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Giornale Italiano Di Nefrologia :... Sep 2017Apheresis therapies play an important role in the treatment of many pathologies, both as first-line and rescue therapies after drug failure or drug toxicity and,... (Review)
Review
Apheresis therapies play an important role in the treatment of many pathologies, both as first-line and rescue therapies after drug failure or drug toxicity and, furthermore, when it is important to reach a therapeutic goal in a short time. Apheresis devices have evolved at an astounding rate over the last decades. Therapeutic apheresis are usually part of a treatment plan, so, a patient-centered approach to select the most appropriate treatment for each patient, balancing personal preferences, medication interferences and technological availability can significantly influence the choice of the protocol to be used. But, if the wide diversity of apheresis treatments may offer a tailored-patient approach, it can also create concerns on the right decision about the most appropriate protocol. Therapeutic apheresis - whose purpose is to cure diseases due to abnormality of blood cells or to toxicity of plasma substances - and, productive apheresis - whose purpose is to produce autologous or allogeneic therapeutic hemocomponents - are widely known as plasma-treatments and cytapheresis. The elementary techniques in apheresis are well represented by three physical separation methods of blood components: 1. differential centrifugation; 2. membrane filtration; 3. adsorption of proteins or cells, from whole blood or from plasma already separated. Starting from these three processes, several apheretic techniques have been developed to ensure, in expert hands, excellent therapeutic efficacy together with a low profile of adverse events.
Topics: Adsorption; Blood Component Removal; Blood Component Transfusion; Blood Transfusion, Autologous; Centrifugation; Filtration; Humans; Membranes, Artificial; Plasma Exchange; Pressure; Sorption Detoxification
PubMed: 28963829
DOI: No ID Found -
Transfusion and Apheresis Science :... Dec 2020
Topics: Blood Component Removal; Emergencies; Humans; Plasmapheresis
PubMed: 33187831
DOI: 10.1016/j.transci.2020.102989 -
Current Opinion in Lipidology Aug 2016Currently, different methods for extracorporeal elimination of atherogenic apolipoprotein B100 containing lipoprotein particles are used in clinical practice. Most of... (Review)
Review
PURPOSE OF REVIEW
Currently, different methods for extracorporeal elimination of atherogenic apolipoprotein B100 containing lipoprotein particles are used in clinical practice. Most of them effectively remove both lipoprotein(a) [Lp(a)] and LDL. The aim of this review is to highlight research describing the clinical advantages of specific Lp(a) immunosorption compared with other lipoprotein apheresis systems.
RECENT FINDINGS
Data on the utility of lipoprotein apheresis in patients with elevated Lp(a) level are limited. However, several longitudinal studies demonstrated improvement in cardiovascular outcomes when both Lp(a) and LDL cholesterol levels were decreased with different apheresis systems. The main limitation of these trials is the absence of a control group. First developed in 1991, studies on apheresis with a specific immunosorbent to Lp(a) were small and noncontrolled before 2000s. The only prospective controlled clinical trial utilising Lp(a) apheresis (Clinicaltrials.gov NCT02133807), demonstrated regression of coronary and carotid atherosclerosis when Lp(a) was removed weekly for 18 months.
SUMMARY
Lipoprotein apheresis usually affects multiple lipoproteins, and there are minimal data regarding the effect of specific removal of Lp(a) alone. There is a need for randomized controlled trial with specific Lp(a) apheresis to investigate its effect on cardiovascular outcomes.
Topics: Blood Component Removal; Humans; Lipoprotein(a)
PubMed: 27213629
DOI: 10.1097/MOL.0000000000000319 -
Renal Failure Dec 2022Besides conventional medical therapies, therapeutic apheresis has become an important adjunctive or alternative therapeutic option to immunosuppressive agents for... (Review)
Review
Besides conventional medical therapies, therapeutic apheresis has become an important adjunctive or alternative therapeutic option to immunosuppressive agents for primary or secondary kidney diseases and kidney transplantation. The available therapeutic apheresis techniques used in kidney diseases, including plasma exchange, double-filtration plasmapheresis, immunoadsorption, and low-density lipoprotein apheresis. Plasma exchange is still the leading extracorporeal therapy. Recently, growing evidence supports the potential benefits of double-filtration plasmapheresis and immunoadsorption for more specific and effective clearance of pathogenic antibodies with fewer side effects. However, more randomized controlled trials are still needed. Low-density lipoprotein apheresis is also an important supplementary therapy used in patients with recurrent focal segmental glomerulosclerosis. This review collects the latest evidence from recent studies, focuses on the specific advantages and disadvantages of these techniques, and compares the discrepancy among them to determine the optimal therapeutic regimens for certain kidney diseases.
Topics: Blood Component Removal; Humans; Kidney Diseases; Kidney Transplantation; Lipoproteins, LDL; Plasmapheresis
PubMed: 35723077
DOI: 10.1080/0886022X.2022.2073892 -
Transfusion and Apheresis Science :... Apr 2023Apheresis is a method of obtaining one or more blood components by machine processing of whole blood in which the residual components are returned to the donor or... (Review)
Review
Apheresis is a method of obtaining one or more blood components by machine processing of whole blood in which the residual components are returned to the donor or patient during or at the end of the process. To achieve this, the desired blood component is separated from the whole blood using centrifugal, filtration and or adsorption techniques. Although the apheresis equipment from various manufacturers look from the outside very different, the working is rather similar with separation in a one-use disposable, connected with bacterial filters to the machine, and various safety features to achieve optimal safety for donor / patient, operator and product.
Topics: Humans; Blood Component Removal; Filtration; Blood Component Transfusion
PubMed: 36870905
DOI: 10.1016/j.transci.2023.103671 -
Transfusion and Apheresis Science :... Oct 2018Hematopoietic stem cell transplantation requires a wide-range of expertise and procedural competence, in which nurses play important roles throughout, including stem... (Review)
Review
Hematopoietic stem cell transplantation requires a wide-range of expertise and procedural competence, in which nurses play important roles throughout, including stem cell mobilization and collection by apheresis. Little is published about post-licensure nursing education in apheresis, which suggests that it proceeds at the discretion of individual institutions, supplemented with practical training by equipment manufacturers. Information can be obtained on a small number of apheresis training courses for nurses in Australia, Canada, Indonesia, Italy, The Netherlands, Sweden and Turkey, and on nurse certification systems in Turkey and the United States. There seems to be no certification officially linked to institutional accreditation or medical insurance reimbursement related to apheresis, except in Turkey. Because apheresis is associated with various adverse events, including citrate toxicity and vasovagal reactions, the Japan Society of Transfusion Medicine and Cell Therapy, in cooperation with 3 other speciality societies, started a "Qualified Apheresis Nurse" certification in 2010, when the Japan Marrow Donor Program officially added circulating stem cell collection to bone marrow harvest from unrelated donors as a source of hematopoietic stem cells. Questionnaire surveys, collected when nurses must renew or surrender their 5-year certification, show that our system matches nurses' learning desire and can be an objective and motive of their learning, thus leading to safer and more effective apheresis practice. We dare to imagine that an internationally standardized curriculum might emerge, to which we would contribute, and from which we would learn.
Topics: Blood Component Removal; Education, Nursing; Humans
PubMed: 30249532
DOI: 10.1016/j.transci.2018.09.010 -
Current Atherosclerosis Reports May 2019Lipoprotein apheresis is a very efficient but time-consuming and expensive method of lowering levels of low-density lipoprotein cholesterol, lipoprotein(a)) and other... (Review)
Review
PURPOSE OF REVIEW
Lipoprotein apheresis is a very efficient but time-consuming and expensive method of lowering levels of low-density lipoprotein cholesterol, lipoprotein(a)) and other apoB containing lipoproteins, including triglyceride-rich lipoproteins. First introduced almost 45 years ago, it has long been a therapy of "last resort" for dyslipidaemias that cannot otherwise be managed. In recent years new, very potent lipid-lowering drugs have been developed and the purpose of this review is to define the role of lipoprotein apheresis in the current setting.
RECENT FINDINGS
Lipoprotein apheresis still plays an important role in managing patients with homozygous FH and some patients with other forms of hypercholesterolaemia and cardiovascular disease. In particular, patients not achieving treatment goals despite modern lipid-lowering drugs, either because these are not tolerated or the response is insufficient. Recently, lipoprotein(a) has emerged as an important cardiovascular risk factor and lipoprotein apheresis has been used to decrease lipoprotein(a) concentrations in patients with marked elevations and cardiovascular disease. However, there is considerable heterogeneity concerning the recommendations by scientific bodies as to which patient groups should be treated with lipoprotein apheresis. Lipoprotein apheresis remains an important tool for the management of patients with severe drug-resistant dyslipidaemias, especially those with homozygous FH.
Topics: Blood Component Removal; Cholesterol, LDL; Homozygote; Humans; Hypercholesterolemia; Hyperlipoproteinemia Type II; Hypolipidemic Agents; Lipoprotein(a); Lipoproteins; PCSK9 Inhibitors; Triglycerides
PubMed: 31041550
DOI: 10.1007/s11883-019-0787-5 -
Seminars in Hematology Apr 2020The early apheresis devices were developed in 1930s, but therapeutic apheresis only became widely used decades later, when automated cell separators were introduced.... (Review)
Review
The early apheresis devices were developed in 1930s, but therapeutic apheresis only became widely used decades later, when automated cell separators were introduced. Progress in technical development of these devices continues to this day. Initial use of therapeutic apheresis has not been evidence based. Documents such as the Guidelines by the American Society for Apheresis provided hematologist with better tools to assess the role of therapeutic apheresis in daily practice. This review focuses on the use of therapeutic apheresis in patients with hematological disorders. Four separate apheresis modalities most encountered by hematologists are discussed: therapeutic plasma exchange, therapeutic leukocytapheresis, red blood cell exchange, and extracorporeal photopheresis. Examples of indications are provided and discussed. The future of therapeutic apheresis and its role in different diseases is undergoing continuous re-evaluation as disease pathogenesis is better understood and new treatment options become available.
Topics: Blood Component Removal; Hematologic Diseases; Humans
PubMed: 32892844
DOI: 10.1053/j.seminhematol.2020.07.008 -
Transfusion and Apheresis Science :... Dec 2021
Review
Topics: Allied Health Occupations; Blood Component Removal; Humans; North America; Nursing
PubMed: 34838442
DOI: 10.1016/j.transci.2021.103307 -
Transfusion and Apheresis Science :... Jun 2019Therapeutic apheresis is an extracorporeal treatment that is capable of removing pathogenic blood components from patients that causes morbidity. In this review an... (Review)
Review
Therapeutic apheresis is an extracorporeal treatment that is capable of removing pathogenic blood components from patients that causes morbidity. In this review an overview is given of the types of indications for which therapeutic plasma exchange is effective. Furthermore, practical and effective topics, as well as complications will be discussed.
Topics: Blood Component Removal; Humans; Plasma Exchange
PubMed: 31047823
DOI: 10.1016/j.transci.2019.04.008