Journal of Clinical Apheresis最新文献

{"title":"Apheresis Medicine as a Multidisciplinary Subspecialty: International Models for Training, Quality, and Professional Societies.","authors":"Rasheed A Balogun, Hind Al-Humaidan, Ahmed Al-Bahrani, Chimezie G Okwuonu","doi":"10.1002/jca.70172","DOIUrl":"https://doi.org/10.1002/jca.70172","url":null,"abstract":"<p><p>Apheresis medicine comprises a group of extracorporeal therapies essential for the management of hematologic, renal, neurologic, immunologic, transplant-related, oncologic, and critical care conditions. Advances in technology, expansion of evidence-based indications, and integration into multidisciplinary care pathways have transformed apheresis from a technical service into a clinically complex subspecialty. We conducted a narrative review of published literature and international society documentation describing models for apheresis training, professional societies, quality assurance, and regulatory interaction across high-income and resource-limited settings. Sources included peer-reviewed literature, international society guidelines, and policy documents published primarily between 2010 and 2026. Professional apheresis societies have emerged internationally to support education, quality assurance, guideline development, and workforce competency, frequently in collaboration with regulatory authorities. These societies function as scientific and educational bodies complementary to, rather than substitutive of, regulatory frameworks. Six core domains of society activity were identified: education and continuing professional development (CPD), quality and patient safety, guidelines and standards, workforce development, research and registries, and professional collaboration. Apheresis medicine has matured into a multidisciplinary clinical subspecialty requiring a dedicated professional infrastructure. International experience demonstrates that professional apheresis societies provide an evidence-based mechanism to advance education, quality assurance, and patient safety while complementing regulatory oversight. These models are generalizable across healthcare systems at varying stages of development.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 4","pages":"e70172"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13494054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793788","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":"Extracorporeal Photopheresis in Tandem With Continuous Renal Replacement Therapy: A Case Report.","authors":"M S Reddy, J Bardahl, A Nord, T Hardy","doi":"10.1002/jca.70170","DOIUrl":"https://doi.org/10.1002/jca.70170","url":null,"abstract":"<p><p>The use of therapeutic plasma exchange in tandem with continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) has been well described; however, evidence showing the use of extracorporeal photopheresis (ECP) in tandem is lacking. Here we report a consult to perform ECP in tandem with CRRT for a 26-year-old female with a history of severe aplastic anemia who underwent allogeneic hematopoietic stem cell transplant, complicated by steroid-refractory acute graft-versus-host disease, vaso-occlusive disease, thrombotic microangiopathy, adenoviremia, and acute renal and respiratory failure. We performed six tandem ECP procedures (seven total) over 19 days, until the patient's decline resulted in compassionate discontinuation of care. During our procedures, CRRT managed the ionized calcium and adjusted the calcium infusion rate accordingly. We encountered red blood cell and optic bowl sensor alarms during ECP. This case, to our knowledge, is the first to describe the inpatient use of ECP in tandem with CRRT.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 4","pages":"e70170"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793799","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":"Treatment of Acute Hemolytic Transfusion Reaction due to ABO-Incompatible Red Blood Cell Transfusion: A Case Report, Review of the Literature and Recommendation.","authors":"C Canté, P E Spronk, J Hulstein, K Le Poole, L Visser, F Swaneveld, H Vrielink","doi":"10.1002/jca.70173","DOIUrl":"10.1002/jca.70173","url":null,"abstract":"<p><p>Although acute hemolytic transfusion reaction (AHTR) due to ABO-incompatible red blood cell transfusion is a rare complication in high-income countries, it is considered a medical emergency because of the severe intravascular hemolysis that can lead to major morbidity or death. AHTR can cause intravascular hemolysis, acute renal failure, disseminated intravascular coagulation (DIC), and shock, and therefore treatment should be prompted early and directed to prevent these complications. We present a case of AHTR due to ABO-incompatible red blood cell transfusion successfully treated with high-dose glucocorticoids, red blood cell, and therapeutic plasma exchange within 24 h. To our knowledge, there is no standard protocol for treatment of ABO-incompatible red blood cell transfusions. We performed a review of the literature and made a recommendation for the treatment of AHTR due to ABO-incompatible transfusion. Based on the existing literature and the presented case we advise, beside supportive measures and hemodialysis in case of renal failure, to consider more invasive therapies, such as therapeutic plasma exchange, red blood cell exchange or complement inhibiting drugs to prevent acute and long-term complications. Daily measures of relevant laboratory parameters should be performed, and if hemolysis is apparent, repeated procedures should be considered.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 4","pages":"e70173"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828601","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":"A Personalized, Rate-of-Rise (ROR)-Driven Model to Optimize Red Cell Exchange Interval in Chronic Sickle Cell Management.","authors":"Menatalla Nadim, Austin Choi, Nicholas Parisi, Yamac Akgun","doi":"10.1002/jca.70169","DOIUrl":"10.1002/jca.70169","url":null,"abstract":"<p><p>Chronic automated red blood cell exchange (RCE) is a cornerstone therapy for preventing sickle cell disease (SCD)-related complications, particularly stroke and recurrent vaso-occlusive crises. Current scheduling commonly relies on uniform empirical intervals of 3-6 weeks and does not account for substantial inter-patient variability in hemoglobin S (HbS) rebound kinetics, potentially resulting in undertreatment of rapid rebounders and unnecessary procedures in slower rebounders. We hypothesized that each patient's personalized rate of rise (ROR) of HbS could be used to generate an individualized, risk-adjusted RCE interval. We retrospectively analyzed adult patients with SCD receiving chronic outpatient RCE. The primary cohort comprised 18 patients with HbSS, while a single patient with HbSC was analyzed separately. HbS values from consecutive outpatient procedures were used to calculate an individual ROR (%HbS/day). A personalized scheduling formula was derived: t(interval) = S(risk) × (HbS(threshold) - HbS(post))/ROR(personal), where S(risk) represents an adjustable safety factor for patients at higher clinical risk. Individualized intervals differed markedly from uniform scheduling. Slow rebounders (< 0.5%/day) could potentially extend beyond 5 weeks, whereas rapid rebounders (> 1.0%/day) reached prespecified HbS thresholds within approximately 2-3 weeks. For most patients, the model recommended shorter intervals than those used, suggesting that under current scheduling many patients may exceed their HbS threshold between procedures. Because most patients would require shorter rather than longer intervals to maintain HbS below 30%, strict implementation of the model could increase program-level blood utilization; therefore, its principal value lies in precision and resource reallocation rather than guaranteed net savings. A personalized ROR-based scheduling framework integrates objective HbS kinetics with clinical risk stratification and may be most applicable to patients with stable, reproducible rebound kinetics. Prospective validation and integration into electronic health record systems are warranted to determine whether model-guided scheduling improves clinical outcomes.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 4","pages":"e70169"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13478349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761319","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":"Plasmapheresis in Hypertriglyceridemia-Associated Acute Pancreatitis: Triglyceride Levels of 5000 mg/dL as a Proposed Threshold","authors":"Ryuichiro Hirano","doi":"10.1002/jca.70165","DOIUrl":"https://doi.org/10.1002/jca.70165","url":null,"abstract":"<div>\u0000 \u0000 <p>Severe hypertriglyceridemia-associated acute pancreatitis is a disease with a high mortality rate, and high triglyceride (TG) levels increase the severity of the disease. Standard treatments include fasting, insulin, and heparin therapy. In severe cases, plasmapheresis such as therapeutic plasma exchange or double filtration plasmapheresis is performed to rapidly lower TG levels. However, studies comparing plasmapheresis with standard treatment have shown inconsistent results regarding its effectiveness, and the usefulness of plasmapheresis remains controversial. The author hypothesized that plasmapheresis would be effective in cases where baseline TG levels are very high and cannot be managed with standard treatment and investigated relevant clinical articles. On April 14, 2026, a literature search in PubMed was performed using the following search queries ((((“acute pancreatitis” [All Fields]) AND (((((“plasma exchange” [All Fields]) OR (“blood purification” [All Fields])) OR (“plasmapheresis” [All Fields])) OR (“double filtration” [All Fields])) OR (“double-filtration” [All Fields]))) AND (“hasabstract” [text])) AND (“English” [lang])) AND (2015/01:2026/03 [dp]). Thirteen comparative studies and one single-arm study were selected. Two out of 12 comparative studies with TG levels below 5000 mg/dL showed clinical effectiveness of plasmapheresis, while the other 10 comparative studies showed no clinical effectiveness. In two clinical studies where TG levels exceed 5000 mg/dL, both studies demonstrated the clinical effectiveness of plasmapheresis. One comparative study involving patients with TG levels exceeding 5000 mg/dL showed that the group receiving plasmapheresis had significantly fewer complications and significantly shorter hospital stays. In another single-arm study, patients were divided into three groups based on the time from diagnosis to the first plasmapheresis administration. The results showed that the group that started apheresis treatment early had a significantly lower incidence of persistent organ failures. In HTG-AP, plasmapheresis is considered effective when TG levels exceed 5000 mg/dL. However, as the evidence is limited, further research is needed to clarify this hypothesis.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616709","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":"The Impact of Lipoprotein apheresis on Plasma Protein Levels: A Meta-Analysis","authors":"Saeed Aslani,&nbsp;Masoud Eslami,&nbsp;Alireza Hatami,&nbsp;Shahab Alizadeh,&nbsp;Bahman Razi,&nbsp;Wael Almahmeed,&nbsp;Tannaz Jamialahmadi,&nbsp;Amirhossein Sahebkar","doi":"10.1002/jca.70160","DOIUrl":"10.1002/jca.70160","url":null,"abstract":"<div>\u0000 \u0000 <p>Lipoprotein apheresis (LA) is used for severe dyslipidemia but can remove non-lipid plasma constituents. In this systematic review and meta-analysis, we synthesized evidence on LA-associated changes in albumin, total protein (TP), and α2-macroglobulin (α2M). PubMed, Scopus, and Web of Science were searched from inception to August 2025 for human observational studies reporting pre-/post-apheresis values for albumin, TP, or α2M. Pooled effects were summarized as weighted mean differences (WMD) with 95% CIs. Prespecified subgroup analyses included apheresis duration (≥ 1 year vs. &lt; 1 year), disease background, and apheresis method. Twenty-eight publications met eligibility (albumin: 22 publications/39 studies; TP: 21 publications/34 studies; α2M: 6 publications/7 studies). LA was associated with lower post-procedure levels of albumin (WMD = −3.80 g/L; 95% CI: −4.61 to −2.99; <i>p</i> &lt; 0.001), TP (WMD = −8.73 g/L; 95% CI: −11.06 to −6.41; <i>p</i> &lt; 0.001), and α2M (WMD = −65.79 mg/dL; 95% CI: −88.98 to −42.60; <i>p</i> &lt; 0.001). Reductions were observed across durations (&lt; 1 year and ≥ 1 year), disease groups, and apheresis methods, with larger albumin decreases in DALI-based protocols and smaller in other methods. Between-study heterogeneity was high but diminished in several subgroups; meta-regression suggested background disease as a potential contributor. Across observational studies, LA reduced albumin, TP, and α2M immediately post-procedure. Magnitudes vary by method, clinical context, and treatment duration. These findings support routine monitoring of protein profiles during maintenance LA.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603008","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":"Trends in Clinical Indications for Plasma Exchange in Adult Patients Between 2008 and 2024 in Bogotá, Colombia","authors":"Edgar Julián Reyes,&nbsp;Federico Tovar-Avendaño,&nbsp;Camilo Alberto Gonzalez-Gonzalez,&nbsp;Diana Carolina Vargas-Angel,&nbsp;Jorge Pulido,&nbsp;Paula Violeta Rodríguez,&nbsp;Deiner-Yivelson Muñoz-Delgado,&nbsp;Kateir Contreras-Villamizar","doi":"10.1002/jca.70161","DOIUrl":"10.1002/jca.70161","url":null,"abstract":"<p>This multicenter retrospective study aimed to describe temporal trends in clinical indications for plasma exchange (PE) in adult patients at four quaternary-care hospitals in Bogotá (2008–2024) and to examine their distribution across successive ASFA guideline editions. Adults ≥ 18 years who received ≥ 1 PE session were included; indications were coded using ICD-10, and outcomes were classified as complete improvement, partial improvement, no change, or death. Descriptive statistics were performed using RStudio. Of 970 patients screened, 758 met eligibility criteria. Median age was 47 years (IQR 33–60); 62.4% were women. Neurological and rheumatological indications predominated (<i>n</i> = 634, 83.6%), particularly neuromyelitis optica spectrum disorders and ANCA-associated vasculitis. A total of 3954 sessions were performed (median: 5 per patient; IQR: 5–6). Hypocalcemia was the most frequent complication. Overall, 74.0% achieved complete or partial improvement, with higher rates in neurological conditions. Sixty-nine deaths occurred (9.1%), mostly attributed to systemic autoimmune diseases. Over the study period, neuroimmunological indications increased markedly, while use of PE for ANCA-associated vasculitis declined following its reclassification to ASFA category III in 2023. ASFA categories I and II accounted for 92.7% of indications; Category I representation declined from 66.7% (2008–2010) to 40.6% (2023–2024), while case volume grew from 21 to 266 patients per triennium. Over 16 years, PE indications shifted substantially toward immune-mediated neurological disorders, driven by expanded diagnostic availability for AQP4-IgG and MOG-IgG and evolving ASFA recommendations. These findings underscore the need for prospective studies and a national PE registry in Colombia.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603251","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":"Respiratory Failure due to Glial Fibrillary Acidic Protein Antibody-Associated Disorders: Recovery Following Plasma Exchange","authors":"Miharuka Yokosaki,&nbsp;Hiroyuki Naito,&nbsp;Hidetada Yamada,&nbsp;Takamichi Sugimoto,&nbsp;Yu Yamazaki,&nbsp;Hirofumi Maruyama","doi":"10.1002/jca.70162","DOIUrl":"10.1002/jca.70162","url":null,"abstract":"<div>\u0000 \u0000 <p>Glial fibrillary acidic protein antibody-associated disorders (GFAP-ADs) generally respond to steroid treatment but may become fulminant when brainstem lesions cause central hypoventilation. A 56-year-old man developed fever, myoclonus, gait instability, urinary retention, and altered consciousness. An analysis of cerebrospinal fluid (CSF) showed pleocytosis and high protein levels, and magnetic resonance imaging (MRI) demonstrated diffuse leptomeningeal enhancement of the brainstem, cerebral cortex, and spinal cord. Despite two courses of intravenous methylprednisolone, he developed respiratory arrest and required mechanical ventilation. Plasma exchange (PE) resulted in rapid extubation and neurological recovery. Anti-GFAPα antibodies were detected in the CSF. Early PE may represent a crucial therapeutic option for steroid-refractory GFAP-ADs with medullary involvement.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603411","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":"Lymphoplasmapheresis for Refractory Anti–N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report","authors":"Rui Tian,&nbsp;Zhenglian Luo,&nbsp;Zhen Hong","doi":"10.1002/jca.70157","DOIUrl":"10.1002/jca.70157","url":null,"abstract":"<div>\u0000 \u0000 <p>Anti–N-methyl-D-aspartate receptor (NMDAR) encephalitis is generally responsive to immunotherapy, but some patients remain refractory despite treatment escalation. Lymphoplasmapheresis (LPE), a modified apheresis technique that removes both plasma components and circulating lymphocytes, may offer a salvage option in selected cases. We report a 61-year-old woman with refractory anti-NMDAR encephalitis who showed limited improvement after corticosteroids, intravenous immunoglobulin, and ofatumumab. After a prolonged interval following ofatumumab induction, she remained severely impaired with persistent disease activity and elevated cerebrospinal fluid and serum anti-NMDAR IgG titers. Three sessions of LPE were performed over 5 days. Clinical improvement was observed after LPE, accompanied by a decline in antibody titers. At 5-month follow-up after LPE, she maintained sustained recovery, with a Clinical Assessment Scale in Autoimmune Encephalitis score of 6 and a modified Rankin Scale score of 2. This case supports a close temporal association between LPE and clinical and immunological improvement, although causality cannot be definitively established from a single case.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591819","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":"Therapeutic Plasma Exchange as a Bridge to Spontaneous Recovery in Pediatric Acute Liver Failure in a Resource-Limited Setting: A Prospective Single-Center Experience in Morocco","authors":"Djoudline Doughmi,&nbsp;Imad Daoudi,&nbsp;Said Benlamkaddem,&nbsp;Adnane Berdai,&nbsp;Mustapha Harandou","doi":"10.1002/jca.70159","DOIUrl":"10.1002/jca.70159","url":null,"abstract":"<div>\u0000 \u0000 <p>In resource-limited settings where liver transplantation is unavailable, pediatric acute liver failure (PALF) carries a markedly high mortality rate. In this context, extracorporeal liver support systems (ELSS), such as therapeutic plasma exchange (TPE), do not serve as a bridge to transplantation, but rather the sole critical bridge to spontaneous liver recovery. We conducted a prospective single-center study in a pediatric intensive care unit, including seven patients admitted with PALF who underwent TPE. Clinical data, biological markers (including transaminase, bilirubin, INR, and ammonia), and patient outcomes were analyzed to evaluate the biological efficacy of TPE and identify factors influencing survival. All seven patients presented with severe biochemical derangement and advanced hepatic encephalopathy (HE) upon admission. TPE demonstrated significant biological efficacy, consistently reducing hepatic cytolysis and ammonia levels. To further optimize continuous ammonia clearance, one patient underwent continuous venovenous hemodialysis (CVVHD) in conjunction with TPE. Despite these biochemical improvements, clinical outcomes remained poor due to significantly delayed presentations. All patients were admitted at least 2 weeks after symptom onset, largely because jaundice was underestimated and not perceived as a life-threatening symptom. TPE is a biologically effective intervention and a vital bridge to spontaneous liver recovery for PALF in settings without liver transplant capabilities. However, its clinical success is severely limited by delayed hospital admission. The pre-existing and irreversible neurological damage caused by prolonged hyperammonemia ultimately drives mortality. Improving survival rates requires a systemic shift toward early recognition of jaundice and immediate intensive care referral. presentation with advanced neurologic injury. The effects of earlier ALF recognition and referral on outcomes require further investigation.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578840","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}