Journal of Clinical Apheresis最新文献

{"title":"Performance of Total Blood Volume Algorithms in Obesity and Severe Obesity","authors":"Caitlin Raymond,&nbsp;Ninet Sinaii,&nbsp;Kamille West-Mitchell","doi":"10.1002/jca.70038","DOIUrl":"https://doi.org/10.1002/jca.70038","url":null,"abstract":"<p>Amid the ongoing obesity epidemic, the estimation of total blood volume (TBV) in obese people remains hotly contested without common agreement among apheresis practitioners. We compare the results of estimated TBV from different formulas across a spectrum of obese BMIs from a cohort of 155 individual patients. We also plot the difference between the resulting TBVs, assigning a threshold of functional significance of 500 mL, at which the choice of formula might make an impact on patient care. We compare the mean TBV estimated in non-severe versus severe obesity for all the above algorithms and determine the impact of algorithm choice on various apheresis procedures. The choice of algorithm has a significant impact on apheresis procedures; for example, we found differences of up to ~3–4 plasma units for a therapeutic plasma exchange depending on the choice of algorithm applied. We additionally find that algorithm performance varies widely in both men and women, particularly in morbid obesity, and often produces values that fall outside an empirically chosen expected range. We do not find a clinically significant difference in mean estimated TBV between non-severe and severe obesity in any algorithm tested, suggesting that physiological changes in obesity may fail to be captured by these algorithms. We hope these results are useful to other apheresis practitioners and help them make an informed choice of algorithm to estimate TBV in their obese patients. However, our current algorithms for estimating TBV may be flawed, and the field may wish to move toward measurement of TBV using recently available commercial options.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273396","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}

{"title":"Training and Practice Gaps in Pediatric Apheresis in Canada: A National Survey","authors":"Soumitra Tole,&nbsp;Amrit Kirpalani","doi":"10.1002/jca.70036","DOIUrl":"https://doi.org/10.1002/jca.70036","url":null,"abstract":"<div>\u0000 \u0000 <p>This study explored the pediatric apheresis landscape in Canada by assessing provider comfort, training adequacy, and prescriber roles for therapeutic plasma exchange (TPE) and automated red blood cell exchange (RBCX). A national survey was completed by 52 pediatric subspecialists (27 nephrologists, 25 hematologists/oncologists) from 12 institutions. Most respondents (63%) reported that both TPE and RBCX were available at their site. Prescribing responsibilities varied by therapy and indication. Across seven clinical domains, comfort scores were moderate for both therapies, with training adequacy scores consistently lower. Training adequacy for TPE was significantly higher than that for RBCX in two domains: identifying (2.48 ± 1.03 vs. 2.10 ± 1.13, <i>p</i> = 0.043) and managing (2.44 ± 1.05 vs. 2.06 ± 1.14, <i>p</i> = 0.035) common complications. Free-text responses emphasized informal training and the need for national education strategies. These findings highlight gaps in pediatric apheresis education and the need for standardized, competency-based training across subspecialties.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255946","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":"Large Volume Leukapheresis in a Patient With Meniere's Disease","authors":"Laura Cooling","doi":"10.1002/jca.70037","DOIUrl":"https://doi.org/10.1002/jca.70037","url":null,"abstract":"&lt;p&gt;Meniere's Disease (MD) is a progressive, debilitating disease of the inner ear, characterized by aural pressure, tinnitus, hearing loss and vertigo. Meniere's disease has a late onset, with most cases occurring after 40 years of age [&lt;span&gt;1&lt;/span&gt;]. MD is caused by endolymphatic hydrops of the inner ear and is typically managed conservatively with a low sodium diet (1500–2300 mg Na++ per day), diuretics, and abundant fluid intake to lower both endolymphatic pressure and plasma antidiuretic hormone levels. Antihistamines (meclizine, betahistamine, and diphenhydramine) are often prescribed to reduce the motion sickness associated with vertigo [&lt;span&gt;1&lt;/span&gt;]. Patients with severe refractory symptoms may require intratympanic injections (steroids and gentamicin) or surgery [&lt;span&gt;1&lt;/span&gt;]. We recently encountered a patient with MD and multiple myeloma who was referred for autologous peripheral blood hematopoietic progenitor cell collection (AHPCC). Per institutional IRB, informed consent is waived.&lt;/p&gt;&lt;p&gt;The patient was diagnosed with vertigo and MD nearly 20 years ago. He was managed conservatively with a low sodium diet (1500 mg Na++/day) and diuretics thrice weekly (triamterene-hydrochlorothiazide 25 mg, MWF). His symptoms were well controlled and limited to intermittent episodes of vertigo, aural fullness, and “feeling off” usually associated with high dietary sodium intake.&lt;/p&gt;&lt;p&gt;The patient's MD history raised concerns for large volume leukapheresis (LVL) due to the volume of acid citrate dextrose anticoagulant (ACDA) administered over the course of AHPCC. ACDA contains trisodium citrate dihydrate (C&lt;sub&gt;6&lt;/sub&gt;H&lt;sub&gt;5&lt;/sub&gt;Na&lt;sub&gt;3&lt;/sub&gt;O&lt;sub&gt;7&lt;/sub&gt;:2H&lt;sub&gt;2&lt;/sub&gt;0), which averages 510 mg Na++ per 100 mL of ACDA [&lt;span&gt;2&lt;/span&gt;]. Adult APHCC patients undergoing a standard 3 blood volume LVL may receive 1200 to 1600 mL ACDA and &gt; 6000 mg Na++. In addition, we prophylactically administer CaCl&lt;sub&gt;2&lt;/sub&gt; in saline (0.1 mEq Ca++/mL saline) for citrate prophylaxis, further adding to the sodium burden. We discussed using heparin-ACDA for anticoagulation, which would decrease both the ACDA administered and minimize citrate toxicity with lower CaCl&lt;sub&gt;2&lt;/sub&gt; infusion [&lt;span&gt;3&lt;/span&gt;]. Unfortunately, heparin-ACDA for LVL using the Spectra Optia (TerumoBCT, Lakewood, CO) is not validated at our institution and was not considered a viable option by the apheresis service.&lt;/p&gt;&lt;p&gt;In a literature review, we found no cases discussing LVL or apheresis in patients with MD. After informal consultation with bone marrow transplant and otolaryngology, a plan was formulated for AHPCC and his subsequent admission for HPC transplant. The patient was mobilized with G-CSF and plerixafor. During leukapheresis, he was prescribed prophylactic meclizine (25 mg, BID) as well as a benzodiazepine (lorazepam 0.5 mg, as needed), which can also reduce vertigo by increasing the inhibitory neurotransmitter GABA (gamma aminobutyric acid) [&lt;span&gt;1, 4&lt;/span&gt;]. In additio","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144264532","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}

{"title":"Therapeutic Apheresis for Neurological Diseases: A Five-Year Retrospective Study at a Large Academic Medical Center","authors":"Yaseen Ali Jamal,&nbsp;Furkan Yigitbilek,&nbsp;Muharrem Yunce","doi":"10.1002/jca.70035","DOIUrl":"https://doi.org/10.1002/jca.70035","url":null,"abstract":"<div>\u0000 \u0000 <p>Therapeutic plasma exchange (TPE) represents a crucial treatment modality for a wide range of neurological disorders. However, data regarding institutional variation in practice and clinical trends over time is limited, especially concerning diagnostic indications, treatment setting, line access, safety, and the impact of novel drug therapies on TPE utilization. We analyzed all TPE procedures performed at our institution between 2019 and 2023 for neurological indications. A total of 109 patients and 1310 procedures were retrospectively reviewed, focusing on procedure volumes, clinical parameters, and safety outcomes. An average of 173 procedures were performed per year, with no significant change in volume year-to-year. However, a significant decrease in the proportion of TPE procedures performed for myasthenia gravis (MG) was found over time. The most common diagnoses included MG, demyelinating diseases, and encephalitis. The overall complication rate was found to be 3.4%, most commonly hypotension and perioral tingling. While most procedures were conducted in the outpatient setting, we found a significant increase in the proportion of inpatient procedures over time. Additionally, most TPE procedures were conducted via central line, and we observed a significant increase in central line use over time. Notably, three MG patients safely received greater than 90 procedures each during the study period, with significantly fewer complications than the general cohort. These findings provide valuable insights into TPE management of neurological disorders, reaffirming its safety even in chronic refractory disease, and highlighting key trends relevant to treatment setting, line access, and the impact of novel drug therapies.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244481","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":"Extracorporeal Blood Purification Therapy to Deal a Deferasirox Induced Life-Threatening Hepatic Encephalopathy in a Septic Child With Sickle-Cell Disease: A Case Report","authors":"E. Rossetti,&nbsp;A. Cappoli,&nbsp;R. Labbadia,&nbsp;G. Leone,&nbsp;F. Chiusolo,&nbsp;F. Tortora,&nbsp;D. Martinelli,&nbsp;M. Marano","doi":"10.1002/jca.70032","DOIUrl":"https://doi.org/10.1002/jca.70032","url":null,"abstract":"<p>This report details a rare pediatric case of hyperammonemic encephalopathy caused by the oral iron chelating drug deferasirox (DFR) in a septic patient. It is our contention that this study lends support to the existing literature, as it describes the case of a 15-year-old female patient with a history of sickle-cell disease who presented with a fever and vomiting, rapid development of sleepiness, consciousness disturbances, medium mydriasis, neck stiffness, and trismus with seizure. Her Glasgow Coma Scale (GCS) score was 5. Laboratory tests revealed an increase in creatinine, metabolic acidosis, hyperammonemia, high cerebrospinal fluid (CSF) glutamine levels, alterations in coagulation and in liver function, rising inflammatory markers, cerebral oedema on brain Computerized Tomography (CT) scan, 10^6 copies/ml of Methicillin-Resistant <i>Staphylococcus Aureus</i> (MRSA) in pulmonary swab film array, and elevated DFR blood level. The treatment plan involved the early cessation of DFR, the correction of acidosis, mechanical ventilation, mannitol and bioarginine, vasoactive drug, antibiotics, and supportive care with continuous veno-venous hemodiafiltration (CVVHDF) for hyperammonemia and therapeutic plasma exchange (TPE) for a high CSF glutamine level resulting from cytotoxic encephalopathy. The patient successfully overcame the multiorgan failure, with no permanent neurologic complications. It is our opinion that healthcare providers and family caregivers of patients with chronic disease may be particularly attuned to the emergence of any sign or symptom, and thus well positioned to take prompt action to avert life-threatening clinical deterioration due to rising DFR levels. It is recommended that critical care providers commence extracorporeal blood purification therapies (EBPT) at the earliest opportunity, taking care to adapt the technique to the specific needs of the patient and to avoid the potential for fatal neurological complications.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118169","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}

{"title":"“Therapeutic Plasma Exchange in Children With Acute Liver Failure: Have Standards Been Deviated?”","authors":"Jagadeesh Menon,&nbsp;Naresh Shanmugam,&nbsp;Giridhar Sethuraman","doi":"10.1002/jca.70034","DOIUrl":"https://doi.org/10.1002/jca.70034","url":null,"abstract":"","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091897","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":"Plasma Exchange as a Therapeutic Modality in Pediatric Acute Liver Failure—Reply to Correspondence","authors":"Bikrant Bihari Lal,&nbsp;Guresh Kumar,&nbsp;Seema Alam","doi":"10.1002/jca.70027","DOIUrl":"https://doi.org/10.1002/jca.70027","url":null,"abstract":"","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091896","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":"Impact of Voxelotor on Red Blood Cell Exchange Therapeutic Procedures: Evaluation of Multi-Institutional Procedure Data","authors":"Sally Campbell-Lee,&nbsp;Ming Jin,&nbsp;Lisandro Fortuny,&nbsp;Daniel Sop,&nbsp;Suzanne Thibodeaux,&nbsp;Susan D-Roseff","doi":"10.1002/jca.70033","DOIUrl":"https://doi.org/10.1002/jca.70033","url":null,"abstract":"<p>Hemoglobin S (HbS) polymerization inhibitor drugs such as voxelotor can result in a split peak in HbS as well as additional peaks with hemoglobin A in quantitative methods of HbS measurement. It is unclear how these results should be used to make transfusion decisions. The goal of this study is to compare RBC exchange (RBCX) replacement volumes calculated with HbS-Vox + HbS versus HbS alone. Patients aged 15–58 years who had variant hemoglobin quantitation performed for clinical care purposes with evidence of voxelotor treatment (split peak in HbS and/or additional peaks with hemoglobin A) were identified by investigator review of variant hemoglobin quantitation test results from the clinical laboratory. The RBCX replacement volume calculated with HbS% total (RBCX volume HbS% total) was compared to the RBCX replacement volume calculated with HbS unmod% (RBCX volume HbS unmod%) in each case. The mean difference between RBCX volume total HbS% and RBCX volume HbS% unmod is 398 mL with 95% CI (198, 598) and RBCX volume total HbS is significantly different from RBCX volume HbS unmod (<i>p</i> value = 0.0006). If the HbS total is not used to calculate RBCX replacement volumes in patients taking voxelotor, there is a significantly lower amount of RBC that would be ordered, which would lead to higher HbS after RBCX. Additional studies regarding the role of transfusion in such patients are necessary.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091954","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}

{"title":"Expanding Horizons: Single-Center Insights on Extracorporeal Photopheresis (ECP) in Non-Lung Solid Organ Transplantation","authors":"V. Rakesh Sethapati,&nbsp;Naureen Narula,&nbsp;Muharrem Yunce","doi":"10.1002/jca.70028","DOIUrl":"https://doi.org/10.1002/jca.70028","url":null,"abstract":"<div>\u0000 \u0000 <p>Transplantation remains the best option for patients with advanced-stage organ failure. In some patients, despite aggressive medical management with immunosuppressants, refractory/recurrent rejection occurs. This single-center retrospective study aims to analyze the role of ECP as an add-on therapy to treat acute cellular rejection (ACR) and/or antibody-mediated rejection (AMR) in non-lung organ transplantation. We identified five non-lung solid organ transplant (SOT) recipients refractory to standard anti-rejection interventions that received ECP therapy in the last 5 years: one liver transplant, two heart transplants, and two small bowel transplants. Baseline demographics, time to ECP initiation, clinical assessment, and biopsy results were analyzed. They received at least 6 months of ECP for biopsy-proven ACR and/or AMR. Graft function was assessed clinically after 6 months by biopsy and/or clinical functional assessment. Graft function improved in all five patients after 6 months of ECP therapy based on clinical functional evaluation and by biopsy in some patients. No complications or adverse events were reported. This study supports the potential for ECP as an adjunctive therapy in non-lung organ transplant recipients who are refractory to standard therapies and present with ACR and/or AMR. ECP has immunomodulating effect with minimal procedural risk. Prospective studies are warranted to confirm the beneficial effects of ECP in the setting of ACR and AMR post organ transplantation.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144074271","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":"Early Recognition of Retinal Signs in Waldenström's Macroglobulinemia: Implications for Therapeutic Plasma Exchange","authors":"Álvaro Ponce-de-León,&nbsp;Alfonso Miranda-Sánchez,&nbsp;Alicia Valverde-Megias","doi":"10.1002/jca.70031","DOIUrl":"https://doi.org/10.1002/jca.70031","url":null,"abstract":"<div>\u0000 \u0000 <p>This report highlights the pivotal role of ophthalmologists in recommending therapeutic plasma exchange (TPE) for systemic disorders like Waldenström's macroglobulinemia (WM). A patient with suspected WM underwent ophthalmic evaluation, revealing peripheral retinal hemorrhages and Roth spots despite no visual complaints. Fundus imaging documented these changes, correlating with elevated IgM levels (86.32 g/L), indicative of hyperviscosity syndrome (HVS). Early retinal findings prompted TPE to mitigate HVS complications. Subsequent bone marrow biopsy confirmed WM with the MYD88 L265P mutation. This case underscores the importance of ophthalmologic insights in guiding hematologic interventions and improving outcomes.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914399","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}