The management of patients with cryoglobulins often meets with limited success. Reported here is the use of plasmapheresis and/or partial plasma exchange in the management of five patients with cryoglobulinemia. The procedure was carried out at room temperature with reinfusion through a blood warmer. Circulating levels of mixed cryoglobulins and monoclonal IgM cryoglobulins were more easily reduced than were IgG cryoproteins. Improvement in symptoms was associated with removal of the cryoprotein. Pheresis can be used as primary therapy for reduction of cryoglobulin levels in cases of symptomatic essential cryoglobulinemia. Where an etiology for cryoglobulinemia is known and specific treatment exists, pheresis can be used as effective adjunct therapy.
LDL-apheresis lowers the LDL level in patients with severe hypercholesterolemia. The present study compared three apheresis methods--DSA, DALI, and plasma exchange--for effectiveness in removal of LDL and effect on various blood parameters involved in atherogenesis. The study group included 6 patients with primary hypercholesterolemia unresponsive to maximal drug therapy. All were treated first with 4 consecutive plasma exchange sessions followed by 4 DSA sessions; in four out of six, an additional 4 sessions of DALI were then performed. Levels of lipoproteins, apoproteins, CRP, homocysteine, fibrinogen, and blood count were determined before and after each session. All 3 procedures yielded a significant reduction in total cholesterol and ApoB-containing lipoproteins, with DALI being the most effective. Also, a significant reduction in triglycerides, HDL, and ApoA1 was observed with all the methods. The reduction in HDL-C with DSA and DALI was greater than previously reported. The LDL/HDL-cholesterol ratio decreased significantly with DSA and DALI and increased with plasma exchange. There was a significant decrease in CRP, fibrinogen, and platelets with all three methods, and a significant decrease in homocysteine only with DSA and DALI. All three procedures effectively reduced the concentration of various compounds involved in atherosclerosis. Plasma exchange is nonselective and cannot be recommended as the procedure of choice.
Abstract Background It is not clear what is the relative importance of fibrinogen, immunoglobulins, highly sensitive C‐reactive protein (hs‐CRP), cholesterol and triglyceride concentrations on the appearance of aggregated red blood cells in the peripheral blood. Design Six hypercholesterolaemic patients undergoing regular LDL apheresis that were examined repeatedly before and following the procedure. Results We determined the degree of erythrocyte adhesiveness/aggregation in relation to the concentration of the above‐mentioned macromolecules in 80 samples. In a linear logistic regression the respective R 2 values for fibrinogen, total cholesterol, triglycerides, hs‐CRP, IgG, IgM and IgA were 0·45 ( P < 0·0001), 0·2 ( P < 0·0001), 0·02 ( P = 0·02), 0·001 ( P = NS) and 0·002 ( P = NS), respectively. We further analyzed the potential of ApoA, ApoB and Lpa to participate in red cell adhesiveness/aggregation and found them to be not significant. Conclusions In a milieu of adhesive macromolecules, lipids and inflammation‐sensitive proteins including fibrinogen, total cholesterol, triglycerides, hs‐CRP and immunoglobins G, M and A, fibrinogen has a dominant role in maintaining the red blood cell adhesiveness/aggregation in the peripheral venous blood. These findings are relevant for the research directed at finding new apheretic modalities to reduce the degree of red blood cell adhesiveness/aggregation in the peripheral blood.
Polysomnography is currently used for diagnosis, evaluation and selection of therapy in patients with obstructive sleep apnoea (OSA), but clinically successful uvulopalatopharyngoplasty (UPPP) is not necessarily reflected by post-operative improvement of polysomnographic recordings. Post-operative polysomnography may suggest deterioration of pre-existing OSA or, in snorers, de-novo precipitation of OSA. Thus, if polysomnography is a reliable indicator of OSA, then OSA may be a post-operative risk of UPPP.(i) to assess the possible deleterious effect of UPPP on sleep patterns; (ii) to further define the role of cardioisotope scanning in the evaluation of OSA; (iii) to assess the reliability of polysomnography given the clinical and cardiosotope scan findings. Symptoms, polysomnography and radionuclide ventriculography were prospectively compared pre- and post-operatively in 41 patients undergoing UPPP. In 12 patients (29 per cent), there were disparate results between pre- or post-operative polysomnography and the clinical and/or radionuclide ventriculography, as follows: In four of 16 patients with abnormal pre-operative ventricular performance, there was pre-operative symptomatology of severe OSA and a bedmate's reports of apnoeic episodes. This was in contrast to normal or near normal sleep apnoea recordings. In eight patients, post-operative improvement of symptoms was reported, despite deterioration of post-operative polysomnographic recordings. In these patients the post-operative improvement of symptoms was also reflected by improved ventricular performance. Worsening of ventricular performance was not demonstrated in any patient. In conclusion, UPPP does not induce OSA. Polysomnography may underestimate or even misdiagnose cases of OSA.(ABSTRACT TRUNCATED AT 250 WORDS)
Four patients with myeloproliferative diseases and acute hemorrhagic or thrombotic complications of thrombocytosis were treated with plateletpheresis by discontinuous‐flow centrifufation. Reduction of platelet counts was achieved rapidly, without complications and was associated with clinical improvement. In all four cases, abnormal platelet aggregation testing was present before pheresis, but improved immediately after pheresis. Platelet‐sizing data obtained in one case suggested that during the pheresis procedure, a population of larger volume platelets was selectively removed. The efficacy of plateletpheresis in these clinical situations may be related to the selective removal of a large abnormal platelet population.
