No abstract

We reviewed a series of 181 patients who were treated with therapeutic plasma exchange (TPE) a total of 1,389 times. Complications were associated with 22 (1.6%) of the procedures and involved 20 (11%) of the patients. Six of the complications were of a technical nature and did not affect the medical conditions of the patients. 8 patients developed the following serious medical problems: unexplained death during the post-TPE period, myocardial infarction, pulmonary embolus, loss of consciousness, myocardial ischemia, cerebral ischemia and chest pain. Although these problems were temporally associated with TPE, none of them could be attributed to the TPE with certainty. The remaining eight medical complications were of a less serious nature.

We reviewed a series of 181 patients who were treated with therapeutic plasma exchange ( TPE ) a total of 1,389 times. Complications were associated with 22 (1.6%) of the procedures and involved 20 (11%) of the patients. Six of the complications were of a technical nature and did not affect the medical conditions of the patients. 8 patients developed the following serious medical problems: unexplained death during the post- TPE period, myocardial infarction, pulmonary embolus, loss of consciousness, myocardial ischemia, cerebral ischemia and chest pain. Although these problems were temporally associated with TPE none of them could be attributed to the TPE with certainty. The remaining eight medical complications were of a less serious nature.

Methyldopa-treated gamma globulin can be demonstrated serologically on either the red cell surface or on latex beads by the indirect antiglobulin reaction. The development of a positive antiglobulin reaction was related to methyldopa concentration and the length and temperature of incubation of methyldopa with protein and could be partially inhibited by the addition of albumin to the incubation mixtures. After more prolonged incubation, antiglobulin positivity also developed with plasma-treated with methyldopa. 14C-methyldopa was covalently bound to gamma globulin. Aggregation of gamma globulin following treatment with methyldopa could be demonstrated by both sedimentation velocity and molecular weight determinations employing low-speed equilibrium centrifugation. Protein aggregation was a function of time, temperature, and methyldopa concentration. Detectability by the antiglobulin reaction, the darkening noted in solutions to which methyldopa or hydroquinone had been added, as well as the aggregation of protein was inhibited by a reducing agent which prevented formation of a quinone from the hydroquinone. Some of the immunologically atypical features of the sensitization of red cells by methyldopa or its structural analogues are explicable by the adherence, in vivo, of chemically modified, nonantibody gamma globulin which renders the red cell directly antiglobulin positive.

This study was undertaken to ascertain the incidence, the associated clinical diseases, and the serologic characteristics and significance of positive direct antiglobulin tests (DAT) in a hospital population. Forty-one (0.9%) of 4,664 medical-surgical patients had positive DAT's on admission. Eight of these 41 people also had antibodies in their sera. Twelve patients were taking alpha-methyldopa and one cephalothin, seven had malignant tumors, nine had immunologic disease, and 12 had miscellaneous conditions. Elution of antibodies from the erythrocytes of 36 patients was attempted: 17 eluates failed to react with panel cells; anti-K antibody was found in the eluates from two patients who had recently received transfusions; five eluates showed no blood-group specificity; and 12 agglutinated all panel cells. Eleven of the last 12 eluates, after absorption with Rh-negative cells, were tested with Rh cells of various phenotypes, and weaker or negative results with Rhnull cells were obtained with seven absorbed eluates. Three of the 41 patients had mild to overt hemolysis.