Journal of Clinical Apheresis最新文献

{"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}

{"title":"Cost-Effectiveness of Preemptive Plerixafor Versus Rescue Plerixafor for Mobilization and Collection of Hematopoietic Stem Cells in Patients With Multiple Myeloma and Lymphoma","authors":"Roselene Mesquita Augusto Passos,&nbsp;Miriam Allein Zago Marcolino,&nbsp;Júlia Augusto Passos,&nbsp;Vinicius Fernando Calsavara,&nbsp;Leila de Lourdes Martins Perobelli,&nbsp;Alessandro Gonçalves Campolina,&nbsp;Cesar de Almeida-Neto","doi":"10.1002/jca.70026","DOIUrl":"https://doi.org/10.1002/jca.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Plerixafor combined with granulocyte colony-stimulating factor (G-CSF) has shown superior efficacy in mobilizing hematopoietic stem cells (HSCs). However, its widespread use is constrained by high costs, and there is ongoing debate regarding the effectiveness of mobilization strategies. This study evaluated the cost-effectiveness of preemptive versus rescue plerixafor in patients from the Brazilian Public Health Care System with multiple myeloma or lymphoma eligible for autologous stem cell transplantation (ASCT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational study assessed the costs and clinical outcomes of preemptive and rescue plerixafor strategies. The incremental cost-effectiveness ratio (ICER) was calculated for the percentage of patients with successful optimal or minimal HSC collections, who underwent ASCT and the number of leukapheresis sessions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 285 patients, 82 in the preemptive and 203 in the rescue group. Preemptive plerixafor resulted in a lower mobilization failure rate, a decreased need for remobilization, a higher proportion of patients progressing to ASCT, and a shorter interval between the beginning of mobilization and ASCT. The incremental cost of preemptive versus rescue plerixafor was US$ 1532.44. The incremental effectiveness observed was 10.1% for minimally successful harvest (ICER US$ 151.28), 4.7% for optimal harvest (ICER US$ 326.05), and 13.1% for patients progressing to ASCT (ICER US$ 116.18). Regarding the number of leukapheresis sessions, preemptive plerixafor was dominated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>Preemptive plerixafor is a cost-effective strategy compared to rescue plerixafor, offering higher efficacy and lower ICER values, making it a clinically beneficial option despite its higher cost.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902797","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":"Granulocyte and Monocyte Adsorptive Apheresis Maintenance Therapy Restored the Loss of Response to Anti-TNF-Alpha Agents in the Patients With UC: A Case Report","authors":"Nobuhiro Ueno,&nbsp;Yu Kobayashi,&nbsp;Aki Sakatani,&nbsp;Tatsuya Dokoshi,&nbsp;Keitaro Takahashi,&nbsp;Katsuyoshi Ando,&nbsp;Shin Kashima,&nbsp;Kentaro Moriichi,&nbsp;Hiroki Tanabe,&nbsp;Yuki Kamikokura,&nbsp;Mishie Tanino,&nbsp;Mikihiro Fujiya","doi":"10.1002/jca.70030","DOIUrl":"https://doi.org/10.1002/jca.70030","url":null,"abstract":"<p>Ulcerative colitis (UC) is a chronic inflammatory condition requiring lifelong management, with anti-tumor necrosis factor α (anti-TNF-α) agents often used for refractory cases. However, secondary loss of response (LOR) to these agents, due to anti-drug antibodies, poses a significant therapeutic challenge. This report describes a case where granulocyte and monocyte adsorptive apheresis (GMA) maintenance therapy successfully restored the efficacy of an anti-TNF-α agent in a 26-year-old male with active UC experiencing LOR to infliximab. Following GMA induction therapy and continued infliximab administration, clinical symptoms improved, fecal calprotectin levels decreased, and clinical remission was achieved. Long-term maintenance with GMA enabled sustained clinical remission, with mucosal healing observed one year post-therapy. This case suggests that GMA maintenance therapy may serve as a novel therapeutic approach for patients with active UC experiencing LOR to anti-TNF-α agents. However, further studies are warranted to elucidate the underlying mechanisms and validate its efficacy.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896914","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":"Challenges in Autologous Peripheral Blood Stem Cell Collection in a Patient With IgM Myeloma and Cryoglobulinaemia","authors":"Julie Gillies,&nbsp;Samantha Drummond","doi":"10.1002/jca.70029","DOIUrl":"https://doi.org/10.1002/jca.70029","url":null,"abstract":"<div>\u0000 \u0000 <p>Cold agglutinins are well recognized to complicate stem cell harvests. There is recognition that in both the collection, the processing, and reinfusion of the stem cells to the patient, the product could be exposed to lower temperatures, and this could affect the cold agglutinins within. There is little published evidence on peripheral blood stem cell (PBSC) collection in patients with cryoglobulinaemia. We would like to present a gentleman who has IgM myeloma and Type 1 cryoglobulinaemia. The patient was young and fit, and the plan was to consolidate his induction chemotherapy with an autologous stem cell transplant (ASCT).</p>\u0000 <p>We would like to discuss the challenges that we faced in this gentleman in trying to harvest stem cells to utilize for the purposes of performing an ASCT. These challenges occurred because of 1. progressive disease, causing an inevitable rise in cryoglobulin levels that prevented therapeutic plasma exchange and stem cell collection and 2. the myelosuppressive effects of the chemotherapeutic agent prohibiting an adequate stem cell dose required to proceed to transplant. We would like to describe the measures that we put in place in trying to collect PBSC in this patient, to utilize for the purposes of performing an ASCT.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883871","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":"Antidote Worse Than the Poison? Emergent Therapeutic Plasma Exchange After Overzealous Intravenous Lipid Emulsion Infusion During Treatment of Local Anesthetic Systemic Toxicity","authors":"Brooke Yasgur,&nbsp;Ari Filip,&nbsp;Pratheepa Ravikumar,&nbsp;Logan Meurer,&nbsp;Gina Drobena","doi":"10.1002/jca.70025","DOIUrl":"https://doi.org/10.1002/jca.70025","url":null,"abstract":"<div>\u0000 \u0000 <p>This case report describes therapeutic plasma exchange as treatment for a rare instance of severe hypertriglyceridemia following high-dose intravenous lipid emulsion (ILE) therapy for bupivacaine-induced local anesthetic systemic toxicity (LAST). The patient received a cumulative ILE dose of 28.0 mL/kg to control seizures, exceeding the typical recommended maximum dose of 10 mL/kg. Clinical presentation included severe headache, visual disturbances, and photophobia, concerning for hyperviscosity syndrome. Laboratory findings revealed a markedly elevated serum triglyceride concentration (&gt; 10 350 mg/dL). Therapeutic plasma exchange with plasma was successfully employed to rapidly reduce serum triglycerides and alleviate symptoms. This case highlights the potential for severe iatrogenic hypertriglyceridemia associated with high-dose ILE therapy for LAST and emphasizes the importance of close clinical monitoring and timely intervention.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857110","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}