| Therapeutic plasma exchange performed in tandem with hemodialysis for patients with M-protein disorders. | |
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MedLine Citation:
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PMID: 16206174 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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M-proteins are monoclonal immunoglobulins or immunoglobulin fragments that aberrantly accumulate in the plasma. Hemodialysis (HD) patients with M-proteins may, under certain circumstances, also need therapeutic plasma exchange (TPE). We employed a protocol for tandem TPE/HD in patients with M-protein disorders. We followed the urea reduction ratio (URR), a measure of the efficiency of HD, to compare the effect of TPE on HD efficiency during tandem procedures versus the efficiency of HD performed as a stand-alone procedure in the same patients. Three men (J.M., R.T., M.M.) underwent 23, 80, and 25 tandem TPE/HD over 3, 17, and 7 months, respectively, almost all in the outpatient setting. Mean whole blood flow rate (in ml/min) was slower during hemodialysis alone than during TPE/HD for J.M. (289 +/- 24 vs. 332 +/- 22, P < 0.0001) and R.T. (310 +/- 20 vs. 367 +/- 15, P < 0.0001) but not for M.M. (395 +/- 65 vs. 404 +/- 62, P = 0.6844). URR was equivalent during hemodialysis alone and during TPE/HD for J.M. (54 +/- 4.2 vs. 58 +/- 1.4, P = 0.3333), R.T. (69 +/- 4.9 vs. 70 +/- 2.5, P = 0.9804), and M.M. (71 +/- 2.4 vs. 67 +/- 1.5, P = 0.1143). J.M.'s renal function recovered sufficiently to permit discontinuation of hemodialysis. R.T. experienced both subjective and objective improvement of his arthritic symptoms. M.M. achieved hemostatic control but ultimately died of amyloidosis. TPE/HD is feasible using disparate pieces of equipment when the therapeutic plasma exchange circuit is connected in parallel with the low-pressure side of the hemodialysis circuit. Our experience illustrates that therapeutic plasma exchange did not adversely impact hemodialysis when the two procedures were performed in tandem. |
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Authors:
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Aftab Mahmood; Donata Sodano; Anthony Dash; Robert Weinstein |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Journal of clinical apheresis Volume: 21 ISSN: 0733-2459 ISO Abbreviation: J Clin Apher Publication Date: 2006 Jul |
Date Detail:
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Created Date: 2006-08-21 Completed Date: 2006-10-11 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8216305 Medline TA: J Clin Apher Country: United States |
Other Details:
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Languages: eng Pagination: 100-4 Citation Subset: IM |
Affiliation:
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Transfusion Medicine Section, Department of Medicine, Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02135, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Amyloidosis Arthritis Blood Flow Velocity Blood Proteins Combined Modality Therapy Hemostasis Humans Immunoglobulins / blood Male Paraproteinemias / complications, therapy* Plasma Exchange* Renal Dialysis* |
| Chemical | |
Reg. No./Substance:
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0/Blood Proteins; 0/Immunoglobulins; 0/M-proteins (Myeloma) |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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