Article

Plasmapheresis therapy of immunologic disease

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Abstract

The term plasmapheresis (removal of plasma with or without replacement with physiologic solutions) was first used in 1914 by Abel et al1 in their paper “Plasma removal with return of corpuscles,” which was an account of their attempt to develop an artificial kidney. Modern experience with plasmapheresis began in the early 1950s when the technique was used to remove abnormal plasma protein in a patient with multiple myeloma.2 In the early 1960s, the procedure was successfully employed to treat the clinical manifestations of hyper-viscosity in a patient with Waldenstrom’s macro-globulinemia.3

In the past decade, great advances have been made in the technique of plasma exchange, and the scope of diseases treated with this method has broadened greatly. In theory, any disease in which a humoral phase is important in pathogenesis may be at least partially mitigated by removal of patients’ plasma and subsequent replacement with another physiologic solution. This therapy might benefit patients with either of two types of immunologic disease: that mediated by antibody (either blocking or cytotoxic) or that mediated by circulating immune complexes (CIC) or both. We report our experience in treating nine patients with a number of different disease states, all of whom had elevated CIC levels. Included are dynamic data concerning the effects of plasma exchange on levels of CIC.

MethodsAssays

1. CICs were determined by Clq binding as described by Zubler et al.4 Results are expressed in units (1 unit = amount of Clq bound by 0.1 μg aggregated IgG). The upper limit . . .


 

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