A patient with a hyperacute hemolytic crisis due to AIHA of the IgG type was treated by combined plasmapheresis and exchange transfusion. A discontinuous flow centrifuge was used. Immediately after the exchange the hemoglobin level rose from 2.6 to 9.8 g/dl. The D. A. T. became weakly positive and the hemolytic crisis subsided. During the days following the exchange the autoantibodies responsible for the hemolytic crisis, switched from IgG1 and IgG3 to IgG2 and IgG4. The clinical and laboratory picture stabilized thereafter.

Since humoral factors have been implicated in the pathogenesis of multiple sclerosis (MS) and previous attempts at therapeutic intervention have not met with uniform success, plasma exchange (PE) was recently proposed for the management of this disease. We are currently investigating the possible effectiveness of PE in the treatment of MS, and to date 6 patients have been entered into the study. At least 4 of our patients who did not respond to conventional therapy have shown unequivocal, moderate to marked improvement following the first session of PE. At the time of treatment, these patients had an acute exacerbation of their disease. We found no correlation between clinical improvement and the serum immune complex levels, suggesting that other poorly known mechanisms were operative. Based on our preliminary results, we feel that PE may be efficacious in treating exacerbations of MS. More evidence is needed on the effects of PE in the chronic stage of the disease.

Background: When infertility is diagnosed, physicians have the difficult task to break bad news. Their communication skills play a central role in improving patients' coping abilities and adherence to infertility treatments. However, specific guidelines and training courses on this topic are still lacking. The aim of the present study is to provide some practical advice for improving breaking bad news in infertility diagnosis through a systematic literature review of qualitative and quantitative studies.Methods: Electronic searches were performed in the MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Psychology and Behavioral Sciences Collection databases. All articles focusing on the communication of the diagnosis of infertility were included. The main findings of each included article were then summarized.Results: Literature search identified 11,838 references that were screened for eligibility. Full texts of 81 articles were retrieved, and their analysis led to the inclusion of 4 articles, which treated the theme of communication of infertility only partially. The main addressed aspects concerning the communication of the infertility diagnosis were the following: (i) the value that patients give to healthcare professionals' communication skills; (ii) the importance of giving clear information on diagnostic procedures and treatments in order to decrease patients' anxiety; and (iii) the importance of involving both partners.Conclusions: This review pointed out that the communication of the infertility diagnosis is still underinvestigated. Specific guidelines are currently not available, but other protocols could be used. Taking into account the principal aspects of communication highlighted with this review, in this study, we suggested an adaptation of the original SPIKES protocol that could be used by healthcare professionals for the communication of the infertility status.

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A 18-year-old woman in the 7th month of pregnancy had a mild enteritis followed within 8 days by a typical Guillain-Barré syndrome with respiratory failure requiring ventilatory support and bulbar palsy. After induction of delivery and discouraging results with steroid therapy, she was treated by plasma exchange. After 2 sessions on alternate days, a recovery of motility was observed and respiratory failure was abolished. It is pointed out that the most significant improvement was recorded immediately after the plasma exchanges, and that this correlated with the removal of immune complexes.