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.
Rheumatoid arthritis (RA) cannot be cured in many patients even with improved drug therapies. Therapeutic apheresis has been explored as an alternative intervention for refractory RA, yet relevant clinical evidence is scattered and mostly derived from early studies. We systematically retrieved eligible studies from PubMed, Web of Science and the Cochrane Library up to December 12, 2024, enrolling randomized controlled trials (RCTs) and case series containing at least five patients that assessed all types of apheresis for RA treatment. A random-effects model was adopted to carry out meta-analysis; the Cochrane Risk of Bias 2 (ROB2) tool and Joanna Briggs Institute (JBI) checklist were used to evaluate methodological quality, while the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was applied to judge the certainty of evidence. Sixteen studies (10 RCTs, 6 case series) were included. Meta-analysis of 8 RCTs revealed no statistically significant benefit of apheresis as a standalone therapy. For Health Assessment Questionnaire (HAQ), the pooled standardized mean difference (SMD) was -1.02 (95% confidence interval [CI]: -2.15 to 0.11). For erythrocyte sedimentation rate (ESR), the pooled SMD was -0.90 (95% CI: -2.41 to 0.62). For C-reactive protein (CRP), the pooled SMD was -0.75 (95% CI: -1.73 to 0.24). Substantial heterogeneity was observed across all outcomes (I2 > 90%). However, subgroup analyses by modality revealed critical distinctions. Double-filtration plasmapheresis (DFPP) demonstrated the most consistent benefits when used as an adjunct to disease-modifying antirheumatic drugs (DMARDs). For ESR, the pooled mean difference (MD) was -22.32 (95% CI: -61.74 to 17.11). For CRP, the pooled MD was -3.04 (95% CI: -7.75 to 1.66). For HAQ, the pooled MD was -0.96 (95% CI: -2.14 to 0.21). In contrast, Therapeutic Plasma Exchange (TPE) and Lymphoplasmapheresis (LPE) showed limited efficacy and higher adverse event rates. The certainty of evidence was very low to low for most outcomes. While therapeutic apheresis as a broad intervention class lacks consistent efficacy in RA, this overall finding masks critical distinctions between technologies. DFPP shows promise as an adjunct to pharmacotherapy in carefully selected patients with highly refractory disease, offering a favorable benefit-risk profile. The clinical utility of apheresis in RA is inextricably linked to technical selectivity, highlighting the need for rigorous sham-controlled trials with standardized protocols.
Apheresis medicine is a continually evolving field with numerous studies published each year. To help apheresis practitioners stay up to date with the current literature, members of the American Society for Apheresis (ASFA) Attending Physician Subcommittee identified and summarized 10 seminal articles published in 2025, from the field of apheresis medicine. PubMed was used to identify articles published in four topics including donor apheresis, therapeutic apheresis, apheresis education, and apheresis collection for cellular therapy. These articles met at least one of the following criteria: novel findings, practice-altering outcomes, international in scope, randomized-controlled trial, relevant to current clinical practice, and/or provide evidence for category III or IV indications based on the ASFA 9th Special Issue of the Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach. Full length, peer-reviewed manuscripts in English with data from human subjects were included while case reports, review articles, and meta-analyses were excluded.
Apheresis is a medical procedure used to remove harmful blood components across different disciplines. This bibliometric analysis evaluated the scientific characteristics of the 100 most-cited articles (T100) with the term "apheresis" in the title published between 1975 and 2025. Data were retrieved from the Web of Science on August 11, 2025, using the keyword "apheresis" in the title field. Among 5765 publications, the T100 articles were identified. Recorded parameters included title, corresponding author, journal, year, total citations, number of authors, adjusted citation index (ACI), and Altmetric score (AmS). Analyses were performed with SPSS 29.0 and VOSviewer. Publication output increased over time, peaking in 2017 (n = 227). The highest number of annual citations occurred in 2024 (n = 2944). Spearman's correlation demonstrated a significant positive relationship between ACI and AmS (r s  = 0.665, p < 0.001). The Journal of Clinical Apheresis contributed the largest share of T100 articles. The United States was the most productive country (30%), while no Turkish publications were included. Schwartz J. was the most cited author, with 2653 citations across five studies. Frequently used keywords were "apheresis" (16%), "plasma exchange" (9%), and "immunoadsorption" (8%). Apheresis research exhibits a dynamic, multidisciplinary structure, with citations peaking years after publication. High-income countries and central institutions dominate scientific output, while contributions from Turkey are absent in the T100. This study highlights key research trends and provides a reference point for future investigations in apheresis.
To review the current role of soluble fms-like tyrosine kinase-1 (sFLT1) and placental growth factor (PlGF) in the pathophysiology, diagnosis, prediction, and treatment of preeclampsia. Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide and has increased in prevalence in the United States. It is characterized by new-onset hypertension, proteinuria, and/or end-organ dysfunction, with early-onset disease often associated with placental ischemia, placental insufficiency, and fetal growth restriction. A central mechanism in preeclampsia is angiogenic imbalance, characterized by increased antiangiogenic factors, particularly sFLT1, and reduced proangiogenic signaling mediated by VEGF and PlGF. This review summarizes current evidence regarding sFLT1 biology, the clinical utility of the sFLT1/PlGF ratio, and emerging therapeutic strategies targeting sFLT1 in preeclampsia. sFLT1 is a soluble splice variant of VEGF receptor-1 that binds circulating VEGF and PlGF, thereby promoting endothelial dysfunction, vasoconstriction, and systemic manifestations of preeclampsia. The sFLT1/PlGF ratio has emerged as a clinically useful biomarker, particularly for short-term risk stratification in women with suspected preeclampsia, with strong negative predictive value for ruling out progression to severe disease within 1 to 2 weeks in appropriately selected patients. The ratio has been incorporated into clinical practice in multiple countries and was approved by the US Food and Drug Administration in 2023 for inpatient risk assessment in singleton pregnancies between 23 and 34 weeks and 6 days of gestation with hypertensive disorders of pregnancy. In parallel, therapeutic approaches targeting sFLT1, including small interfering RNA, antibodies, VEGF or PlGF-based molecular strategies, and apheresis, have shown promise in preclinical and early translational studies. sFLT1 is central to the pathophysiology of preeclampsia and has substantial clinical relevance as both a biomarker and a potential therapeutic target. The sFLT1/PlGF ratio is reshaping risk assessment and management of preeclampsia, while sFLT1-directed therapies may offer future disease-modifying treatment options. Further refinement of biomarker-guided use and therapeutic development is needed before broader implementation.
Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy, and 5%-20% of newly diagnosed patients present with hyperleukocytosis (HL). HL, most often defined as WBC > 100 000/μL, is a hematologic emergency associated with severe complications, early mortality, and poor prognosis, requiring immediate intervention. From November 2005 to September 2025, 65 newly diagnosed AML patients with HL underwent leukocytapheresis (LCP) at University Hospital Olomouc. Clinical data were retrospectively collected from medical records. The primary objective was to evaluate the procedural efficacy and safety. Clinical and laboratory data were analyzed. Survival outcomes were assessed by Kaplan-Meier analysis and compared using the log-rank test. Median age at diagnosis was 57 years. Dyspnea (60.0%), neuropsychiatric symptoms (31.7%), and visual impairment (6.2%) were the most common leukostasis manifestations. LCP effectively reduced WBC counts without significant adverse events, median of 2.2 TBV was treated, and 52.3% of the patients requiring more than one session. FLT3-ITD and NPM1 mutations were detected in 26/46 (56.5%) and 17/43 (39.5%), respectively, KMT2A rearrangements were present in 5/57 (8.8%). Intensive chemotherapy was feasible in 56.9% of patients, with 26.2% undergoing allo-HSCT. Median OS was 5.9 months (95% CI: 1.3-8.4), significantly longer in therapy-eligible patients, but outcomes remained poor, highlighting HL as an unmet clinical need. LCP remains a valuable therapeutic option for patients with HL in newly diagnosed AML. Our long-term experience supports its safety and efficacy, particularly in symptomatic patients, as a bridge to definitive therapy regardless of treatment intensity eligibility.
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. < 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; p < 0.001), TP (WMD = -8.73 g/L; 95% CI: -11.06 to -6.41; p < 0.001), and α2M (WMD = -65.79 mg/dL; 95% CI: -88.98 to -42.60; p < 0.001). Reductions were observed across durations (< 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.
Dual specialty ports were evaluated for safety and efficacy in therapeutic apheresis by analyzing outcomes across 97 port placement events in 88 patients, focusing on two configurations: dual Bard PowerFlow (BP2) and a combination of Bard PowerFlow with AngioDynamics SmartPort (BP + AD). This retrospective cohort study was conducted at a tertiary care center from December 2017 to July 2024 and included 97 port placement events (194 total ports) across 88 patients with conditions such as bronchiolitis obliterans, sickle cell disease, myasthenia gravis, and graft-versus-host disease who required therapeutic apheresis. Measured outcomes included port revisions, removals, total port days, and complications. The BP2 configuration was used in 43 events (44.3%), and the BP + AD configuration in 54 events (55.7%). Common indications included bronchiolitis obliterans (40.2%), sickle cell disease (17.5%), myasthenia gravis (12.4%), and GVHD (12.4%). Revisions were necessary in 5.7% of ports due to mechanical issues or thrombosis, while 36.1% of ports were removed, mainly due to infection/bacteremia or completion of therapy. Port functionality ranged from 22 to 2080 days, with a mean of 564 days. The mortality rate during follow-up was 21.6%. Dual specialty ports demonstrate viable long-term access for therapeutic apheresis in selected patients, with functionality extending from months to years. Success appears highly dependent on patient selection, with infection risks particularly notable in immunocompromised populations. These findings support the use of specialty ports as an alternative to traditional tunneled catheters, particularly for those with preserved immune function requiring chronic therapy.
Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) are associated with high mortality, and therapeutic plasma exchange (TPE) is increasingly used as a bridging therapy. This retrospective observational study evaluated outcomes and predictors of response in 22 liver failure patients undergoing TPE. Demographic details, hepatic encephalopathy (HE) grade, timing of TPE initiation, laboratory parameters, and clinical outcomes were analyzed. Clinical improvement was defined as ≥ 1-grade HE improvement with hemodynamic stabilization and biochemical recovery. The mean age was 22.9 years, with alcohol-related liver failure and Wilson's disease being the most common indications. Patients with lower HE grades showed significantly better clinical improvement (p = 0.031). Earlier initiation of TPE (< 10 days) demonstrated a trend toward improved outcomes, although not statistically significant. Significant reductions in bilirubin, INR, ALT, and AST were observed following TPE. However, biochemical improvement did not always correlate with clinical recovery. Early TPE may improve clinical and biochemical recovery and potentially prevent progression to advanced encephalopathy; however, larger prospective studies and randomized controlled trials are needed to establish the optimal timing of TPE and evaluate its prophylactic role in preventing worsening HE.
Collection of hematopoietic progenitor cells and mononuclear cells by leukocytapheresis is a critical step of procuring cellular starting materials for future therapeutic use. Leukocytapheresis requires use of anticoagulant to prevent blood clotting in the extracorporeal circuit during collection. A commonly used anticoagulant is Acid Citrate Dextrose Solution A (ACD-A). ACD-A primarily prevents blood clotting by reversibly chelating free ionized calcium, which is essential for the clotting cascade. Electrolytes frequently affected by ACD-A include calcium, magnesium, potassium, phosphate, and bicarbonate. Risks for development of electrolyte derangements include procedure-related parameters as well as patient comorbidities. Symptoms range from mild paresthesias to life-threatening cardiac arrhythmias. Recognition of related signs and symptoms is important for prompt intervention with procedure modification and electrolyte replacement to optimize patient safety. This paper will provide an enhanced understanding of the underlying pathophysiology and assist in timely identification and management of electrolyte abnormalities associated with cellular therapy collections.
Successful hematopoietic stem cell transplantation relies on the collection of a sufficient number of CD34+ hematopoietic progenitor cells (HPCs). While acid citrate dextrose solution A (ACD-A) is a common anticoagulant (AC) for HPC apheresis [HPC(A)], recent evidence suggests that concomitant heparin may enhance intra-apheresis recruitment (IAR) of CD34+ cells and improve collection efficiency. This study aimed to compare citrate-only and citrate-heparin protocols in routine HPC(A) procedures, with a focus on their effects on IAR and efficiency outcomes. A retrospective analysis was performed on 266 HPC(As) from 193 apheresis donors in autologous and allogeneic settings. Donor demographics, procedural parameters, and collection outcomes were compared between the ACD-A-only and ACD-A plus heparin protocols. The study endpoints included apheresis yield (AY/kg), collection efficiencies (CE1, CE2, and cruCE), recruitment ratio (RR), and performance ratio (PR). Statistical analyses included Mann-Whitney U tests, effect sizes, and partial least squares (PLS) regression. Heparinized procedures demonstrated higher processed total blood volume ratios, lower AC volumes, and superior outcomes across CE1 (83.8% vs. 72.5%, p = 0.00027), CE2 (70.8% vs. 64.2%, p = 0.0055), cruCE (77.0% vs. 72.4%, p < 0.0001), RR (2.3 vs. 1.7, p < 0.0001), PR (239.3% vs. 208.2%, p < 0.0001), and AY/kg (6.75 vs. 5.23 × 106 CD34+ cells/kg, p = 0.0025). The effect size and PLS analyses confirmed the contribution of heparin as an adjunct AC enhancing multiple apheresis outcomes. In summary, citrate-heparin anticoagulation was found to be a feasible strategy that improved key collection efficiency and IAR metrics during HPC(A).
To retrospectively review the indications, timing, outcomes, and complications of membrane-based therapeutic plasma exchange (mTPE) in critically ill children at a single-center pediatric intensive care unit (PICU). Retrospective observational study. A tertiary-care PICU at All-India Institute of Medical Sciences (AIIMS), Raipur. A total of 106 patients aged 1 month to 18 years who underwent mTPE between January 2022 and December 2024. Patients had a median age of 144 months (IQR: 13-216). Renal and hepatic diseases were the most common indications. Overall, 61.3% of patients recovered and were discharged. Complications (inclusive of minor and line-related events) were observed in 35.8% of patients. Logistic regression analysis identified fluid-refractory shock at admission (p < 0.001), elevated Pediatric Risk of Mortality (PRISM-3) scores (p = 0.007), and concurrent continuous renal replacement therapy (CRRT) (p = 0.016) as statistically significant predictors of mortality. In the subgroup of patients with liver disease, time to mTPE initiation was an independent, significant predictor of mortality (p = 0.013). Membrane-based therapeutic plasma exchange is a safe and feasible adjunct therapy in critically ill children. While mTPE is most effective for conditions classified as American Society for Apheresis (ASFA) category I, its outcomes are highly variable and are significantly influenced by the underlying condition and the timing of the intervention, particularly for acute liver failure.
The objective of this in vitro experimental was to determine the utility of hemoadsorption (HA) using the CytoSorb adsorber to remove meloxicam and diclofenac from porcine plasma. For this purpose 12 1-L aliquots of porcine plasma, 6 units were spiked with 293 μg/mL (262-320 μg/mL) diclofenac and 6 with 42.8 μg/mL (41.4-44.7 μg/mL) meloxicam, respectively. Each unit was processed in a circular setup with the CytoSorb adsorber using the PuriFi HA platform until a recirculated volume of 20 L was reached. Pre- and post-adsorber samples were obtained at seven time points. Percentage reduction, clearance, and change from baseline were calculated. Drug concentrations were compared using Friedmann test with post hoc Dunn's multiple comparison test and Wilcoxon matched pairs rank sum test. p < 0.05 were considered significant. Diclofenac was reduced by a median of 242 mg (204-262 mg; 82.1%; 77.0%-83.6%). Total clearance was 40.5 mL/min (33.2-46.2 mL/min). Clearance at a plasma flow of 100 mL/min decreased from 39.9 mL/min (25.3-46.6 mL/min) at 0.2 L to 6.4 mL/min (-3.8 to 14.8 mL/min) at 20 L. Median reduction of meloxicam was 40.4 mg (38.6-42.2 mg; 94.4%; 93.2%-94.6%); total clearance was 94.38 mL/min (93.2-94.6 mL/min). Clearance at a plasma flow of 100 mL/min decreased from 65.3 mL/min (56.7-71.7 mL/min) at 0.2 L to 3.6 mL/min (-13.0 to 4.2 mL/min) at 20 L. HA using the CytoSorb adsorber successfully removed meloxicam and diclofenac from porcine plasma.
Recurrence of focal segmental glomerulosclerosis (FSGS) following kidney transplantation remains a significant cause of allograft loss. Much remains unknown about the efficacy of apheresis treatments and the factors that determine favorable treatment outcomes. This retrospective cohort study involved adult patients with pre-transplant diagnosis of FSGS, who developed recurrent FSGS in the post-transplant period over 6 years, from January 1, 2017, to December 31, 2022. Twenty patients with biopsy-confirmed FSGS who received therapeutic plasma exchange (TPE) as part of their treatment regimen were included. Demographic data, transplant characteristics, procedure details, urine protein levels, and other relevant variables were retrieved. Data was compiled in a Microsoft Excel spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS, IBM NY, 2023, version 29). A p-value of less than 0.05 was considered statistically significant. Data from 20 patients encompassing 169 TPE sessions were analyzed. Of these, 15 patients (75%) achieved remission of proteinuria, while 5 (25%) did not. The median time to remission was 6 months, and the median number of TPE was 7 (interquartile range [IQR] = 2-13). There was no significant difference in time to remission between patients with complete and partial remission. Receiving more than five TPE sessions (adjusted odds ratio [AOR] = 1.6 (1.01-2.46); p = 0.02) and having lower baseline proteinuria at treatment initiation (AOR = 1.9 (1.03-8.94); p = 0.01) were independent predictors of remission. The complication rate was 10.7%, with hypocalcemia being the most common, occurring in 5.9% of cases. One mortality was recorded during apheresis, yielding a procedure mortality rate of 0.6%. Initiating treatment at lower levels of proteinuria (i.e., earlier in the course of disease recurrence) appear to enhance the likelihood of remission. Our result suggests that a trial of therapy extending beyond the initial induction phase may be necessary to capture late-responding patients. The procedure was generally well tolerated, with few reversible adverse events. However, vigilant monitoring remains essential for optimal management.
Objective study was the quantification of controlled/inadequately controlled generalized myasthenia gravis (gMG) disease burden, health care resource utilization and costs in MG patients, followed-up at a reference center for MG in Italy. The study is a 2010 to 2020 retrospective analysis of gMG patients. Clinical and health economics variables were those observed during routine clinical care. Data were anonymized and treated in aggregated forms in compliance with GDPR. Only patients with gMG were included in the study. Out of 237 patients, 55.3% were males and 44.7% females with a median follow up duration of 4.7 years. Males were older, with a median age at onset of 58.3 years versus 45.7 years for females; an increased representation of late and very late onset patients was recorded. A shorter time from onset to diagnosis was observed in males. The incidence rate per year of exacerbations changed from 0.76 in the first year to 0.23 at the sixth year, with a similar trend for MG crisis; both exacerbations and crisis incidence were higher in inadequately controlled patients. Disease burden and health care resources utilizations were particularly evident in inadequately controlled patients, which showed a 138% increase of costs. Our data confirmed the observed epidemiological changes occurring in MG population and the high use of health care system resources in uncontrolled patients. The estimates obtained will provide a useful basis for assessing the impact of recently introduced targeted therapies on healthcare expenditure for MG.
Therapeutic apheresis (TA) is effective in autoimmune neurological disorders and is increasingly used due to intravenous immunoglobulin (IVIg) shortages. Although three modalities exist-membrane-based therapeutic plasma exchange (mTPE), centrifugal therapeutic plasma exchange (cTPE), and double-filtration plasmapheresis (DFPP)-comparative real-world data, especially within the same patients, remain scarce. We conducted a retrospective, intraindividual comparison of mTPE, cTPE, and DFPP in 72 sessions from five clinically stable chronic inflammatory demyelinating polyneuropathy patients. Outcomes included session duration, plasma removal efficiency (PRE), technical aspects, tolerance, clotting, and per-session costs. All sessions used peripheral venous access. cTPE achieved the highest PRE but required longer sessions. DFPP and mTPE enabled faster exchanges, but required more nursing input. Clotting occurred only with filtration modalities, mostly linked to intravenous calcium under citrate. All approaches were well tolerated, with no bleeding or relapses. DFPP was feasible with saline-only replacement, without causing hypotension. Session costs were lowest with cTPE, although the cost per liter was similar to that of DFPP. This is the first real-world study comparing all three modalities within the same patients. Each has distinct advantages and limitations. DFPP emerges as an efficient, cost-saving alternative, especially in settings with limited resources. These results support a tailored approach to TA, particularly as plasma exchange gains importance amid IVIg shortages.
There is a need to better understand the indications and safety profiles for therapeutic plasma exchange (TPE) in children. We aimed to assess pediatric TPE practice at a large academic center by retrospective chart review from 2011 to 2022. Patient demographics and clinical information including American Society for Apheresis (ASFA) category were analyzed. The cohort consisted of 438 patients, 52.1% female with a median age of 11.4 years, who underwent 3385 TPE procedures. The adverse reaction rate was 6.8%, with hypotension being most common. Tandem circuits were used in 3.9% of procedures, and the adverse reaction rate was significantly higher, 16.1% (p = < 0.05). Cryoprecipitate transfusion occurred in 29.0% of procedures for hypofibrinogenemia (median treatment number 3) and 19.1% of procedures required an RBC prime. Our findings highlight contemporary practical considerations for running a pediatric apheresis service, provide insight into managing tandem procedures, and may provide guidance for future research endeavors and clinical practice.
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.
Autologous peripheral blood stem cell (PBSC) collections are routinely performed in the outpatient setting and typically involve placement of an apheresis-compatible central venous catheter (CVC). There is reluctance to discharge outpatients with non-tunneled CVCs due to safety concerns. We characterized our center's practice of multiday non-tunneled CVC use in vetted adult outpatients undergoing autologous PBSC collections. No patient with social, cognitive, hygienic, caregiver, or bleeding concerns had non-tunneled CVC placement. All patients and caregivers were counseled about potential risks of non-tunneled CVCs and were provided with basic CVC care education. In total, 117 autologous PBSC collections were performed in 65 adult outpatients via non-tunneled CVCs. Apheresis nursing staff removed CVCs from all patients on their final PBSC collection day. There was one minor CVC site bleed that was successfully controlled with manual compression. In our small population, multiday non-tunneled CVC use in vetted adult outpatients undergoing autologous PBSC collections was feasible and well tolerated.
While lipoprotein apheresis (LA) is established for lipid management in primary biliary cholangitis, the role of apheresis techniques in drug-induced cholestatic liver disease remains unexplored. We report the novel application of double filtration plasmapheresis (DFPP) for rapid reversal of severe hypercholesterolemia in iatrogenic cholestasis, where conventional therapies failed or were contraindicated. A 56-year-old male developed severe cholestatic hepatitis following the use of herbal agents. Laboratory investigation revealed extreme hypercholesterolemia, with a total cholesterol (TC) of 41.39 mmol/L and a low-density lipoprotein cholesterol (LDL-c) of 38 mmol/L. Standard medical therapy proved ineffective. Two sessions of DFPP resulted in > 90% reduction in cholesterol levels and simultaneous improvement in bilirubin and liver enzymes, with sustained normal levels at 1-year follow-up. DFPP may serve as a novel rescue therapy for drug-induced cholestatic hypercholesterolemia, providing simultaneous removal of cholesterol and bilirubin where other treatments are ineffective or at high risk.