Martin Blažek

Safety and Tolerability of Long Lasting LDL-apheresis in Familial Hyperlipoproteinemia

Abstract:  The aim of this work is to arbitrate the incidence of side effects and tolerability of long lasting LDL‐apheresis in familial hyperlipoproteinemia. 1200 procedures were performed and the last 463 of them were evaluated. An immunoadsorption method of LDL‐apheresis was used (continuous blood cell separator Cobe Spectra; secondary device: automated adsorption‐desorption ADA, Medicap; absorption columns: Lipopak). As a whole, 6.26% adverse events were found and subsequently resolved by standard symptomatic therapy. Vaso‐vagal reactions (symptoms of neurovegetative lability) were the most common adverse effects, presented as malaise, weakness, slight and short‐term drop in blood pressure or other general signs. They were all well controlled by symptomatic therapy. We conclude that LDL‐apheresis in the hands of experienced personnel is a safe procedure. An acceptable procedure duration limit, balancing the possibility to achieve a targeted cholesterol level while still maintaining an acceptable patient tolerance, was confirmed to be 4 hours.

Haemorheopheresis could block the progression of the dry form of age‐related macular degeneration with soft drusen to the neovascular form

Purpose:  To evaluate the influence of haemorheopheresis on anatomical and functional findings in patients with soft‐drusen maculopathy.

WAA apheresis registry in the Czech Republic: two centers experience.

INTRODUCTION Hemaphereses are sophisticated procedures performed for many indications even in severely ill patients. Many authors consider quite necessary to register as many details as possible of treatments with therapeutic apheresis. WAA meets the requirement to compare data with centers not performing apheresis for the same diagnosis. In Czech Republic hemaphereses are used in a broad spectrum of indications. Since the year 2004 data on hemaphereses done in Czech Republic have been registered. In this paper we present a survey of our to date recordings. PATIENTS AND METHODS Data of performed therapeutic hemaphereses (plasma exchange, erythrocytapheresis, leukapheresis, thrombocytapheresis, photopheresis, immunopheresis, and rheopheresis) have been entered in WAA registry with many details. We have been evaluated 1289 procedures in 216 patients done in our two centers (center I, center II). RESULTS Center I registered 129 procedures in 41 patients, center II 1260 procedures in 175 patients. The patients are divided according to centers specialization (center II has registered 12 long-term treated patients with LDL-apheresis; mean time of therapy 7.1 years and a median of 34 procedures/patient. Side-effects registered in center I and center II were 3.1% and 5.6% of the procedures, respectively. Most frequent side-effects were citrate toxicity, neurovegetative lability, problems with venous access and hypotension. All were easy to treat, no serious events or death occurred. CONCLUSIONS In Czech Republic hemaphereses are performed in a broad scale of indications and now it is nearly 5 years that data are registered in our two university centers. In 2004 we entered WAA registry because it meets the requirement to compare data with centers that do not perform aphereses for the same diagnosis. This comparison would certainly improve efficacy of the hemapheresis therapy even further. To enter WAA registry is easy, at no expense and without any problems.

Prevention of Infection Transmission during Stem Cell Transplantation

Group of 152 patients (investigated before autologous transplantation) and 35 healthy donors for allogeneic transplantation was examined for the risk of infection transmission that can be associated with the infusion of cryopreserved peripheral blood progenitor cells to the patient and/or cross-contamination of stored grafts. No laboratory signs of active infection were found in 22 donors (63 %) and in 91 patients (60%). The most common was active infection by herpes viruses — 50 cases in patients, 21 cases in donors; hepatitis B was found in only two cases. The rate of clinically unsuspected (but dangerous) infections in donors and patients thus remains relatively high in spite of the fact that the system of donor search and the whole transplantation procedure have improved in the last years. The system of safety assurance is extremely important and the whole palette of preventive tests according to EBMT (European Blood and Marrow Transplantation Group) and ISHAGE (International Society for Hemotherapy and Graft Engineering) is fully justified.