Eduardo Gasparotto Roveri

Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients

We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD +/- 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD +/- 35.2); median 100.5 (extremes of 55 and 215). The mean volume of plasma exchanged in each session was 2396 ml (SD +/- 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.

Viability of automated collection of peripheral blood progenitor cells in a horse: report of procedure

The biotechnology used in tendon, bone and joint recoveries in Equine Medicine has improved in recent years. The most used are platelet rich plasma and stem cells from adipose tissue and bone marrow. However, recent studies have shown that stem cells can be found in the bloodstream, also named peripheral blood progenitor cells (CPP). This note aims at reporting the feasibility of automated collection of CPP in horses. The procedure was conducted in an equine, female, Quarter Horses, 2 years old, 385kg. The automated collection of CPP was conducted using apheresis equipment Fresenius- Kabi coupled to C4Y kit. The procedure lasted two hours and 30 minutes without complications, processing 5054mL of whole blood and obtaining 351mL of CPP. Upon completion of the collection, the content of CPP was separated into 10 ml aliquots and immediately stored at -18°C. The automated technique proved to be feasible for horses, but needs improvement in order to achieve greater efficiency and reduce procedure time.The biotechnology used in tendon, bone and joint recoveries in Equine Medicine has improved in recent years. The most used are platelet rich plasma and stem cells from adipose tissue and bone marrow. However, recent studies have shown that stem cells can be found in the bloodstream, also named peripheral blood progenitor cells (CPP). This note aims at reporting the feasibility of automated collection of CPP in horses. The procedure was conducted in an equine, female, Quarter Horses, 2 years old, 385kg. The automated collection of CPP was conducted using apheresis equipment Fresenius- Kabi coupled to C4Y kit. The procedure lasted two hours and 30 minutes without complications, processing 5054mL of whole blood and obtaining 351mL of CPP. Upon completion of the collection, the content of CPP was separated into 10 ml aliquots and immediately stored at -18°C. The automated technique proved to be feasible for horses, but needs improvement in order to achieve greater efficiency and reduce procedure time.

Padronização da técnica de plasmaférese automatizada em equinos

This paper aimed to study feasibility and standardize the automated plasmapheresis in five healthy horses, showing the complications during the procedure, adjustments in relation to the procedures in humans and assessing the recovery of globular volume and plasma total proteins in donors. The procedures were performed with the Fresenius AS104 equipment, with an average duration of one hour and forty six minutes, processing 5758mL of whole blood and harvest average of 3133mL of plasma. There were no significant variations in globular volume after the automated plasmapheresis. The recovery of plasma total proteins was 91.4% at 96 hours after the procedure. The automated plasmapheresis appeared viable for the equine species, decreasing the time of hematimetric level recovery in donors.

Plasmaférese como tratamento de glomeruloesclerose segmentar focal (GESF) recorrente após transplante renal. Relato de caso e revisão da literatura

Focal segmental glomerulosclerosis (FSGS) is a renal disease characterized by a nephrotic syndrome frequently evolving to end-stage renal failure. At this stage, renal transplantation, using either cadaver or live donors, is the only therapeutic option. However, after renal transplantation relapse is high, at a rate of 50% on average. The cause seems to be related to a peripheral humoral factor responsible for increasing glomerular permeability. The clearance of this factor by apheresis is today considered a good therapeutic option. We describe the case of a 12-year-old male patient, with relapsed FSGS after renal transplantation, who was treated by plasmapheresis. After five procedures a sustained improvement in the renal function was obtained. Reports published on plasmapheresis for the treatment of FSGS before and after renal transplantation are still limited to short-term results involving a small number of patients. Some predictive factors for good responses were identified by several investigators including the early start of treatment after relapse and lower ages. The number of plasmapheretic procedures to reach remission varies widely, and should be determined on a case to case basis. Another possibility presented by some investigators is prophylactic plasmapheresis, but this still lacks evidence on efficacy. This case report is an example of FSGS with a good response to plasmapheretic procedures, showing a potential benefit of this treatment. However, further controlled studies involving a higher number of patients are necessary.

Factors Influencing PBPC Mobilisation and Collection in Haematological Malignancies

Peripheral blood progenitor cells (PBPC), mobilised by several and collected in apheresis procedures are able to restore hemopoiesis after myeloablative, intensive chemotherapy. This has been currently used in the treatment of several solid tumours as well as haematological neoplasias. Several studies have show tha a safe threshold of PBPS, measured as CD34+ cells, in order to produce a prompt and durable engraftment of autologous marrow is that of 5 × 106 CD34+ cells/kg recipient body weight. Values below lead to a risk for delayed peripheral blood count recovery or even engraftment failure [1]. Many factors affect the number of CD34+ cells after mobilisation procedures, such as time from diagnosis to mobilisation, amount of previous chemotherapy regimens received by the patients, specially the cumulative dosis of alkylating agents and fludarabine [2, 3, 4, 5, 6].