Therapeutic apheresis during pregnancy: A single center experience

Colpo, Anna; Marson, Piero; Pavanello, Francesca; Tison, Tiziana; Gervasi, Maria Teresa; Zambon, A.; Ruffatti, Amelia; Silvestro, Giustina De; Hoxha, Ariela

doi:10.1016/j.transci.2019.07.009

Cited by 25 publications

(28 citation statements)

References 26 publications

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“…Adverse events occurred in 2.1% of all patients analysed, which is reported to be lower than the Italian average. Peripheral veins are preferred as a vascular access during pregnancy to avoid the risks associated with a central venous catheter [ 39 ].…”

Section: Resultsmentioning

confidence: 99%

Apheresis in Autoimmune Encephalitis and Autoimmune Dementia

Rößling

Prüß

2020

JCM

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Autoimmune encephalitis (AE) is a rapidly progressive inflammatory neurological disease. Underlying autoantibodies can bind to neuronal surfaces and synaptic proteins resulting in psychiatric symptoms, focal neurological signs, autonomic dysfunction and cognitive decline. Early and effective treatment is mandatory to reduce clinical symptoms and to achieve remission. Therapeutic apheresis, involving both plasma exchange (PE) and immunoadsorption (IA), can rapidly remove pathogenic antibodies from the circulation, thus representing an important first-line treatment in AE patients. We here review the most relevant studies regarding therapeutic apheresis in AE, summarizing the outcome for patients and the expanding clinical spectrum of treatment-responsive clinical conditions. For example, patients with slowly progressing cognitive impairment suggesting a neurodegenerative dementia can have underlying autoantibodies and improve with therapeutic apheresis. Findings are encouraging and have led to the first ongoing clinical studies assessing the therapeutic effect of IA in patients with anti-neuronal autoantibodies and the clinical presentation of dementia. Therapeutic apheresis is an established and well tolerated option for first-line therapy in AE and, potentially, other antibody-mediated central nervous system diseases.

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Section: Resultsmentioning

confidence: 99%

Apheresis in Autoimmune Encephalitis and Autoimmune Dementia

Rößling

Prüß

2020

JCM

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“…One pregnant patient had an anti-PP1Pk antibody causing recurrent spontaneous abortion in early pregnancy and one was affected by high-risk antiphospholipid syndrome, for whom after multidisciplinary discussion (Gynecologist, Immuno-hematology and Apheresis Specialists) the decision to continue was undertaken. These indications are not present in the current ASFA 2019 guidelines [4], but data in the medical literature, our previous experience and the discussion with Clinicians and Gynecologists justified the decision [5,6]. Also, treatment of pediatric patients with HoFH and an adult with hyperLp(a) with advanced cardiovascular disease continued as scheduled, while frequency of treatment in 2 adult patient affected by HeFH and one adult patients with hyperLp(a) was reduced from biweekly to monthly.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 pandemic in the activity of a Therapeutic Apheresis unit in Italy

Colpo

Astolfi²,

Tison

et al. 2020

Transfusion and Apheresis Science

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The recent Coronavirus Disease 2019 (COVID-19) outbreak has led to profound and rapid changes in the Italian and Veneto Region Healthcare System. This context also includes the quick reorganization which the Apheresis Unit (AU) of the Padova University Hospital, i.e. the Regional Reference Center for Therapeutic Apheresis (TA), had to face. Material and Methods: The study retrospectively evaluated the TA activity (procedures performed, patients treated and consultations) during the COVID-19 pandemic, from March to April 2020, comparing the activity in the same time period in 2018 and 2019. Results: In the period analyzed, a significant reduction in both the total number of procedures performed and of patients treated, respectively by 17 % and 16 % for the procedures and by 19 % and 20 % for patients treated compared to the same period of 2018 and 2019, respectively, was observed. A concomitant reduction in requests for TA consultation for new patients (both outpatients and inpatients) was observed, equal to 32 % and 21 % compared to 2018 and 2019, respectively. Conclusion: Many reasons determined the observed reduction in the TA activity during the recent COVID-19 outbreak. The AU itself was quickly reorganized in terms of location and supplies to allow for the appropriate COVID-19 patients care. Many non urgent cases, after multidisciplinary discussion between Clinicians and Apheresis Specialists, were deferred, maintaining close phone and e-mail contact with patients.

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“…The number of side effects in pregnancy found in literature shows that the incidence of hypotension is higher (5.2 %), while all other complications are either equal or less than in the non-pregnant population. One of the largest cohorts included, performed apheresis procedures in 57 pregnancies in a single centre and had 20 (2.1 %) adverse events during 13.251 sessions, of which 65 % technical problems, and none required prolongation of hospitalization [3].…”

Section: Safety Issuesmentioning

confidence: 99%

“…Since many of the diseases listed in the ASFA guidelines can also be present in pregnancy, they state in their guidelines that apheresis can be performed safely during pregnancy, while warning for potential side effects such as hypotension which theoretically can result in decreased placental perfusion and fetal oxygenation [1][2][3][4][5]. Also, important physiological changes during pregnancy, such as increased circulating blood volume, haemodilution, increased cardiac output, and potentially increased risk of infections, should be kept in mind when performing apheresis procedures in pregnant women [2].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic plasma exchange in pregnancy: A literature review

Wind

Gaasbeek

Rabelink

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Therapeutic plasma exchange (TPE) is indicated as a treatment for a wide array of diseases, extensively addressed in the Guidelines of the American Society for Apheresis. In pregnancy, TPE is an uncommon event and application is largely based on extrapolation of efficacy and safety in a non-pregnant population. This review intends to describe the currently available experience of TPE in pregnancy to help clinicians recognise indications during pregnancy and to support current guideline recommendations with literature-based experiences. In order to identify the clinical indications for which TPE is applied in pregnant women, we performed a literature search including studies till November 2019, without a start date restriction. Data extraction included medical indication for TPE and safety of TPE in pregnant women. 279 studies were included for analysis. Nowadays, TPE is predominantly applied for thrombotic microangiopathies, lipid disorders and a variety of autoimmune diseases. The application of TPE during pregnancy remains largely empiric and relies on individual case reports in the absence of high-quality studies and definitive evidence-based guidelines. Safety profile of TPE during pregnancy appears to be comparable to application of TPE in non-pregnant patients. In conclusion, based on the limited evidence that we found in literature with a high risk of publication bias, TPE procedures can be used safely during pregnancy with the appropriate preparation and experience of a multidisciplinary team.

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Therapeutic apheresis during pregnancy: A single center experience

Cited by 25 publications

References 26 publications

Apheresis in Autoimmune Encephalitis and Autoimmune Dementia

Apheresis in Autoimmune Encephalitis and Autoimmune Dementia

Impact of COVID-19 pandemic in the activity of a Therapeutic Apheresis unit in Italy

Therapeutic plasma exchange in pregnancy: A literature review

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