Critical updates in the 7^th edition of the American Society for Apheresis guidelines

Abstract

The 7 th edition of the American Society for Apheresis (ASFA) guidelines was composed by an international physicians committee, and includes 14 new diseases, and 2 new indications for diseases described in the former guidelines. Several indications have either changed names or were excluded from this edition. The guidelines are developed after taking into account documented evidence, either supporting or negating use of apheresis technology in the treatment of diseases. Based on this evidence, the committee revises, updates and includes or excludes disease entities/indications in the guidelines. This article describes the revisions to the 7 th edition of the ASFA guidelines, in a comprehensive manner. K E Y W O R D Sapheresis, ASFA guidelines, critical updates, diseases and indications, 7th edition

Neonatal Fc receptor in human immunity: Function and role in therapeutic intervention

“…85 PLEX is predominantly used in the acute setting to ameliorate disorders mediated by autoantibodies, such as MG, chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain-Barre syndrome, ITP, systemic lupus erythematosus crisis (including catastrophic antiphospholipid syndrome), and pulmonary-renal syndrome. 86,87 Short-term PLEX is less effective in chronic diseases, due to continued autoantibody synthesis and/or rapid IgG redistribution from the extravascular to the intravascular space. 88 Because IgM is 95% intravascular, a single PLEX is very effective for IgM-mediated autoimmune diseases.…”

EarLy Elimination of Fatty Acids iN hypertriglyceridemia-induced acuTe pancreatitis (ELEFANT trial): Protocol of an open-label, multicenter, adaptive randomized clinical trial

“…Our main hypothesis is that elimination of FFAs from the blood improves the severity and mortality of HTG-AP. Literature data suggest that early removal of FFAs and TGs from the blood could be beneficial; however, there is no high-quality evidence for this statement [46]. ELEFANT is designed to provide the first evidence for or against early intervention in HTG-AP.…”

Update on management of hypertriglyceridaemia-induced acute pancreatitis

“…As per updates in the 7th edition of the American Society for Apheresis guidelines, plasmapheresis as an initial therapy can be considered in any one of the following: (1) hypocalcaemia; (2) lactic acidosis; (3) two or more signs of worsening inflammation; and (4) worsening organ dysfunction. 5 To remember that, citrate anticoagulation during plasmapheresis has an independent survival benefit and hence recommended. Role of heparin is currently controversial as it is known to stimulate release of endothelial lipoprotein lipase, which promotes the conversion of triglycerides to free fatty acids, one of the lipotoxic agents, and hence heparin should not be used as an anticoagulation.…”