Electroconvulsive therapy and/or plasmapheresis in autoimmune encephalitis?

Autoimmune encephalitis is a poorly understood condition that can present with a combination of neurological and psychiatric symptoms, either of which may predominate. There are many autoantibodies associated with a variety of clinical syndromes-anti-N-Methyl-D-Aspartate receptor(NMDAR) is the commonest. Currently, the most widely used therapy is prompt plasmapheresis and steroid treatment(and tumour resection if indicated), followed by second line immunosuppression if this fails. Given the growing awareness of autoimmune encephalitis as an entity, it is increasingly important that we consider it as a potential diagnosis in order to provide timely, effective treatment. We discuss several previously published case reports and one new case. These reports examined the effects of electroconvulsive therapy(ECT) on patients with autoimmune encephalitis, particularly those in whom psychiatric symptoms are especially debilitating and refractory to standard treatment. We also discuss factors predicting good outcome and possible mechanisms by which ECT may be effective. Numerous cases, such as those presented by Wingfield, Tsutsui, Florance, Sansing, Braakman and Matsumoto, demonstrate effective use of ECT in anti-NMDAR encephalitis patients with severe psychiatric symptoms such as catatonia, psychosis, narcolepsy and stupor who had failed to respond to standard treatments alone. We also present a new case of a 71-year-old female who presented to a psychiatric unit initially with depression, which escalated to catatonia, delusions, nihilism and auditory hallucinations. After anti-NMDAR antibodies were isolated, she was treated by the neurology team with plasmapheresis and steroids, with a partial response. She received multiple sessions of ECT and her psychiatric symptoms completely resolved and she returned to her premorbid state. For this reason, we suggest that ECT should be considered, particularly in those patients who are non-responders to standard therapies.

A comparison of desensitization methods: Rituximab with/without plasmapheresis in ABO-incompatible living donor liver transplantation

Background: Plasmapheresis is a desensitization method used prior to ABO-incompatible(ABO-I) living donor liver transplantation. However, studies on its usefulness in the rituximab era are lacking.Methods: Fifty-six adult patients underwent ABO-I living donor liver transplantation between January2012 and October 2015. A single dose of rituximab(300 mg/m~2) was administered 2 weeks before surgery with plasmapheresis in all patients until February 2014(RP group, n = 26). Patients were administered rituximab only, without plasmapheresis between March 2014 and October 2015(RO group, n = 30).Results: The 6-, 12-and 18-month overall survival rates were 92.3%, 80.8% and 76.9% in the RP group and 96.6%, 85.4% and 85.4% in the RO group, respectively(P = 0.574). When the initial isoagglutinin titers < 16, neither group showed a rebound rise of isoagglutinin titers. For patients with initial isoagglutinin titers ≥ 16, the rebound rise of isoagglutinin titers was more prominent in the RP group. There was no difference in time-dependent changes in B cell subpopulations and ABO-I-related complications.Conclusions: Sufficient desensitization for ABO-I living donor liver transplantation can be achieved using rituximab alone. This desensitization strategy does not affect the isoagglutinin titers, ABO-I-related complications and patient survival.

Extracorporeal continuous portal diversion plus temporal plasmapheresis for “small-for-size” syndrome

AIM:To investigate the effect of plasmapheresis via the portal vein for"small-for-size"syndrome(SFSS)aided by extracorporeal continuous portal diversion(ECPD).METHODS:Extensive or total hepatectomy in the pig is usually adopted as a postoperative liver failure(PLF)or SFSS model.In this study,animals which underwent85%-90%hepatectomy were randomized into either the Systemic group(n=7)or the Portal group(n=7).In the Systemic group,all pigs received temporal plasmapheresis(PP)via the extracorporeal catheter circuit(systemic to systemic circulation)from 24 to 30 h posthepatectomy(PH);in the Portal group,all pigs received ECPD to divert partial portal vein flow(PVF)to the systemic circulation after hepatectomy,then converted to temporal PP from 24 to 30 h PH,and subsequently converted to ECPD again until 48 h PH.In the Portal group,the PVF was preserved at 3.0-3.3 times that of the baseline value,similar to that following 70%hepatectomy,which was regarded as the optimal PVF to the hypertrophic liver remnant.At 48 h PH,all pigs were re-opened and the portal vein pressure(PVP),PVF,and HAF(hepatic artery flow)were measured,and then diversion of the portal venous flow was terminated.After1 h the PVP,PVF,and HAF were re-measured.The portal hemodynamic changes,liver injury,liver regeneration and bacterial/lipopolysaccharide(LPS)translocation were evaluated in the two groups.RESULTS:The PVP in the Portal group was significantly lower than that in the Systemic group during the time period from 2 to 49 h PH(P<0.05).Serum alanine aminotransferase(ALT),total bilirubin(TB)and ammonia were significantly reduced in the Portal group compared with the Systemic group from 24 to 48 h PH(P<0.05).The Portal group may have attenuated sinusoidal endothelial injury and decreased the level of HA compared with the Systemic group.In the Systemic group,there was significant sinusoidal dilation,hydropic changes in hepatocytes and hemorrhage into the hepatic parenchyma,and the sinusoidal endothelial lining was partially destroyed and detached into the sinusoidal space.CD31immunostaining revealed significant destruction of the endothelial lining.In the Portal group,there was no intraparenchymal hemorrhage and the sinusoidal endothelial cells and hepatocytes were well preserved.CD31immunostaining was mild which indicated less destruction of the endothelial lining.HA was significantly decreased in the Portal group compared with the Systemic group from 2 to 48 h PH.The rate of liver remnant regeneration was elevated,while apoptosis was attenuated in the Portal group compared with the Systemic group.Thymidine kinase activity was much higher in the Portal group than in the Systemic group at 48 h PH.The PCNA index was significantly increased and the apoptotic index was significantly decreased in the Portal group compared with the Systemic group.Bacterial translocation and endotoxin,as well as the inflammatory response,were significantly attenuated in the Portal group compared with the Systemic group.LPS,tumor necrosis factor-and interleukin-6 levels were all significantly decreased in the Portal group compared with the Systemic group from 24 to48 h PH,while bacterial DNA level was significantly decreased from 2 to 48 h PH.CONCLUSION:PP plus ECPD via the portal vein can attenuate toxic load and hyperperfusion injury,and should be undertaken instead of PP via the systemic circulation in SFSS or PLF.

Early plasmapheresis and rituximab for acute humoral rejection after ABO-compatible liver transplantation

Acute humoral rejection （AHR） is uncommon after ABO- compatible liver transplantation. Herein, we report two cases of AHR treated with plasmapheresis and rituximab in two ABO-compatible liver-transplant patients with preformed anti-human leukocyte antigen donor-specific antibodies. Patient 1 experienced a biopsy-proven AHR at day 10 post-transplant. She was treated by steroid pulses, and OKT3. Because of persisting signs of biopsy-proven AHR at day 26, she was treated by plasmapheresis and rituximab. Uver enzyme levels did not improve, and she died on day 41. Patient 2 experienced a biopsy-proven AHR on day 10 post-transplant. She was treated by steroid pulses, plasmapheresis, and rituximab. Liver enzymes returned to within normal range 18 d after diagnosis. Uver biopsies, at 3 and 9 mo post-transplant, showed complete resolution of AHR. We conclude that plasmapheresis should be started as soon as AHR is diagnosed, and be associated with a B-cell depleting agent. Rituximab may be considered as a first-line therapy.

Plasmapheresis and corticosteroid treatment for persistent jaundice after successful drainage of common bile duct stones by endoscopic retrograde cholangiography

Prolonged cholestasis is a very rare complication of endoscopic retrograde cholangiography (ERC). Only few cases with this complication are reported in the English literature. We report persisting cholestatic jaundice in a 73-year old man after successful therapeutic ERC for choledocholithiasis. Serologic tests for viral and autoimmune hepatitis were all negative. A second-look ERC was normal also. He denied any medication except for prophylaxis given intravenous 1 g ceftriaxon prior to the ERC procedure. After an unsuccessful trial with ursodeoxycholic acid and cholestyramine for 2 wk, this case was efficiently treated with corticosteroids and plasmapheresis. His cholestatic enzymes became normal and intense pruritis quickly resolved after this treatment which lasted during his follow- up period. We discussed the possible mechanisms and treatment alternatives of intrahepatic cholestasis associated with the ERC procedure.

Rituximab or plasmapheresis for prevention of recurrent focal segmental glomerulosclerosis after kidney transplantation:A systematic review and meta-analysis

BACKGROUND Focal segmental glomerulosclerosis(FSGS)is one of the most common glomerular diseases leading to renal failure.FSGS has a high risk of recurrence after kidney transplantation.Prevention of recurrent FSGS using rituximab and/or plasmapheresis has been evaluated in multiple small studies with conflicting results.AIM To assess the risk of recurrence of FSGS after transplantation using prophylactic rituximab with or without plasmapheresis,and plasmapheresis alone compared to the standard treatment group without preventive therapy.METHODS This meta-analysis and systematic review were performed by first conducting a literature search of the MEDLINE,EMBASE,and Cochrane databases,from inception through March 2021;search terms included‘FSGS,’’steroid-resistant nephrotic syndrome’,‘rituximab,’and‘plasmapheresis,’.We identified studies that assessed the risk of post-transplant FSGS after use of rituximab with or without plasmapheresis,or plasmapheresis alone.Inclusion criteria were:Original,published,randomized controlled trials or cohort studies(either prospective or retrospective),case-control,or cross-sectional studies;inclusion of odds ratio,relative risk,and standardized incidence ratio with 95%confidence intervals(CI),or sufficient raw data to calculate these ratios;and subjects without interventions(controls)being used as comparators in cohort and cross-sectional studies.Effect estimates from individual studies were extracted and combined using a random effects model.RESULTS Eleven studies,with a total of 399 kidney transplant recipients with FSGS,evaluated the use of rituximab with or without plasmapheresis;thirteen studies,with a total of 571 kidney transplant recipients with FSGS,evaluated plasmapheresis alone.Post-transplant FSGS recurred relatively early.There was no significant difference in recurrence between the group that received rituximab(with or without plasmapheresis)and the standard treatment group,with a pooled risk ratio of 0.82(95%CI:0.47-1.45,I2=65%).Similarly,plasmapheresis alone was not associated with any significant difference in FSGS recurrence when compared with no plasmapheresis;the pooled risk ratio was 0.85(95%CI:0.60-1.21,I2=23%).Subgroup analyses in the pediatric and adult groups did not yield a significant difference in recurrence risk.We also reviewed and analyzed posttransplant outcomes including timing of recurrence and graft survival.CONCLUSION Overall,the use of rituximab with or without plasmapheresis,or plasmapheresis alone,is not associated with a lower risk of FSGS recurrence after kidney transplantation.Future studies are required to assess the effectiveness of rituximab with or without plasmapheresis among specific patient subgroups with high-risk for FSGS recurrence.

Double filtration plasmapheresis for pregnancy with hyperlipidemia in glycogen storage disease type Ia:A case report

BACKGROUND Glycogen storage disease type Ia(GSDIa) is an autosomal recessive inborn error of carbohydrate metabolism that is caused by deficiency of the enzyme glucose-6-phosphatase(G6Pase),leading to disturbed glycogenolysis and gluconeogenesis.Patients with GSDIa show severe fasting hypoglycemia,hyperlipidemia,hyperlactacidemia,and hyperuricemia,which are associated with fatal outcomes in pregnant women and fetuses.CASE SUMMARY Herein,we report the case of a 24-year-old female who on her first visit to the hospital,presented with pregnancy combined with extremely high hyperlipidemia and hyperlactic acidosis with anemia,and frequent hypoglycemia occurred during the treatment.Genetic tests revealed a mutation in the G6Pase gene(G6PC) at 17q21,the patient was finally diagnosed with glycogen storage disease type Ia for the first time after 22 years of inaccurate treatment.She has been treated with a continuous double filtration plasmapheresis(DFPP) strategy to remove blood lipids,and a cornstarch diet therapy.The patient did not develop pancreatitis during the course of the disease and a healthy baby girl weighing 3 kg was delivered.CONCLUSION Patients with GSDIa may be misdiagnosed as epilepsy.DFPP can be used to control hyperlipidemia in GSDIa patients during pregnancy.

A case of Bickerstaff brainstem encephalitis successfully treated with intravenous immunoglobulin and methylprednisolone after unsuccessful immunoadsorption plasmapheresis

Bickerstaff brainstem encephalitis (BBE) is a rare post-infectious neurological syndrome for which an effective treatment strategy has not been established. Here, we report a case of a 71-year-old male who suffered from an upper respiratory tract infection, and 7 days later, developed numbness of the bilateral upper and lower limbs, unsteady gait and dysarthria. Brain magnetic resonance imaging was normal, nerve conduction study and cerebral spinal fluid analysis were nonspecific. Based on the clinical features, we tentatively diagnosed Guillain-Barré syndrome and started immunoadsorption plasmapheresis. However, consciousness progressively declined to coma level within 10 days. Electroencephalogram showed diffuse slowing, and auditory evoked brainstem response (ABR) demonstrated absence of waves II, III and V. Serum anti-GQ1b IgG autoantibody and anti-GM1b IgG autoantibody were negative. Subsequently, we diagnosed BBE, and clinical symptoms resolved after treatment with intravenous immunoglobulin and methyllprednisolone. On day 62, neurological symptoms were remarkably alleviated with an improvement in ABR. Our observations suggest that immunoadsorption plasmapheresis should be used only when anti-ganglioside antibodies are detected. Combination therapy with intravenous immunoglobulin and methylprednisolone or plasma exchange?is recommended as initial therapy.

Role of plasmapheresis in early allograft dysfunction following deceased donor liver transplantation

The role of plasmapheresis in liver failure and hepatic encephalopathy is undefined and its use as a strategy to salvage patients with severe allograft dysfunction after liver transplantation remains investigational. We present a case of early allograft dysfunction following deceased donor liver transplantation(DDLT) where plasmapheresis was effective as a bridge to recovery and possibly avoiding a retransplantation. A 16 years old boy, known to have decompensated Wilson's disease underwent DDLT at our Public Sector Hospital. He received a healthy liver from a brain-dead donor, whose liver was considered too large for the boy. The graft was reduced in situ to a left lobe graft. Surgery was uneventful and the recipient was well for the initial 96 h. On Doppler and further computed tomography scan, a partial portal vein thrombus was noted. He was reexplored and a Fogarty endothombecteomy was performed. Following the second surgery, he developed severe allograft dysfunction with a peak bilirubin of 40 mg/d L. He underwent imaging to rule out technical causes for the dysfunction, followed by a liver biopsy, which revealed acute cellular rejection. Multiple cycles of plasmapheresis were initiated. Over the next two weeks, the graft demonstrated a gradual recovery. He was discharged on the 30 th postoperative day, with a serum bilirubin of 5.5 mg/d L. He remains well on follow-up, with the liver function tests improving further. Our report demonstrates the beneficial effect of plasmapheresis, which appears to be an effective treatment option for early allograft dysfunction following liver transplantation and may obviate the need for retransplantation.

Reduction of High-Titer Cold Agglutinins by Plasmapheresis to Resolve Serological Problem in a Patient

Background: Cold agglutinins are auto-antibodies that can be a nuisance in cross matching and in blood grouping. Here we report an unusual case of a high titer and wide amplitude cold agglutinin reduced by plasmapheresis. Methods and Materials: A 56-year-old man with severe anemia requested a transfusion of red blood cells. However, there was a problem in blood for blood grouping. The discrepancy of blood typing was subsequently resolved using group O absorbed plasma along with repetition of forward grouping with warm-washed red blood cells. The presence of high-thermal-amplitude and a high-titer anti-I cold agglutinin were detected in further serologic investigation. It revealed reactivity against autologous and adult O red blood cells at 37°C by the thermal amplitude screening test, and demonstrated a very high titer of 65,536 against adult O cells by titration studies at 4°C. The patient received two plasma exchange sessions of 1.5 plasma volumes each. There was a significant reduction of the titer of cold agglutinins and of the thermal amplitude by plasmapheresis as well (p < 0.01). Results: After successful cross-matching with post plasma exchanges, four units of red blood cells were infused to the patient without any hemolysis symptoms or signs. Conclusions: We now reported a patient with abnormally ascended titer of cold agglutinins and wide-thermal-amplitude, but we also successfully performed ABO typing and cross matching after 2 plasma exchange sessions of 1.5 plasma volumes each.

双重滤过血浆置换和血浆置换对ABO血型不容肾移植受者术前血型抗体去除效果单中心对比研究

目的 对比研究双重滤过血浆置换(double filtration plasmapheresis,DFPP)和血浆置换(plasma exchange,PE)对ABO血型不相容肾移植(ABO incompatible kidney transplantation,ABOi-KT)术前血型抗体去除效果。方法 收集郑州大学第一附属医院2021年2月—2023年12月ABOi-KT术前36例单纯DFPP和27例单纯PE受者的临床资料以及每次治疗前后抗体效价,并对其进行差异化分析。结果 DFPP组和PE组分别进行了98次和82次治疗;DFPP和PE治疗后血型抗体效价均较治疗前显著降低(P<0.05);DFPP和PE均显示出对高效价抗体较好的去除效果,DFPP对效价≥32组IgG抗-A、IgG抗-B和IgM抗-B抗体去除效果优于效价≤16组(P<0.05),PE治疗对效价≥32组IgM抗-A和IgM抗-B抗体去除效果优于效价≤16组(P<0.05);整体上,DFPP和PE对不同类型抗体去除效果均无显著差异,但当效价≥32时,DFPP和PE均显示出对IgM类抗体较好的去除效果,PE更为明显;PE对抗-A抗体去除效果优于DFPP,这种优势主要表现为,当效价≤16时,PE较DFPP表现出对IgG抗-A抗体较好的去除效果(P<0.05),当效价≥32时,PE较DFPP表现出对IgM抗-A抗体较好的去除效果(P<0.05),两种方法对其他血型抗体的去除效果差异无统计学意义(P>0.05)。结论 DFPP和PE均可显著降低血型抗体效价,两种方法均对高效价抗体去除效果较好。除PE对低效价IgG抗-A和高效价IgM抗-A抗体去除效果较DFPP好外,两种方法对其他血型抗体去除效果无显著差异。

双重滤过血浆单采清除肾移植术前群体反应性抗体临床疗效及安全性观察

目的观察双重滤过血浆单采(double filtration plasmapheresis,DFPP)在清除肾移植术前群体反应性抗体(panel reactive antibody,PRA)的临床疗效及安全性。方法回顾分析2021年1月—2023年6月,本院11例肾移植术前PRA阳性患者行DFPP治疗后PRA变化情况,监测治疗前后血常规、肝功能和止凝血等参数。结果11例终末期肾衰竭患者经DFPP治疗后PRA明显下降,由阳性转为阴性或者弱阳性,除1例患者因一般情况较差,放弃肾移植手术,其余患者顺利进行肾移植手术。患者共进行了62次DFPP治疗。分析显示,患者在行DFPP治疗前后相比,RBC、HB、PLT、ALB、TBIL、PT、APTT、K、Na、Cl、HCO_(3)^(–),差异无明显变化(P>0.05)。结论DFPP有效地降低了患者肾移植术前高PRA指标和降低肾移植术后急性排斥反应的风险,且治疗过程安全。

单采血浆频次与献浆者骨密度和骨代谢相关性研究

目的了解单采血浆捐献者血清骨代谢生化标志物水平以及骨密度情况,为保障我国单采血浆捐献者健康安全提供科学依据。方法招募2022年7月1日—9月30日湖南省临武单采血浆站437名单采血浆捐献者,测定捐献者血清总钙、白蛋白、血清25-羟基维生素D(25OHD)、血清Ⅰ型原胶原N-端前肽(P1NP)、1型胶原交联羧基端肽(β-CTX)水平。采用双能X射线法对单采血浆捐献者腰椎前后位(L1-L4)骨密度、双侧股骨颈骨密度进行测量。将单采血浆捐献者按照献浆类型(新献浆者和重复献浆者)分组来评估各组间骨密度以及血清骨代谢生化标志物水平的差异。采用限制性立方样条分析献浆总次数与生化指标间的剂量反应关系,并对有显著影响的指标通过多重线性回归进行影响因素的探究。结果本研究共纳入437名研究对象,其中新献浆者187名,重复献浆者250名。新献浆者与重复献浆者两组之间不同部位骨密度及骨质疏松患病率差异均无统计学意义(P>0.05)。与新献浆者组相比,重复献浆者白蛋白及25OHD水平更低,P1NP水平更高,且均具有统计学差异。限制性立方样条结果表明,献浆总次数与25OHD及P1NP均呈非线性剂量反应关系(P<0.05)。多重线性回归结果表明,献浆频次与25OHD水平呈负相关,献浆总次数与P1NP水平呈正相关。结论单采血浆捐献不会因为长期抗凝剂的使用而影响献浆者的骨骼健康以及增加骨质疏松的风险,但会增加献浆者体内成骨活动。建议中老年献浆者适当补充维生素D。

甲亢危象的识别与处理实践

甲亢危象是一种罕见的、危及生命的内分泌急症,患者有严重的甲状腺毒症临床表现。美国和日本的研究显示,甲亢危象的年发病率分别为(0.57~0.76)/10万和0.2/10万。甲亢危象占甲状腺毒症患者的0.22%,占住院甲状腺毒症患者的5.4%。即使在获得及时治疗的情况下,甲亢危象患者的死亡率仍高达10%~30%;若未治疗,则患者的死亡率可达90%。甲亢危象的急诊漏诊和误诊率高达43.48%。导致甲亢危象的诱因可能包括突然停用抗甲状腺药物或急性事件(如感染、创伤、甲状腺或非甲状腺手术、急性碘负荷或分娩)以及其他少见的病因。目前尚无公认的标准或临床工具用于诊断甲亢危象,其诊断依据包括存在甲亢的生化证据(游离T4或T3升高、TSH降低),以及危及生命的严重症状(高热、心血管功能障碍及精神状态改变等)。伯奇-沃托斯基点量表(Burch-Wartofsky point scale,BWPS)近30年来一直被广泛应用于甲亢危象的诊断。甲亢危象的主要治疗包括一般对症治疗及针对甲状腺的特异性治疗,包括去除诱因和治疗并发症,如使用抗甲状腺药物、碘剂、糖皮质激素及β受体阻滞剂等抑制甲状腺激素合成,或阻断外周T4向T3转换或抑制甲状腺激素释放,对上述治疗后病情改善不明显者,则可以尝试血液净化(血浆置换)治疗。此外,支持治疗对于甲亢危象患者亦至关重要。甲亢危象患者经过积极治疗,病情多在1~2d内改善。甲亢危象抢救成功后,应采用根治方法治疗甲亢。

肾移植非糖尿病患者血浆置换或透析的危险因素

目的探讨肾移植非糖尿病患者血浆置换或透析的危险因素。方法回顾性研究,收集2019年1月至2020年12月在西安交通大学第一附属医院接受肾移植的507例患者临床资料,其中男349例,女158例,年龄15~65岁。根据移植后1年内有无血浆置换或透析,分为有治疗组(49例)和无治疗组(458例)。采用非参数检验、χ^(2)检验/连续校正χ^(2)检验和Fisher确切概率法比较两组一般资料,多因素logistic回归分析血浆置换或透析的独立危险因素。结果与无治疗组相比,有治疗组术后第8天空腹血糖(FPG)≥7.8 mmol/L与移植肾功能延迟恢复(DGF)患者比例较高,术后第8天胱抑素C(CysC)和肌酐水平较高,肾小球滤过率较低(χ^(2)=5.202、5.030,Z=-4.676、-5.002、-4.937,均P<0.05)。多因素logistic回归分析发现术后第8天FPG≥7.8 mmol/L[OR=1.216,95%置信区间(CI)1.003~1.473,P<0.05]和术后第8天CysC(OR=1.610,95%CI 1.300~1.995,P<0.05)是血浆置换或透析的独立危险因素。结论术后第8天FPG和CysC两个临床指标可用来评估是否增加肾移植非糖尿病患者血浆置换或透析的风险,以便早期评估、早期防治。

2例双重滤过血浆置换治疗白血病患者严重铁过载报道及文献复习

报道2例使用双重滤过血浆置换(double filtration plasmapheresis,DFPP)治疗白血病患者严重铁过载,治疗后铁蛋白显著降低且未见严重不良反应。提示DFPP可能是严重铁过载时快速清除铁蛋白的方法,可以用于祛铁药物治疗欠佳或药物不耐受的铁过载患者。

高血脂患者乳糜血对血常规检验指标的影响

目的探讨高血脂患者乳糜血对血常规检验指标的影响。方法选取2019年4月至2022年4月苏州工业园区疾病防治中心收治的60例高血脂患者作为观察组,选取同期本院60名健康体检者作为对照组。两组均行血常规检验,比较两组血浆置换前后血常规指标[WBC、中性粒细胞比例(NEUT%)、红细胞计数(RBC)、血红蛋白(Hb)、血小板计数(PLT)、血细胞比容(HCT)、红细胞平均体积(MCV)和平均血小板体积(MPV)]。结果对照组血浆置换前后WBC、NEUT%、RBC、Hb、PLT、HCT、MCV和MPV比较差异无统计学意义;观察组血浆置换前后HCT、MCV、RBC比较差异无统计学意义;而血浆置换后,观察组WBC、Hb、PLT水平均低于血浆置换前,MPV小于血浆置换前,NEUT%高于血浆置换前,差异有统计学意义(P<0.05)。两组血浆置换前后HCT、MCV、RBC值比较差异无统计学意义;血浆置换前后,观察组NEUT%均低于对照组,Hb、PLT水平均高于对照组,MPV均大于对照组,差异有统计学意义(P<0.05);血浆置换前,观察组WBC高于对照组,差异有统计学意义(P<0.05);血浆置换后,两组WBC比较差异无统计学意义。结论乳糜血会对血常规检验结果造成影响,而对高血脂患者采用血浆置换法,可以减少乳糜血对血常规结果的影响,提高结果准确性,为临床提供有价值的诊断依据。

抗体清除血液净化技术治疗抗中性粒细胞胞质抗体相关血管炎的研究进展

抗中性粒细胞胞质抗体相关血管炎(AAV)是一类累及多系统的自身免疫性疾病,有较高的病死率和进展至终末期肾病的风险。体外循环血液净化技术已成为除糖皮质激素和免疫抑制剂之外治疗AAV的重要辅助手段,包括血浆置换、双重滤过血浆置换和免疫吸附。本文系统综述了抗体清除血液净化技术治疗AAV的研究进展以及指南推荐的变化,为临床应用提供参考。

双重膜滤过式血浆置换技术的临床应用分析

近年来,双重膜滤过式血浆置换技术(DFPP)作为一项重要的临床治疗手段,在多种疾病中显示出其独特的价值和效能。DFPP基于精细的膜分离技术,能有效去除血浆中的病理物质,保留对机体有益的成分,为患者提供更加有效、安全的治疗选择。随着科技的不断发展和医疗需求的增长,DFPP已从最初仅用于治疗免疫介导性疾病扩展至更广泛的疾病领域,包括肾脏疾病、神经系统疾病、风湿免疫性疾病、血液系统疾病、内分泌代谢性疾病、副蛋白血症、严重皮肤病等,并在安全性、血流动力学稳定性以及成本效益上表现出了明显优势。该文综合分析DFPP在临床应用中的最新进展,特别是在治疗风湿免疫性疾病、肾脏疾病、神经系统疾病等方面的研究进展,以期为进一步的研究提供理论基础和实践方向。