, Ken Brady, Oliver Karam
{"title":"Plasma Exchange in the Setting of Immune-Mediated Multiple Organ Failure in the Cardiac ICU During ECMO: A Case Series","authors":"Sonia Labarinas, Kalpana Norbisrath, Ibeh Nnaemeka, Yu Bai, Hlaing Tint, Dana Johnson, Ken Brady, Oliver Karam","doi":"10.1002/jca.70061","DOIUrl":"10.1002/jca.70061","url":null,"abstract":"<div>\u0000 \u0000 <p>Extracorporeal membrane oxygenation (ECMO) is a last resort treatment for children with cardio-respiratory failure. Some of these patients will develop thrombocytopenia-associated multiple organ failure (TAMOF), which is sometimes managed with therapeutic plasma exchange (TPE). Our objective is to describe critically ill children on ECMO who underwent TPE for TAMOF. We conducted a single-center retrospective case series of seven children with congenital cardiac disease, requiring ECMO, diagnosed with TAMOF, and treated with TPE between 12/2023 and 6/2024. A centrifugation-based apheresis instrument was used to process 1.5 total blood volume. One packed red blood cell was used to prime the apheresis circuit. Systemic bivalirudin was used for anticoagulation. Seven patients (median age: 55 days, median weight: 4.0 kg, median bypass time: 172 min, 100% VA ECMO, 85% central cannulation, 100% bivalirudin) underwent a total of 30 TPE sessions. The median number of sessions per patient was 3, with a median time to first session of 27.3 h after cannulation. Plasma was used as the replacement fluid in all sessions, with a median volume of 168 mL/kg. The median platelet count increased from 45 × 10<sup>9</sup>/L (38; 54) pre-TPE to 64 (IQR: 45; 75, <i>p</i> < 0.001) post-TPE, despite no platelet transfusions during TPE. The modified organ severity index decreased significantly from 13 to 12 (<i>p</i> < 0.001). The mortality rate was 71%. TPE may improve platelet counts and reduce organ severity scores in critically ill children with TAMOF on ECMO.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lea U. Krauß, Andreas M. Brosig, Patricia Mester, Tanja Elger, Stephan Schmid, Martina Müller, Vlad Pavel
{"title":"High-Dose Phenprocoumon Intoxication Treated With Therapeutic Plasma Exchange","authors":"Lea U. Krauß, Andreas M. Brosig, Patricia Mester, Tanja Elger, Stephan Schmid, Martina Müller, Vlad Pavel","doi":"10.1002/jca.70062","DOIUrl":"10.1002/jca.70062","url":null,"abstract":"<p>Phenprocoumon inhibits the synthesis of coagulation factors II, VII, IX, and X, as well as proteins C and S [<span>1</span>]. It is commonly used for prophylactic anticoagulation, particularly after artificial heart valve replacement. Therapeutic monitoring is performed using the International Normalized Ratio (INR) [<span>2</span>], with a therapeutic plasma level of phenprocoumon (PLP) ranging between 1.0 and 3.5 mg/L. Overdoses are typically due to poor compliance; however, cases involving suicidal intent have also been described [<span>3</span>]. Overdose may lead to gastrointestinal bleeding, cerebral bleeding, or liver injury [<span>4, 5</span>]. In massive overdoses, dialysis is ineffective because of the high plasma protein binding of the drug [<span>6</span>].</p><p>This work was reviewed and approved by the Ethics Committee of the University of Regensburg, Regensburg, Germany (25-4254-104). Written informed consent for publication was obtained from the patient.</p><p>A 78-year-old woman presented to the emergency department 13 h after the intentional ingestion of 300 mg phenprocoumon. She denied any bleeding, gastrointestinal, or neurological symptoms. Her medical history included atrial fibrillation and mechanical heart valve replacement. The target INR was between two and three. Given the high risk of bleeding, she was admitted to the intensive care unit (ICU).</p><p>Initial laboratory tests revealed an INR of 2.9, a partial thromboplastin time (PTT) of 34.3 s, and a PLP of 51.4 mg/L. However, it is known that the anticoagulant effect of phenprocoumon starts with a latency of approximately 48–72 h [<span>3</span>]. Analysis of coagulation factors revealed abnormal values of factor VII (38%) and factor IX (47%). The coagulometric method was performed for measuring INR. Thromborel S was used as a reagent. After an initial dose of vitamin K1, the PLP remained high at 48.5 mg/L. Due to the drug's > 98% plasma protein binding and long half-life [<span>5</span>], we opted for therapeutic plasma exchange (TPE) to facilitate the elimination of albumin-bound phenprocoumon.</p><p>Since ultrasound of the neck vessels revealed optimal anatomy for a safe puncture, a central line catheter was placed in the right internal jugular vein. If the placement of a central line is considered high-risk for bleeding complications, in most cases TPE can be performed also using a peripheral catheter [<span>7</span>]. Daily TPE using fresh frozen plasma (FFP) was performed for three consecutive days using the Spectra Optia cell separator (Terumo BCT Inc., Lakewood, CO). Each TPE involved 1.3 times the patient's plasma volume (averaging 48.9 mL/kg body weight) (Table 1).</p><p>Due to the presence of mechanical heart valves, PTT-controlled anticoagulation with unfractionated heparin began 15 h after ingestion. Vitamin K1 was administered repeatedly, guided by INR and PTT values.</p><p>After the first TPE, PLP dropped to 29.2 mg/L. 14 days post-ingestion, the","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yandy Marx Castillo-Aleman, Carlos Agustin Villegas-Valverde, Maysoon Al-Karam, Shinnette Lumame, Jay Mary Rose-Roque, Ehab Bawadi, Dina El-Mouzain, Stefano Benedetti, Yendry Ventura-Carmenate, Fatema Mohammed Al-Kaabi, Antonio Alfonso Bencomo-Hernandez, Alexander Sach, David Andel, Yannick P. Kok, Rupert Handgretinger, Stefan R. Bornstein
{"title":"Double Filtration Plasmapheresis for Environmental Toxin Removal: A Case Series of Patients With Hyperlipoproteinemia(a)","authors":"Yandy Marx Castillo-Aleman, Carlos Agustin Villegas-Valverde, Maysoon Al-Karam, Shinnette Lumame, Jay Mary Rose-Roque, Ehab Bawadi, Dina El-Mouzain, Stefano Benedetti, Yendry Ventura-Carmenate, Fatema Mohammed Al-Kaabi, Antonio Alfonso Bencomo-Hernandez, Alexander Sach, David Andel, Yannick P. Kok, Rupert Handgretinger, Stefan R. Bornstein","doi":"10.1002/jca.70060","DOIUrl":"10.1002/jca.70060","url":null,"abstract":"<div>\u0000 \u0000 <p>Double filtration plasmapheresis (DFPP) is a promising method for removing environmental toxins, but comparative data on toxin-specific removal patterns remain limited. This study investigates the removal effectiveness of various pollutants in patients with hyperlipoproteinemia(a) undergoing DFPP. We retrospectively analyzed procedures performed using the Inuspheresis System with two filters with differing pore sizes. We assessed the clearance of heavy metals, volatile organic compounds, and organic pollutants by calculating the “<i>redistribution ratio</i>” (RR) and the percentage of captured analyte (CA). Analytes with large volumes of distribution and low protein binding, such as toluene, methyl isobutyl ketone, and barium, showed high rebound (RR: 1.95, 1.31, and 1.97, respectively), suggesting redistribution from peripheral compartments. Moderate rebound was observed for partially protein-bound toxins, including PCB 153 (0.76), PCB 138 (0.74), and hexachlorobenzene (0.66). Low or negative RRs were seen with arsenic (−0.49), mercury (−0.05), and cobalt (0.08), likely reflecting limited redistribution. High CA values were recorded for lipophilic, protein-bound toxins such as PCBs and p,p′-DDE. Herein, we demonstrate that DFPP is effective in removing environmental toxins from the human body. The pharmacokinetic properties of each compound are key determinants of DFPP effectiveness and may help guide the development of personalized detoxification strategies to optimize its clinical use.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesco Sbrana, Beatrice Dal Pino, Carmen Corciulo, Federico Bigazzi, Tiziana Sampietro
{"title":"Neutrophil-Gelatinase Associated Lipocalin (NGAL) as Biomarker of Kidney Perfusion in Lipoprotein Apheresis","authors":"Francesco Sbrana, Beatrice Dal Pino, Carmen Corciulo, Federico Bigazzi, Tiziana Sampietro","doi":"10.1002/jca.70057","DOIUrl":"https://doi.org/10.1002/jca.70057","url":null,"abstract":"","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond Donation: Rethinking Long-Term Support Systems for Hematopoietic Stem Cell Donors","authors":"RishiRaj Sinha","doi":"10.1002/jca.70055","DOIUrl":"https://doi.org/10.1002/jca.70055","url":null,"abstract":"","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Prospective Comparative Study of High-Yield Plateletpheresis Using Haemonetics MCS+, Trima Accel, and Spectra Optia Devices in a Resource-Constrained Setting","authors":"Eiman Hussein, Azza A. Aboul Enein","doi":"10.1002/jca.70054","DOIUrl":"https://doi.org/10.1002/jca.70054","url":null,"abstract":"<div>\u0000 \u0000 <p>In a resource-constrained setting, maximizing plateletpheresis efficiency is critical. We believe leveraging advanced apheresis device software to enhance platelet yield, reduce consumables, and shorten procedure times offers significant advantages. This study compared Haemonetics, Trima, and Optia apheresis devices, analyzing donor and machine parameters. It also assessed how high-yield collections and recent software updates on Trima and Haemonetics devices impact donor safety. The goal was to find the best practices for optimizing both donor safety and platelet collection. Analyzing 900 procedures (300 per device), Trima and Optia yielded significantly more platelets (9 × 10<sup>11</sup>) in less time compared to Haemonetics (5.7 × 10<sup>11</sup>) (<i>p</i> < 0.05). Trima collected10–12 × 10<sup>11</sup> platelets from significantly more donors with lower pre-donation counts than Optia (<i>p</i> < 0.05). Optia led to the fewest adverse events (0.7%). Donor weight was significantly higher for yields > 9 × 10<sup>11</sup> on Optia and Trima (<i>p</i> < 0.05). Haemonetics' 3.6–3.8 × 10<sup>11</sup> yield group had significantly lower session time, donor weight, and presession platelet counts (<i>p</i> < 0.05). Software updates (200 sessions/device) significantly boosted Trima's yields to 14.8 × 10<sup>11</sup> while reducing adverse events (1% vs. 2.3% pre-update). Haemonetics also saw improved yields and fewer adverse events (1% vs. 4.3%), though its overall yield remained lower (6.3 × 10<sup>11</sup>, <i>p</i> < 0.05). Both maintained safe post-procedure platelet counts (> 130 000/μL). However, Trima's predicted yields for very high collections (> 12 × 10<sup>11</sup>) significantly differed from lab-determined yields. Trima and Optia provide better platelet collection efficiency than Haemonetics. Software updates improved both Trima and Haemonetics' performance and safety; however, Trima's high-yield predictions need refining. Optimal settings, updated software, and careful donor selection are essential for maximizing platelet yield and donor safety in resource-limited areas.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144998903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nisar Amin, Tim Carll, Harleen Chela, Amir Kamran, Geoffrey D. Wool, Ebubekir Daglilar
{"title":"The Role of Therapeutic Plasma Exchange in Treating Hypertriglyceridemia-Associated Acute Pancreatitis: A Real-World Effectiveness Analysis Using the TriNetX Global Collaborative Network","authors":"Nisar Amin, Tim Carll, Harleen Chela, Amir Kamran, Geoffrey D. Wool, Ebubekir Daglilar","doi":"10.1002/jca.70053","DOIUrl":"https://doi.org/10.1002/jca.70053","url":null,"abstract":"<div>\u0000 \u0000 <p>Therapeutic plasma exchange (TPE) is used to lower triglyceride levels in patients with severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP). However, evidence supporting the effectiveness of TPE in preventing end-organ damage remains limited. This retrospective cohort study was conducted using the TriNetX database to evaluate adults with acute pancreatitis, triglyceride levels > 1000 mg/dL, and “worrisome criteria”, defined as clinical indicators of disease severity such as fever, leukocytosis, elevated lactate, or signs of shock. Patients receiving TPE within 3 days of diagnosis were compared with patients with no TPE within 30 days. Outcomes included triglyceride reduction to < 500 mg/dL, ICU admission, end-organ damage, and mortality. Of 14 188 patients with HTG-AP, 3% (<i>n</i> = 419) received TPE; 97% (<i>n</i> = 13 237) were treated without TPE. After 1:1 propensity-score matching, 2 well-matched, 412-patient cohorts were created. More patients in the TPE cohort had a reduction in triglyceride levels to < 500 mg/dL at 1 week (81% vs. 40%, <i>p</i> < 0.001) and 1 month (86% vs. 48%, <i>p</i> < 0.001). However, the TPE cohort also had higher ICU admission rates (39% vs. 19%, <i>p</i> < 0.001). No significant differences in organ failure rates were observed at 1 week (4.4% vs. 3.3%, <i>p</i> = 0.47) or 1 month (5.8% vs. 5.0%, <i>p</i> = 0.71). Similarly, 30-day (4.4% vs. 6.3%, <i>p</i> = 0.21) and 3-month (5.3% vs. 7.8%, <i>p</i> = 0.16) all-cause mortality were comparable between the cohorts. In patients with HTG-AP, use of TPE within 3 days of diagnosis reduces triglyceride levels effectively but does not significantly reduce the risk of end-organ damage or mortality. TPE is associated with increased ICU care requirements, which may reflect protocolized ICU admission.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cyril Jacquot, Maria Di Mola, Reuben Jacob, Gagan Mathur, Cheryl Pacheco, Angelica Vivero, Zachary Corey, Ileana Lopez-Plaza, Kyle Annen
{"title":"Developing a Protocol for Therapeutic Plasma Exchange in Tandem With Continuous Renal Replacement Therapy (CRRT) and ExtraCorporeal Membrane Oxygenation (ECMO) in Pediatric Patients","authors":"Cyril Jacquot, Maria Di Mola, Reuben Jacob, Gagan Mathur, Cheryl Pacheco, Angelica Vivero, Zachary Corey, Ileana Lopez-Plaza, Kyle Annen","doi":"10.1002/jca.70051","DOIUrl":"https://doi.org/10.1002/jca.70051","url":null,"abstract":"<div>\u0000 \u0000 <p>Therapeutic plasma exchange (TPE) in pediatric patients presents many challenges, including management of a large extracorporeal volume (ECV) and calcium replacement for patients who may not be able to express signs of hypocalcemia or other associated adverse events with a large ECV. Pediatric patients who are critically ill on continuous renal replacement therapy (CRRT) and/or extracorporeal membrane oxygenation (ECMO) may have indications for TPE, such as sepsis or liver failure anticipating transplant. It may be difficult or clinically detrimental to take the patient off the CRRT or ECMO circuit to perform TPE. Connecting the TPE device into the preexisting circuit is feasible with the understanding of the principles of the circuit flow set up and monitoring to mitigate adverse events. Effective communication among clinical teams managing distinct extracorporeal circuits is critical to ensuring coordinated patient care.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mishi Bhushan, Thomas M. Schneider, Jeanne E. Hendrickson
{"title":"A Single-Center Retrospective Study Evaluating the Role of Therapeutic Plasma Exchange in Patients With an Initial Diagnosis of Optic Neuritis","authors":"Mishi Bhushan, Thomas M. Schneider, Jeanne E. Hendrickson","doi":"10.1002/jca.70052","DOIUrl":"https://doi.org/10.1002/jca.70052","url":null,"abstract":"<div>\u0000 \u0000 <p>Few studies have explored the outcomes of patients with optic neuritis (ON) who undergo treatment with therapeutic plasma exchange (TPE). We hypothesized that patients with detectable antibodies may respond more favorably to TPE than those without. Data were retrospectively collected from the electronic medical record on patients ≥ 18 years old with a diagnosis of ON that our apheresis service consulted on between October 2022 and July 2024. A total of 288 admissions for ON occurred, and the apheresis service was consulted on 66 (23%); all patients were on high-dose steroids at the time of the consult. Fifty-four patients were diagnosed with neuromyelitis optica spectrum disorder (<i>n</i> = 24, 44%), myelin oligodendrocyte glycoprotein antibody-associated disease (<i>n</i> = 13, 24%), multiple sclerosis (<i>n</i> = 6, 11%), or ON not otherwise specified (<i>n</i> = 11, 20%). The mean age was 44 years, 74% were female, and 63% were Black. The average duration of visual symptoms prior to the initiation of TPE was 23 days; most patients underwent five TPE treatments, and the average improvement after the TPE course on a scale of 1–5 was 2.9. No relationship was observed between the duration of symptom onset prior to TPE and outcome, regardless of ON cause. Despite a long duration of symptoms prior to TPE, most patients showed moderate clinical improvement. The cause of ON or the presence of detectable antibodies did not impact the outcome, suggesting that removal by TPE of cytokines, complement, or other substances may be important.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}