Solute Removal Capacity of High Cut‐Off Membrane Plasma Separators

Ohkubo, Atsushi; Kurashima, Naoki; Nakamura, Ayako; Miyamoto, Satoko; Iimori, Soichiro; Rai, Tatemitsu

doi:10.1111/1744-9987.12114

Cited by 18 publications

(39 citation statements)

References 4 publications

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“…As mentioned above, the removal ratio of IgG was lower in SePE than in PE. The SC of Fib by SePE was 0.0 . A substance that has a molecular weight greater than Fib such as immunoglobulin M cannot be eliminated by SePE.…”

Section: Discussionmentioning

confidence: 93%

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Removal Characteristics of Immunoglobulin G Subclasses by Conventional Plasma Exchange and Selective Plasma Exchange

et al. 2015

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Selective plasma exchange (SePE) using a selective membrane separator is a modified method of simple plasma exchange (PE). Immunoglobulin G (IgG) subclass distribution is one of the important immunological characteristics of IgG. However, there is little information regarding the removal characteristics of IgG subclasses by SePE and conventional PE. Here, we investigated the removal ratio of IgG subclasses by PE and SePE in seven patients with immunological disorders. When the mean processed volume was 0.88 plasma volume (PV) (corresponding to 2.12 L), the mean percent reductions by PE were as follows: IgG, 63.2%; IgG1, 64.5%; IgG2, 64.0%; IgG3, 61.4%; and IgG4, 69.5%. When the mean processed volume was 1.18 PV (corresponding to 2.98 L), the mean percent reductions by SePE were as follows: IgG, 51.6%; IgG1, 55.3%; IgG2, 52.0%; IgG3, 53.7%; and IgG4, 64.6%. In both PE and SePE, using albumin solution as the supplementary fluid, IgG was effectively eliminated regardless of IgG subclasses.

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Section: Discussionmentioning

confidence: 93%

“…The removal ratio of IgG and IgG subclasses were higher in PE than in SePE. We have previously reported that the SC of each substance by SePE was as follows: TNF‐α, 0.99; Alb, 0.73; IgG, 0.50; coagulation factor XIII (FXIII), 0.17; and Fib, 0.0; respectively . The SCs of plasma proteins and Fib by PE were approximately 1.00 .…”

Section: Discussionmentioning

confidence: 97%

Removal Characteristics of Immunoglobulin G Subclasses by Conventional Plasma Exchange and Selective Plasma Exchange

et al. 2015

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“…The sieving coefficient of coagulation factors of the EVACURE EC‐4A10 is reportedly less than 0.2. Therefore, coagulation factors with molecular weights greater than that of IgG such as FXIII and fibrinogen can be retained even when large volume plasma exchange is performed during SePE without the use of plasma . In this case, the measurements of FXIII and fibrinogen decreased by as much as 50% of the normal level during DFPP.…”

Section: Discussionmentioning

confidence: 99%

Selective plasma exchange can reduce auto‐antibodies in patients with bullous pemphigoid without affecting factor XIII and fibrinogen

Nasu

Hanafusa

Nangaku

2016

J of Clinical Apheresis

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Bullous pemphigoid (BP) is an autoimmune blistering skin disorder characterized by circulating serum IgG antibodies against two hemidesmosomal proteins: BP180 and BP230. Fundamentally, immunosuppressive therapies are administered to treat this disease, but plasmapheresis can be added for refractory patients. We experienced the case of a 63-year-old patient with refractory BP for which we administered double filtration plasmapheresis (DFPP). His skin lesions improved along with decreased IgG BP180 antibodies, but factor XIII (FXIII) and fibrinogen were also reduced by DFPP repetition. Reportedly, deficiency of those factors can cause lethal bleeding. Especially, decreased FXIII cannot be detected by prolongation of bleeding or coagulation time. To prevent further reduction of those factors and bleeding complications, DFPP was switched to selective plasma exchange (SePE), a new modality of plasmapheresis that uses a membrane plasma separator with smaller than ordinary pores. SePE further reduced pathogenic IgG BP180 antibodies, but FXIII and fibrinogen recovered. For this case, we measured the mean of reduction ratios in serum IgG and FXIII both before and after plasmapheresis sessions and detected the decreased levels of FXIII and fibrinogen during DFPP. We were able to switch to SePE from DFPP appropriately before any bleeding event occurred. The utility of SePE was demonstrated, especially for the reduction of pathogenic antibodies with retention of FXIII and fibrinogen, which have the longest half-lives among coagulation factors and which take a long time to recover.

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“…The reduction in AChRAb by SeIA can be lower than that by IA because the plasma concentration of IgG and IgG subclasses before IM‐TR in SeIA can be reduced to half of that in IA. In SeIA, the plasma fibrinogen concentrations and FXIII activities were much lower than those in IA because the SCs of fibrinogen and FXIII by EC‐4A was approximately 0 and 0.17, respectively . Furthermore, this is also the first report to investigate the removal kinetics of AChRAb, IgG, IgG subclasses, fibrinogen, and FXIII during SeIA.…”

Section: Discussionmentioning

confidence: 79%

Removal Characteristics of Immunoadsorption with the Tryptophan‐Immobilized Column Using Conventional and Selective Plasma Separators in the Treatment of Myasthenia Gravis

et al. 2019

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Autoimmune neurological diseases are often treated by immunoadsorption using a conventional plasma separator and tryptophan‐immobilized column (IA). However, there is only one case report on treatment with immunoadsorption using a selective plasma separator and tryptophan‐immobilized column (SeIA) in clinical practice. This study aimed to investigate the removal characteristics of antibodies against acetylcholine receptors (AChRAb), immunoglobulin G, fibrinogen, and factor XIII (FXIII) in IA and SeIA in four patients with myasthenia gravis. A total of 19 sessions of immunoadsorption were performed (five sessions of IA and 14 sessions of SeIA) when the processed plasma volume was 2 L. The corresponding reductions were 52.5% ± 6.2% for AChRAb, 58.8% ± 4.2% for fibrinogen, and 36.9% ± 5.5% for FXIII after one session of IA. The corresponding reductions were 45.2% ± 9.9% for AChRAb, 3.5% ± 6.9% for fibrinogen, and −4.6% ± 11.1% for FXIII after one session of SeIA. The removal rates for AChRAb, fibrinogen, and FXIII in IA were significantly higher than those in SeIA. IA could effectively remove AChRAb, and SeIA could retain fibrinogen and FXIII. IA can be combined with SeIA, resulting in both IgG autoantibodies removal by IA and retention of coagulation factors by SeIA.

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Solute Removal Capacity of High Cut‐Off Membrane Plasma Separators

Cited by 18 publications

References 4 publications

Removal Characteristics of Immunoglobulin G Subclasses by Conventional Plasma Exchange and Selective Plasma Exchange

Removal Characteristics of Immunoglobulin G Subclasses by Conventional Plasma Exchange and Selective Plasma Exchange

Selective plasma exchange can reduce auto‐antibodies in patients with bullous pemphigoid without affecting factor XIII and fibrinogen

Removal Characteristics of Immunoadsorption with the Tryptophan‐Immobilized Column Using Conventional and Selective Plasma Separators in the Treatment of Myasthenia Gravis

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