Academic literature on the topic 'Blood plasma exchange therapy'
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Journal articles on the topic "Blood plasma exchange therapy"
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Sadler, J. Evan. "Von Willebrand factor, ADAMTS13, and thrombotic thrombocytopenic purpura." Blood 112, no. 1 (July 1, 2008): 11–18. http://dx.doi.org/10.1182/blood-2008-02-078170.
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Abstract Discoveries during the past decade have revolutionized our understanding of idiopathic thrombotic thrombocytopenic purpura (TTP). Most cases in adults are caused by acquired autoantibodies that inhibit ADAMTS13, a metalloprotease that cleaves von Willebrand factor within nascent platelet-rich thrombi to prevent hemolysis, thrombocytopenia, and tissue infarction. Although approximately 80% of patients respond to plasma exchange, which removes autoantibody and replenishes ADAMTS13, one third to one half of survivors develop refractory or relapsing disease. Intensive immunosuppressive therapy with rituximab appears to be effective as salvage therapy, and ongoing clinical trials should determine whether adjuvant rituximab with plasma exchange also is beneficial at first diagnosis. A major unanswered question is whether plasma exchange is effective for the subset of patients with idiopathic TTP who do not have severe ADAMTS13 deficiency.
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Gertz, Morie A. "Acute hyperviscosity: syndromes and management." Blood 132, no. 13 (September 27, 2018): 1379–85. http://dx.doi.org/10.1182/blood-2018-06-846816.
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Plasma hyperviscosity is a rare complication of both monoclonal and polyclonal disorders associated with elevation of immunoglobulins. Asymptomatic patients with an elevation in the serum viscosity do not require plasma exchange, and the majority will have other indications for therapeutic intervention. For patients with hemorrhagic or central nervous system manifestations, plasma exchange is the therapy of choice and is relatively safe. Viscosity measurements are not required to initiate therapy if the index of suspicion is high and the clinical presentation is typical. However, patients should have a sample sent for confirmation of the diagnosis. Whole-blood hyperviscosity is seen in patients with extreme elevation of the red cell and white cell count. Phlebotomy of patients with primary and secondary elevation of the red cell count is a well-established therapy.
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Farhat, M. H., B. de Souza, and A. Hanbali. "Cancer-related TTP: Role of plasma exchange." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e13527-e13527. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e13527.
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e13527 Background: Thrombotic thrombocytopenic purpura (TTP) is a multisystemic disease classically described by thrombocytopenia, microangiopathic hemolytic anemia, fever, neurologic manifestations and renal dysfunction. It is considered a hematologic emergency for which, the treatment of choice is plasma exchange therapy. However, its diagnosis and treatment can be particularly challenging in the setting of disseminated malignancy, as the misdiagnosis of TTP in a patient with cancer-associated thrombotic microangiopathy (TMA) will lead to ineffective use of plasma exchange and delay the timely delivery of chemotherapy. Moreover, patients with disseminated malignancy respond less often to plasma exchange and have a higher mortality rate. Methods: Three patients with disseminated malignancy who presented as TTP are discussed. Two of the three patients were given plasma exchange and had fatal outcomes, while the third patient received chemotherapy as the initial therapy and survived hospitalization. The three patients had prolonged PT with normal aPTT; LDH levels (>1,000 IU/L); and presence of schistocytes in the peripheral blood smear. Results: TMA associated with disseminated malignancy remains a challenging and underdiagnosed condition with very poor prognosis. Plasma exchange has no clinical use is potentially even life-threatening especially when it delays the administration of the appropriate chemotherapy which is the ultimate treatment for the underlying malignancy that resulted in TMA. We propose that the following criteria be used for diagnostic consideration of disseminated malignancy-associated TMA: evidence of hemolysis; leukoerythroblastic picture on the peripheral blood; coagulopathy consisting of elevated d-dimer, prolonged PT with normal aPTT; extreme elevations in the LDH levels (>1,000 IU/L); and presence of schistocytes in the peripheral blood smear. Such patients should be immediately considered for a bone marrow biopsy as chemotherapy should be initiated as soon as possible. Conclusions: See Table. [Table: see text] No significant financial relationships to disclose.
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S., Aswin Kumar, Latha B., and Dhivya x. Dhivya K. "Therapeutic plasma exchange in neuro-immunological disorder." International Journal of Research in Medical Sciences 5, no. 4 (March 28, 2017): 1550. http://dx.doi.org/10.18203/2320-6012.ijrms20171263.
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Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used to remove high molecular weight substances from the plasma. Examples of these substances include immune complexes, pathogenic autoantibodies, endotoxin, cryoglobulins and cholesterol-containing lipoproteins and myeloma light chains. Therapeutic Plasma exchange is a well-established therapeutic procedure most commonly used in many neuro-immunological disorders. The benefit of plasma exchange occurs by elimination of pathognomonic inflammatory mediators, including complement components, autoantibodies and cytokines. Various studied have demonstrated that TPE plays an important role in neuro-immunological disorder (eg. Guillain-Barré syndrome, myasthenia gravis and other forms of immune neuropathies).Methods: It is descriptive and prospective study on the effect of TPE in neuro-immunological disorders. TPE are studied prospectively for a period from September 2011 to August 2013. The amount of plasma to be exchanged during TPE was determined using the formula EPV = (0.065 x weight [kg]) x (1-hematocrit). TPE was performed using a Haemonetics MCS+ intermittent flow cell separator. An average of 1-1.5 plasma volume is removed on alternative days. Clinical outcome of TPE was assessed at the time of discharge.Results: A total of 138 Therapeutic plasma exchange procedure were performed on 30 patients. In which the improvement begins within days of commencing the treatments and progressed steadily so that 25 out of 30 patients who responded favourably to TPE with a manageable adverse reaction. And only 5 patients failed to respond this therapy. So the clinical outcome for therapeutic plasma exchange for Neuro-immunological cases were 83.3% and remaining 16.7% doesn’t show any improvement after five plasma exchanges.Conclusions: Therapeutic plasma exchange is a first line of management for most of the neuro-immunological disorder. In our study there was an improvement in motor performance after 3-5 plasma exchanges which are mainly due to removal of unbound antibodies from the plasma. Although the statistical power of our study was not sufficient to allow definitive conclusion, the result strongly suggest that 3-5 procedures on alternative days with 1-1.5 volume of plasma exchange gives a better result in patient with neuro-immunlogical diseases. The success of therapeutic plasma exchange also depends on composition of the replacement fluid. The risk and complication associated with procedure are also minimal and easily manageable.
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Miletić, Marija, Miloš Stojanović, Biljana Nedeljković-Beleslin, Mirjana Stojković, Jasmina Ćirić, and Miloš Žarković. "Taking all the sideroads of hyperthyroidism therapy: Pitfalls and possibilities." Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma 26, no. 80 (2021): 108–25. http://dx.doi.org/10.5937/medgla2180108m.
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There are three basic modalities for the treatment of thyrotoxicosis: thyrosuppresive drug therapy, ablation with radioactive iodine and surgical treatment. Patients who do not achieve adequate thyrotoxicosis control, as was the case of described patient, have a high mortality rate due to the possibility of developing a thyroid storm. The use of drug therapy for hyperthyroidism, as the first line of treatment, is associated with the appearance of various side effects, as was the case in our patient. Side effects of Methimazole are dose-dependent, while in the case of Propylthiouracil, the occurrence of side effects is not clearly dose-dependent. In the case of the described patient, all alternative, lesser known modalities for the treatment of hyperthyroidism were applied, after the occurrence of adverse reactions to thyrosuppressive therapy. Sodium perchlorate, ie. Sodium with perchloric acid is rarely used in the treatment of hyperthyroidism, as in cases of severe idiosyncratic reactions to thionamides, agranulocytosis or hepatitis, if the eumetabolic state is not achieved and the application of a therapeutic dose of radioiodine is not possible. It is applied in the form of a solution, usually 8%; In more severe forms of the disease, when hyperthyroidism is very pronounced, 10 to 15 drops a day are given 4 to 6 times and the dose is sometimes reduced to the minimum maintenance dose. After the adverse reaction even to sodium perchlorate therapy we were left with one more, last option-Plasma Therapy exchange. Plasma Therapy Exchange (TPE) is an out-of-body blood purification technique designed to remove high-molecular-weight substances bound to plasma proteins (autoantibody pathogens, immunocomplexes, cryoglobulins, myeloma light chains, endotoxins, lipoprotein-containing cholesterol, and thyroid). The effectiveness of treatment depends on the volume of blood being processed, the volume of plasma exchanged in each process, the number of procedures performed, the frequency of exchange and the rate of mobilization, stabilization and re-synthesis of cells or plasma components. TPE is an effective alternative treatment that provides an opportunity to prepare patients for definitive treatment: ablative therapy such as RAI ablation or thyroidectomy. Therapeutic plasmapheresis, if performed in specialist centers, is a safe, fast and effective method.
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Luo, Ming, Xian-jun Zhang, and Wu-kui Cao. "Blood Purification for Severe Hepatitis in Vivo and Vitro." Infection International 2, no. 1 (March 1, 2013): 43–46. http://dx.doi.org/10.1515/ii-2017-0039.
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Abstract Exterior and interior blood purification (EIBP) refers to the combined therapy of interior blood purification (IBP) and exterior blood purification (EBP) for severe hepatitis. For one thing, integrated traditional Chinese and Western medicine therapy should be applied in IBP to reduce and prevent the generation and absorption of harmful substances in vivo. For another, EBP such as the artificial liver support system (ALSS) can extract blood from the body and various kinds of existing harmful substances in the blood can be cleared in vitro, using the treatment of plasma exchange, plasma perfusion, plasma adsorption, hemofiltration, hemodialysis. Therefore, IBP should be cooperated with EBP for the treatment of severe hepatitis, and EIBP can prevent the deterioration of this disease and lower the mortality of patients.
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Yamada, Yuji, Hiroyuki Ohbe, Hideo Yasunaga, and Yoshitaka Miyakawa. "Clinical Practice Pattern of Acquired Thrombotic Thrombocytopenic Purpura in Japan: A Nationwide Inpatient Database Analysis." Blood 134, Supplement_1 (November 13, 2019): 2374. http://dx.doi.org/10.1182/blood-2019-125170.
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Introduction: Acquired thrombotic thrombocytopenic purpura (TTP) is a medically emergent disorder that is almost always fatal without proper treatment. While daily plasma exchange is recommended by several guidelines, its optimal frequency is unclear, and until March 2018 plasma exchange up to only three times a week was reimbursed by Japanese health insurance. In addition, rituximab has not been approved for acquired TTP in Japan. While it is known that clinical practice guidelines for TTP treatment in Japan may differ from those in other countries, real-world practice patterns remain unknown. Thus, we evaluated patients' characteristics and clinical practice patterns using a large nationwide inpatient database. Methods: For this nationwide epidemiologic study, we used the Japanese Diagnosis Procedure Combination inpatient database, which includes discharge abstracts and administrative claims data from more than 1,200 acute-care hospitals and covers approximately 90% of all tertiary-care emergency hospitals in Japan. All hospitalized patients who were diagnosed with TTP (International Classification of Diseases-Tenth Revision, code M311) on admission and who received plasma exchange during hospitalization were included in the study. Patients younger than 18 years were excluded. When patients with the ICD code for TTP were admitted more than once during the study period, we used data only from the first admission. We then evaluated patients' characteristics and clinical practice patterns. Results: We identified 1,638 patients who were newly diagnosed with acquired TTP from July 2010 to March 2017. The median (interquartile range [IQR]) age was 64 (47-74) years, and 674 (41%) patients were male; 648 (40%) required ICU admission, 447 (34%) required catecholamine, and 497 (30%) required mechanical ventilation. Although relatively contraindicated, 658 (40%) patients received platelet transfusion. In-hospital mortality was 32% (n=529/1,638). Median (IQR) length of hospital stay was 45 (25-78) days, and median total cost was US$40,897 ($24,204-$64,012). Among survivors, 856 (77%) were discharged home and 235 (21%) required subacute rehabilitation or chronic care facility. The median (IQR) interval from admission to plasma exchange was 4 (2-10) days; 385 (24%) patients received plasma exchange on the day of admission. Median (IQR) frequency of plasma exchange within 7 days of initial exchange was 3 (2-5) days; median (IQR) duration of plasma exchange was 10 (4-21) days. Of the 1,519 (93%) patients who received steroids, 1,071 (71%) received steroid pulse therapy. Among the 529 (32%) patients administered immunosuppressants, 221 (13%) received cyclophosphamide, 152 (9.3%) rituximab, 140 (8.6%) cyclosporine, and 86 (5.3%) tacrolimus. Conclusions: We assessed real-world clinical practice for TTP patients in Japan for the first time using the nationwide inpatient database. Our analysis showed a disparity between guidelines and real-world clinical practice, especially regarding frequency of plasma exchange. Optimal treatment strategy, efficacy, and safety should be evaluated in future studies. Disclosures Miyakawa: Zenyaku Kogyo: Consultancy; Sanofi: Speakers Bureau; Ablynx: Speakers Bureau; Chugai: Speakers Bureau.
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Laje, Pablo, Dezhi Shang, Wenjing Cao, Masami Niiya, Masayuki Endo, Antoneta Radu, Nicole DeRogatis, et al. "Correction of murine ADAMTS13 deficiency by hematopoietic progenitor cell–mediated gene therapy." Blood 113, no. 10 (March 5, 2009): 2172–80. http://dx.doi.org/10.1182/blood-2008-08-173021.
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Abstract ADAMTS13, a metalloprotease primarily synthesized in liver and endothelial cells, cleaves von Willebrand factor (VWF) at the central A2 domain, thereby reducing the sizes of circulating VWF multimers. Genetic or acquired deficiency of plasma ADAMTS13 activity leads to a potentially fatal syndrome, thrombotic thrombocytopenic purpura (TTP). To date, plasma infusion or exchange is the only proven effective therapy for TTP. In search for a better therapy, an autologous transplantation of hematopoietic progenitor cells transduced ex vivo with a self-inactivating lentiviral vector encoding a full-length murine Adamts13 and an enhanced green fluorescent protein (GFP) reporter gene was performed in Adamts13−/− mice after irradiation. All recipient mice showed detectable ADAMTS13 antigen and proteolytic activity in plasma despite only low levels of bone marrow chimerism. The levels of plasma ADAMTS13 were sufficient to eliminate the ultralarge VWF multimers and offered systemic protection against ferric chloride–induced arterial thrombosis. The data suggest that hematopoietic progenitor cells can be genetically modified ex vivo and transplanted in an autologous model to provide adequate levels of functional ADAMTS13 metalloprotease. This success may provide the basis for development of a novel therapeutic strategy to cure hereditary TTP in humans.
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Shah, Md Salahuddin, ATM Atikur Rahman, and Momena Begum. "Autoimmune haemolytic anaemia treated by therapeutic plasma exchange and retuximab: A case report." Bangladesh Medical Research Council Bulletin 45, no. 2 (August 7, 2019): 126–28. http://dx.doi.org/10.3329/bmrcb.v45i2.42546.
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Autoimmune haemolytic anaemia (AIHA) is an uncommon disorder characterized by shortened red blood cell (RBC) survival and the presence of autoantibodies directed against autologous RBCs. It presents with anaemia, jaundice, and splenomegaly with reticulocytosis, unconjugated hyperbilirubinaemia, and direct antiglobulin test (DAT) positivity.' AIHA has an estimated incidence of 1—3 cases per 100,000 subjects per year, a prevalence of 17:100,000 and a mortality rate of 11%.' AIHA is classified as warm AIHA (75.0% of all AIHA cases), cold AIHA (about 15.0%), and mixed type AIHA (less than 5.0%), based on the thermal range of autoantibodies involved in the pathogenesis.6 It can be idiopathic (50.0%) or secondary to lymphoproliferative syndromes (20.0%), autoimmune diseases (20.0%), infections, tumors and drugs.’ The laboratory diagnosis of AIHA depends on the result of direct antiglobulin test (DAT) which shows positivity with anti-IgG (usually in warm AIHA) and/or anti-C3d (usually in cold AIHA) antisera, and also the presence of laboratory findings supporting hemolysis such as increase of serum lactate dehydrogenase (LDH), reticulocytosis and spherocytosis in peripheral blood smears.‘ The treatment of AIHA is still not evidence-based. The first-line therapy for warm AIHA is corticosteroids, which are effective in 70.0-85.0% of patients and should be slowly tapered over a time period of 6-12 months. For refractory/relapsed cases, the current sequence of second-line therapy is splenectomy (effective approx. in 2 out of 3 cases but with a presumed cure rate of up to 20.0%), rituximab (effective in approx. 80.0-90.0% of cases), and thereafter any of the immunosuppressive drugs (azathioprine, cyclophosphamide, cyclosporin, mycophenolate mofetil). Additional therapies are intravenous immunoglobulins, danazol, plasma-exchange, and alemtuzumab and high-dose cyclophosphamide as last resort option.’ Most of the immunosuppressive drugs have many deleterious side-effects and the onset of action is slow. Splenectomy carries the risk of an overwhelming post splenectomy sepsis.‘ Rituximab (so called “medical splenectomy”) is an effective second-line therapy, can work quickly with lasting effects, providing high initial response rates up to 87.0% and prolonged disease free survivals of 56.0% up to 2 years with reduced adverse reactions.‘ ' For warm AIHA, rituximab therapy is considered as a second line option as monotherapy or combined therapy. It can also be used as a first line therapy in combination with steroids for newly diagnosed patients. ' Another option, with less supportive
evidence in the literature, is the use of therapeutic plasma exchange (TPE) to quickly reduce the pahologic antibody titer in patients with an overwhelming hemolysis. 2 TPE has been performed in a relatively small
number of severely affected warm AIHA patients in whom the anemia could not be stabilized with steroids
and transfusion therapy alone, as a temporizing measure which seemed to stabilize the disease and increase the efficiency of blood transfusions.4 Current indication categories endorsed by the American Association of Blood Banks (AABB) and the American Society for Apheresis, TPE for AIHA is considered as acategory III indication, i.e. an application representing “heroic or last-ditch efforts on behalf of a patient”." Decision to transfuse RBC in AIHA should be based on the clinical condition of the patient. No critical patient should be denied blood transfusion due to serological incompatibility and “the least incompatible” RBC should be transfused in this situation.4 ”' Severe AIHA cases sometimes misdiagnosed or lately diagnosed. Early diagnosis and appropriate emergency interventions can save the life of these patients. In this case, we demonstrate the concomitant use of TPE and rituximab in the treatment of life-threatening warm AIHA.
Bangladesh Med Res Counc Bull 2019; 45: 126-128
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Dau, Peter C. "Increased antibody production in peripheral blood mononuclear cells after plasma exchange therapy in multiple sclerosis." Journal of Neuroimmunology 62, no. 2 (November 1995): 197–200. http://dx.doi.org/10.1016/0165-5728(95)00121-4.
Full textDissertations / Theses on the topic "Blood plasma exchange therapy"
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Davies, Philip Andrew. "Physical and engineering aspects of protein separation processes." Thesis, University of Oxford, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.253017.
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Ren, Yuan. "The Plasma, Whole Blood and Intracellular Concentrations of Antiretroviral Agents in South African Children Receiving Combination Antiretroviral Therapy with and without Concomitant Antitubercular Treatment." Doctoral thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3297.
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Background: Tuberculosis (TB) is the most common opportunistic infection in children with human immunodeficiency virus (HIV) infection in developing countries, and co-treatment for HIV infection and TB is frequently indicated. Efavirenz and lopinavir/ritonavir (ratio 1:1) as part of antiretroviral therapy are used in combination with rifampicin-based antitubercular treatment in South African TB/HIV co-infected children. Adult studies show that concomitant rifampicin significantly reduces efavirenz and lopinavir plasma concentrations. However, the pharmacokinetics (PK) of efavirenz and lopinavir/ritonavir are poorly characterized in children, especially African children and no study has evaluated the effect of rifampicin-based antitubercular treatment on efavirenz and lopinavir/ritonavir plasma concentrations in children. Although therapeutic drug monitoring (TDM) is recommended in selected patients (including young children and patients receiving concomitant antitubercular treatment), TDM is seldom available in resource-constrained countries. There is an urgent need to develop a field friendly method which requires small volumes of blood, and inexpensive processing and storage conditions. Furthermore, because HIV replicates in the cells, efavirenz and lopinavir need to penetrate into these infected cells to inhibit viral replication. Therefore, directly measurement of intracellular concentrations of these drugs in HIV-infected children could provide better understanding of drug exposure at the action site. It is also important to evaluate the effects of frequently co-administered drugs on intracellular accumulation of efavirenz and lopinavir. Objectives: 1) To evaluate efavirenz and lopinavir/ritonavir plasma concentrations and determine the effects of rifampicin on efavirenz and lopinavir/ritonavir PK in HIV-infected African children with and without rifampicin-based antitubercular treatment. 2) To develop and validate the dried blood spot (DBS) method as an alternative to conventional plasma methods of drug concentration measurement in TDM. 3) To evaluate in vivo intracellular concentrations of efavirenz and lopinavir/ritonavir in HIV-infected children with and without concomitant antitubercular treatment. 4) To determine the in vitro modulation effects on the intracellular accumulation of efavirenz IV and lopinavir in human peripheral blood mononuclear cells (PBMCs) by drug efflux protein inhibitors, as well as frequently co-administered rifampicin and ritonavir (at low dose; as pharmacoenhancer). Methods: 1) Plasma efavirenz and lopinavir/ritonavir concentrations were measured by validated liquid chromatography/tandem mass spectrometry (LC/MS/MS) method in TB/HIV co-infected children during and after rifampicin-based antitubercular treatment as well as in a group of controls (HIV-infected children without TB). Children in the efavirenz study (n= 30) were receiving standard doses of efavirenz as part of antiretroviral treatment. Trough concentrations (Cmin) of efavirenz were estimated by extrapolation of the log-linear concentration-time line to 24 hours after the previous dose. Children in the lopinavir/ritonavir study were receiving additional ritonavir (lopinavir: ritonavir ratio 1:1) during antitubercular treatment (n= 15), and standard doses of lopinavir/ritonavir (LPV/r; ratio 4:1) after antitubercular treatment, and in controls (n= 15). The PK of lopinavir and ritonavir were characterized from concentration-time curves using WinNonlin version 4.1 by non-compartmental analysis. 2) Aliquots of 50 μ L of whole blood from the efavirenz and lopinavir/ritonavir studies were dried onto filter paper. The drug concentrations were analyzed using validated LC/MS/MS method. The effects of high temperature and direct sunlight on the stabilities of these antiretroviral drugs in DBS samples were tested. 3) Intracellular concentrations of efavirenz, lopinavir and ritonavir were measured in trough concentrations of 11 TB/HIV co-infected children using a validated LC/MS/MS method. Six children were receiving double dose of LPV/r (4:1) with concomitant rifampicin; 5 children were receiving standard doses of efavirenz with rifampicin-based antitubercular treatment, 3 of them had intracellular concentrations measured again after completing rifampicin-based antitubercular treatment. 4) in vitro intracellular accumulation of efavirenz and lopinavir were measured in human PBMCs in the absence and presence of P-glycoprotein inhibitors (verapamil at 50 μ M, V furosemide at 50 μ M and cyclosporine A at 20 μ M) and frequently co-administered drugs at levels representing the average concentrations found in patients (ritonavir at 5 mg/L and rifampicin at 4 mg/L). The concentrations of efavirenz and lopinavir in PBMCs were determined by LC/MS/MS. Results and Conclusions: 1) The co-administration of rifampicin did not significantly reduce efavirenz estimated Cmin concentrations. A high proportion of children with and without concomitant antitubercular treatment had sub-therapeutic efavirenz concentrations despite being correctly dosed according to the manufacturer's instructions, raising concerns about the adequacy of current efavirenz dosing recommendations in children. The lopinavir key PK parameter, Cmin, was not significantly different in same group of children during and after rifampicin-based antitubercular treatment or compared to HIV-infected children without tuberculosis. The recommended minimum therapeutic concentration was achieved in 87% of children during antitubercular treatment and in 92% without concomitant antitubercular treatment. Therefore, in the context of limited options, LPV/r with additional ritonavir (ratio 1:1) is an acceptable approach to treat young children receiving concomitant rifampicin-based antitubercular treatment, although safety remains a concern and hepatic alanine transaminase levels should be monitored regularly. 2) Plasma and DBS concentrations of efavirenz, lopinavir and ritonavir were strongly correlated. The median (interquartile range, IQR) DBS/plasma concentration ratios for efavirenz, lopinavir and ritonavir were 0.93 (IQR 0.83, 1.08), 0.73 (IQR 0.61, 0.90) and 1.05 (IQR 0.74, 1.21), respectively. PK parameters of efavirenz and ritonavir were closely similar between DBS and plasma; whereas lopinavir pre-dose and Cmin (at 12 hours after lopinavir intake) concentrations were 16% lower in DBS samples. The 3 antiretroviral drugs in DBS samples were stable at 37 deg C for 7 days and with exposure to direct sunlight for 2 hours. DBS can be used as an alternative field-friendly method for efavirenz, lopinavir and ritonavir concentration monitoring. However, pre-dose and Cmin concentrations of lopinavir in DBS samples need to be increased by 16% when used to predict plasma concentrations. VI 3) In vivo median intracellular/plasma concentration ratios for efavirenz, lopinavir and ritonavir amongst 11 TB/HIV co-infected children during antitubercular treatment were 0.91 (IQR 0.54, 1.19), 0.22 (IQR 0.09, 0.31) and 4.17 (IQR 1.30, 7.33), respectively. Two children had efavirenz intracellular/plasma concentration ratios during vs. after antitubercular treatment: 1.00 vs. 0.61 and 0.27 vs. 0.79. 4) Furosemide significantly increased efavirenz and lopinavir accumulation in healthy human PBMC samples by 1.2- 1.5 fold. Whereas, neither verapamil nor cyclosporin A had significant effects on efavirenz or lopinavir intracellular accumulation. Despite being an inducer of P-glycoprotein, rifampicin increased the accumulation of both efavirenz and lopinavir to different extents in all 3 PBMC samples. The low-dose ritonavir (at the concentration found in HIV-infected patients) had no effect on intracellular accumulation of efavirenz and lopinavir at therapeutic concentrations.
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Roynette, Catherine E. "Effects of a functional oil rich in medium chain triglycerides and phytosterols on plasma lipid profiles and body composition in hypercholesterolemic, overweight men." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=84069.
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Localised accumulation of body fat significantly influences the development of obesity related co-morbidities and cardiovascular disease (CVD) risk. Medium chain triglycerides (MCT) have been suggested to modulate body fat distribution. Phytosterols (PS) have demonstrated unequivocal cholesterol-lowering effects. A healthy dietary solution combining MCT and PS could thus become first-line obesity and CVD prevention. The aim of this study was therefore to investigate the effects of a functional oil (FctO) rich in MCT and PS on blood lipid levels and body adiposity, compared to olive oil. Twenty-three hypercholesterolemic, overweight men, were randomly assigned, in a single-blind crossover study, to consume a FctO, or olive oil, incorporated into a 40% fat diet for 6 wks. Blood lipid levels were measured and body composition was assessed. Total and LDL cholesterol were significantly reduced in subjects consuming the FctO versus the control oil. No significant differences for weight or adiposity loss of subjects were observed between the two oils. Results support the cardio-protective role of this FctO.
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Sampaio, Thiago Pacheco de Almeida. "Relação entre a concentração de serotonina no plasma rico em plaquetas e a resposta à terapia comportamental baseada em exposição com prevenção de resposta no transtorno obsessivo-compulsivo." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5142/tde-20022009-141000/.
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INTRODUÇÃO: Entre os tratamentos existentes para o transtorno obsessivocompulsivo (TOC) os mais eficazes são o farmacológico, com inibidores de recaptura de serotonina (IRS; inibidores seletivos de recaptura de serotonina [ISRS] e clomipramina), e o comportamental, baseado na técnica de exposição com prevenção de resposta (EPR). Ambas apresentam eficácia semelhante para os sintomas obsessivo-compulsivos e estudos demonstram que a EPR produz modificações neurobiológicas semelhantes às provocadas pelo tratamento com ISRS. Essas evidências sugerem que a resposta clínica à EPR está diretamente relacionada a um aumento da biodisponibilidade de 5HT no cérebro. A concentração de 5HT no sangue periférico é uma medida representativa do sistema serotonérgico central, e é utilizada como um marcador biológico indireto. O objetivo deste estudo foi comparar a concentração serotonérgica (basal e variação em 8 semanas) e a resposta à terapia comportamental baseada em EPR. MÉTODOS: Foram incluídos nesse estudo 30 pacientes com diagnóstico operacional de TOC. Destes, 29 iniciaram o tratamento, 27 chegaram até a quarta semana e 24 completaram o protocolo padronizado com 16 sessões (8 semanas) de terapia. As dosagens de 5-HT foram feitas nas semanas 0 e 8 e as avaliações clínicas pelas escalas Y-BOCS e CGI, bem como medidas de sintomas secundários (depressão, ansiedade e incapacidade) nas semanas 0, 4 e 8. RESULTADOS: Encontrou-se correlação positiva entre a concentração basal de 5HT e a resposta clínica em quatro semanas de EPR (p<0,05).Observouse maior concentração basal e maior redução em 8 semanas nos níveis de 5HT em pacientes respondedores comparados aos não respondedores. Entretanto não houve significância estatística. CONCLUSÃO: Na amostra estudada os dados sugerem que a alta concentração basal de 5-HT é um marcador biológico preditor de boa resposta clínica a quatro semanas de EPR. Amostras maiores talvez mostrassem a concentração de 5-HT no plasma rico em plaquetas como um preditor de resposta a 8 semanas de EPR. Protocolos com amostras maiores e com grupos controle são necessários para confirmar esses achadosINTRODUCTION: Both gold standard treatments for obsessive-compulsive disorder (pharmacotherapy with serotonin reuptake inhibitors, and behavioral with exposure and response prevention [ERP]) are equally effective. Studies have demonstrated similar neurobiological changes elicited by these different treatments in OCD patients. These findings are suggestive that the clinical response to ERP is directly related to an increase of the 5-HT concentration in the brain. The platelet 5-HT concentration have been shown as a representative measure of central serotonergic system and used as a biological marker of the synaptic transmition. OBJECTIVE: To compare the platelet 5-HT concentration (basal and variation in 8 weeks) and the clinical response to ERP treatment. METHODS: 30 OCD patients were included and 29 started the treatment. 27 patients compleated at list 4 weeks and 24 completed all 8 weeks (16 sesions) ERP protocol. Patients had the basal and final (after 8 weeks) platelet 5-HT concentrations dosed and the clinical response measured by Y-BOCS, CGI and measures of secondary symptoms as well (depression, anxiety and disability). RESULTS: Data shows a positive correlation between the basal concentration of 5-HT and the 4 week ERP response (p<0,05). There were higher basal concentration and reduction in 8 weeks of platelet 5-HT concentration in the responders group compared with non-responders. Nevertheless, this differences was not significant (p>0,05). CONCLUSION: In the studied sample data suggest that high basal 5-HT platelet concentration is a biologic predictor of fast onset (4 weeks) of clinical response to ERP. Probably larger samples would show the basal 5-HT platelet concentration as a predictor of 8 weeks ERP outcome. Controlled trials are needed to confirm these findings
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Santos, Patrícia da Silva. "Cationic porphyrins in the photoinactivation of viruses in blood." Master's thesis, 2019. http://hdl.handle.net/10773/29251.
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In the last years, besides the implementation of haemovigilance systems in many countries, the application of blood disinfection methods has been used in order to improve transfusion quality and safety. However, infections transmitted through blood transfusion still occur. The development of new methods to treat not only plasma and platelets, but also the whole blood and erythrocytes concentrates, can be an important measure to decrease the incidence of blood transfusion infections. Conventional disinfection techniques are currently in use essentially for plasma due to the collateral damage in cellular fractions. Antimicrobial photodynamic therapy (aPDT) represents an alternative to the conventional methods even for the whole blood and erythrocytes concentrates. aPDT involves the exposure of a photosensitizer (PS) to light in the presence of oxygen, which results in the production of reactive oxygen species (ROS) that causes irreversible damage in the pathogenic microorganisms. This therapy is already approved in some countries, but is limited to the use of three PSs, methylene blue (MB) for plasma disinfection and riboflavin and psoralen for plasma and platelet disinfection.
The aim of this study was to evaluate the aPDT effect using cationic porphyrinic PSs (Tri-Py(+)-Me, Tetra-Py(+)-Me and Tetra-S-Py(+)-Me) in the photoinactivation of viruses in plasma and whole blood and the results were compared with the efficiency of an already approved PS to disinfect plasma, the MB. Possible side effects of aPDT on erythrocytes were also assessed by osmotic fragility tests of erythrocytes cytoplasmic membrane using increasing NaCl concentrations and erythrocytes count before and after aPDT treatment. The T4 bacteriophage was used as a model of mammalian viruses. For this purpose, a phage suspension of 108 PFU/mL in plasma and whole blood was exposed to white light (150 mW/cm2) for 270 minutes with a PS concentration of 10 μM.
The results indicated that porphyrinic PSs were more effective than MB in the photoinactivation of T4 phage in plasma, with special emphasis of Tetra-S-Py(+)-Me. However, their efficiency decreased in the whole blood, possibly due to the aPDT blocking effects caused by the matrix complexity. None of the PSs tested caused osmotic stress and subsequent haemolysis in the erythrocytes at the isotonic condition. Therefore, porphyrinic derivatives, mainly the Tetra-S-Py(+)-Me, can be considered a promising PSs to photoinactivate viruses in plasma, but further improvements are required for aPDT use in whole blood.Nos últimos anos, além da implementação de sistemas de hemovigilância em muitos países, a aplicação de métodos de desinfeção de sangue tem sido utilizada para melhorar a qualidade e segurança das transfusões. No entanto, infeções transmitidas por transfusão de sangue ainda ocorrem. O desenvolvimento de novos métodos para tratar, não apenas o plasma e as plaquetas, mas também o sangue total e os concentrados de eritrócitos, pode ser uma medida importante para diminuir a incidência dessas infeções. Atualmente, técnicas convencionais de desinfeção são usadas apenas para plasma devido aos danos colaterais que estas causam nas frações celulares. A terapia fotodinâmica antimicrobiana (aPDT) representa uma alternativa aos métodos convencionais, mesmo para o sangue total e concentrados de eritrócitos. A aPDT envolve a exposição de um fotosensibilizador (PS) à luz na presença de oxigénio, o que resulta na produção de espécies reativas de oxigénio (ROS) que causam danos irreversíveis nos microrganismos patogénicos. Esta terapia já está aprovada em alguns países, mas é limitada ao uso de três PSs, o azul de metileno (MB) para a desinfeção de plasma e a riboflavina e o psoraleno para a desinfeção de plasma e plaquetas. O objetivo deste estudo foi avaliar o efeito da aPDT usando PSs porfirínicos catiónicos (Tri-Py(+)-Me, Tetra-Py(+)-Me e Tetra-S-Py(+)-Me) na fotoinativação de vírus no plasma e sangue total e os resultados foram comparados com a eficiência de um PS já aprovado para desinfetar plasma, o MB. Os possíveis efeitos colaterais da aPDT nos eritrócitos também foram avaliados através de testes de fragilidade osmótica da membrana citoplasmática dos eritrócitos usando concentrações crescentes de NaCl e da contagem de eritrócitos antes e após o tratamento com aPDT. O bacteriófago T4 foi utilizado como modelo de vírus que infetam mamíferos. Para tal, uma suspensão fágica de 108 PFU/mL em plasma e sangue total foi exposta à luz branca (150 mW/cm2) durante 270 minutos com uma concentração de PS de 10 μM. Os resultados indicaram que os PSs porfirínicos foram mais eficazes que o MB na fotoinativação do fago T4 no plasma, especialmente a Tetra-S-Py(+)-Me. No entanto, a sua eficiência diminuiu no sangue total, possivelmente devido aos efeitos bloqueadores da aPDT causados pela complexidade da matriz. Nenhum dos PSs testados promoveu stress osmótico e subsequente hemólise nos eritrócitos na condição isotónica. Assim, os derivados porfirínicos, principalmente a Tetra-S-Py(+)-Me, podem ser considerados PSs promissores para fotoinativar vírus no plasma, mas são necessárias melhorias para o uso da aPDT em sangue total.
Mestrado em Biologia Molecular e Celular
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Sousa, Vera Catarina Ferreira de. "Cationic porphyrinic photosensitizers in the inactivation of Candida albicans in blood." Master's thesis, 2019. http://hdl.handle.net/10773/28437.
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Blood is an essential body fluid but is yet a source of microbial infections transmission. Consequently, the ability to disinfect blood and its derivatives has assumed great importance. Currently, the most used method for inactivating microorganisms, which can be only used in plasma or protein concentrates, is the combined use of a tri(n-butyl)phosphate and the detergent Tween 80. However, these chemicals must be removed after disinfection procedure once they are harmful to the membranes of erythrocytes and platelets of blood receptors. Antimicrobial Photodynamic Therapy (aPDT) has been suggested as an alternative technique to blood disinfection. Methylene blue (MB), psoralen and riboflavin are already approved photosensitizers (PS) in some countries to disinfect plasma/platelets, but there is no aPDT approved application for whole blood and erythrocytes concentrates. The aim of this study was to evaluate the effectiveness of aPDT to inactivate Candida albicans in blood, a microorganism frequently involved in bloodstream infections. For that, several cationic porphyrin derivatives were used to photoinactivate C. albicans in phosphate buffered saline (PBS), plasma and whole blood. Once MB is the mostly used PS to disinfect plasma, its efficacy was also evaluated for comparison. Samples and controls were exposed for 270 min to white light (380-700 nm) at an irradiance of 2.5 mW/cm2 and 150 mW/cm2 for PBS and whole blood/plasma, respectively.
All the tested cationic porphyrin derivatives were effective to photoinactivate C. albicans in PBS. However, MB under the same conditions (concentration and light dose) did not appear to be efficient in C. albicans inactivation. In plasma, FORM and Tri-Py(+)-Me proved to be promising PSs in C. albicans photoinactivation. Although in whole blood the inactivation rates obtained with porphyrin derivatives were higher than the ones obtained with MB, further improvements are required. Nevertheless, the results indicate that aPDT using cationic porphyrinic photosensitizers seems to be a promising approach for the photoinactivation of C. albicans in plasma.
Additionally, none of these PSs, in the tested concentrations in plasma and whole blood, had promoted significant hemolysis at the isotonic conditions when hemolysis was evaluated in whole blood and after the addition of aPDT treated plasma with these PSs to concentrated erythrocytes.O sangue é um recurso essencial, porém também é uma fonte de transmissão de infeções. Consequentemente, a capacidade de desinfetar o sangue e seus derivados assume uma grande importância na prática clínica. Atualmente, o método de desinfeção mais eficaz na inativação de microrganismos usado apenas em plasma e concentrados proteicos, baseia-se no uso combinado do tri(n-butil)fosfato e do detergente Tween 80. No entanto, estes produtos devem ser removidos após o procedimento de desinfeção, pois são prejudiciais quer para as membranas dos eritrócitos quer para as plaquetas dos indivíduos transfundidos. A Terapia Fotodinâmica Antimicrobiana (aPDT) tem sido sugerida como uma técnica alternativa à desinfeção do sangue. Os fotossensibilizadores (PS) azul-de-metileno (MB), derivados de psoraleno e riboflavina já se encontram aprovados em alguns países para desinfetar plasma e plaquetas, no entanto não há até à data nenhuma aplicação aprovada baseada em aPDT para a desinfeção de sangue total e de concentrados de eritrócitos. O objetivo deste estudo foi avaliar a eficácia da aPDT na inativação de Candida albicans, um microorganismo frequentemente envolvido em infeções sistémicas. Para isso, foram usados derivados porfirínicos catiónicos na fotoinativação de C. albicans em tampão fosfato-salino (PBS), plasma e sangue total. Uma vez que o MB é o PS mais usado para desinfetar plasma, a sua eficácia também foi avaliada para comparar com a eficiência dos derivados porfirínicos testados. As amostras e os controlos foram expostos durante 270 min a luz branca (380-700 nm) com uma irradiação de 2,5 e 150 mW/cm2 para PBS e sangue total / plasma, respetivamente. Todos os derivados porfirínicos catiónicos testados foram eficazes na fotoinativação de C. albicans em PBS, no entanto, o MB nas mesmas condições (concentração e dose de luz) não demonstrou possuir capacidade de inativar C. albicans. No plasma, a FORM e Tri-Py(+)-Me provaram ser fotossensibilizadores promissores na inativação de C. albicans. Apesar de no sangue total as taxas de fotoinativação obtidas com os fotossensibilizadores porfirínicos tenham sido mais altas que as obtidas com MB, mais estudos serão necessários para melhorar as taxas de inativação obtidas. No entanto, os resultados indicam que a aPDT usando fotossensibilizadores porfirínicos catiónicos parece ser uma abordagem promissora para a fotoinativação de C. albicans no plasma. Destaca-se o facto que nenhum destes fotossensibilizadores porfirínicos nas concentrações testadas no plasma e no sangue total promoveu hemólise significativa em condições isotónicas. Uma situação similar foi observada quando foi avaliada a hemólise após a adição de plasma tratado com esses PSs a concentrados de eritrócitos.
Mestrado em Biomedicina Molecular
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Medina, Martínez Ana Maria. "Transport in the blood of an anti-tumor water-soluble rutheniun cyclopentadienyl complex: a fluorescence study on albumin binding." Master's thesis, 2014. http://hdl.handle.net/10400.1/8664.
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Dissertação de mestrado, Qualidade em Análises, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2014O Cancro é a segunda maior causa de morte em países desenvolvidos. Estima-se que o número global de mortes por cancro aumente em 50% até 2030, criando a necessidade urgente de encontrar soluções para este problema de saúde global. A cisplatina, carboplatina e oxaliplatina são os únicos metalofármacos aprovados para uso clínico em todo o mundo mas, apesar da sua eficácia, apresentam efeitos secundários que limitam muito a sua utilização. Os compostos de ruténio são já reconhecidos como uma alternativa promissora aos fármacos de platina usados em quimioterapia, dada a sua menor citotoxidade e maior selectividade. Além disso, oferecem diferentes mecanismos de acção e um espectro de atividade diferente, mais alargado, que os metalofármacos de Pt. O seu mecanismo de acção é intensamente estudado actualmente e a ligação a proteínas séricas parece ter um papel importante na sua resposta biológica. O estudo da interacção com proteínas séricas e com a albumina do plasma humano (HSA) em particular reveste-se de uma grande importância no contexto do desenvolvimento de metalofármacos. Por um lado, a interacção com a albumina tem um impacto importante na biodisponibilidade do complexo em estudo. Por outro lado, a HSA desempenha um papel fulcral no transporte de compostos endógenos e exógenos, sendo também crucial como veiculo transportador de compostos terapêuticos para lhe permitir atingir as células e tecidos-alvo onde exercem a sua acção. Além disso, é um requisito da FDA (Food and Drug Administration) que resultados da interacção com proteínas séricas sejam incluídos no processo de pre-selecção de potenciais fármacos e metalofármacos. Neste trabalho estudou-se a interacção de um complexo organometálico de ruténio(II) de estrutura em banco de piano com a albumina de plasma humano (sem ácidos gordos, fafHSA). O complexo [RuII(Cp)(bipy)(CO)][PF6] (designado neste trabalho por RuC), com uma actividade moderada para o adenocarcinoma de ovário humano, é solúvel em água o que o torna muito interessante no contexto de desenvolvimento de novos agentes terapêuticos. A sua ligação à HSA foi estudada em meio aquoso a pH 7.4 (tamponizado com HEPES) e à temperatura de 37ºC por espectroscopia de UV-Vis e espectroscopia de Fluorescência (em estado estacionário e resolvida no tempo) usando a emissão do resíduo Trp214 da proteína como sonda de fluorescência intrínseca. A interacção do complexo com a HSA ocorre rapidamente e resulta na extinção da fluorescência do Trp214 por um processo misto estático e dinâmico, para o qual se obtiveram as constantes de Stern-Volmer KD = (4,8 ± 0,3)x104 M-1 e KS =(2,3 ± 0,7)x104 M-1 (calculadas a em=338 nm pelo método dos mínimos quadráticos para um nível de confiança de 95%). O modelo proposto para a interacção RuC–HSA engloba a formação de dois aductos complexo-proteína de estequiometrias 1:1 e 1:2 para os quais são calculadas constantes de formação condicionais log β’1= (4,78 ± 0,01) (para o aducto 1:1 {HSA-RuC}) e log β’2= (9,52 ± 0,01) (para o aducto 1:2 {HSA-(RuC)2}. Reacções de competição com “marcadores” conhecidos como a varfarina e a dansilglicina, para os quais a ligação à HSA é específica e está bem estudada, são utilizadas para obter informação sobre os locais de ligação do RuC à proteína. Os resultados obtidos neste trabalho permitem concluir que o complexo organometálico estudado interactua com a HSA de forma moderada, podendo ser eficientemente transportado pelo sangue através da ligação a esta proteína.
Ruthenium (Ru) complexes have captivated an increasing interest in recent years; they are a promising alternative to platinum-based complexes due to the fact that some of them have been repeatedly described for showing higher selectivity and lower cytotoxicity regarding their effects on cancer cells. The interactions studied between the Ru-complexes and serum proteins such as fatty acid free Human Serum Albumin (fafHSA) are of very high importance considering that their bioavailability and effects depend on their binding to albumin to reach the targeted cells. In addition, the Food and Drug Administration (FDA) has set the report on plasma protein binding for prodrugs as a requirement in order to do the screening for potential therapeutic agents. The interactions and several aspects related to the binding between the ruthenium (II) complex [RuII(Cp)(bipy)(CO)][PF6] (or RuC, also named pmc44) and HSA are addressed using fluorescence spectroscopy, steady-state and time-resolved measurements, and UV-Visible absorption in 10 mM HEPES buffered medium pH 7,4. Additionally, in order to obtain a deeper insight into the HSA binding properties of the complex at the specific drug binding sites, displacement experiments with the site markers Warfarin and Dansylglycine (for which the binding site is well known) were performed. The results show that the complex strongly quenches the intrinsic fluorescence of albumin and that the interaction is quite fast, indicating that the complex successfully binds the protein. The outcome from the Stern-volmer linearizations (both time-resolved and steady-state measurements) displayed more than one type of quenching mechanism; albumin fluorescence is quenched by a combination of dynamic and static quenching mechanisms. The most representative values obtained for KD and KS from the averages were (4,8 ± 0,3)x104 M-1 and (2,3 ± 0,7)x104 M-1 respectively, calculated with the Stern-Volmer linearization at em=338 nm by a Minimum Square Fit procedure with variance analysis (ANOVA) with a 95% confidence level. A speciation model with two protein-RuC adducts is proposed with global conditional binding constants of log β’1= (4,78 ± 0,01) (for the 1:1 adduct {HSA-RuC}) and log β’2= (9,52 ± 0,01) (for the 1:2 adduct {HSA-(RuC)2} with a fitting parameter of 1,16x105 using the computer program PSEQUAD. The conclusions achieved with the site markers´ experiments revealed that the complex binds to both sites I and II of the protein. Altogether, the results from this work indicated that the complex studied can bind human serum albumin in a moderate way and thus it be efficiently transported in the blood by HSA.
Books on the topic "Blood plasma exchange therapy"
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G, Rock, ed. Apheresis: Proceedings of the 2nd International Congress of the World Apheresis Association, held in Ottawa, Ontario, Canada, May 18-20, 1988. New York, NY: Wiley-Liss, 1990.
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Patrias, Karen. Therapeutic plasmapheresis in neurological disorders: January 1980 through April 1986 : 371 citations. Bethesda, Md: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, 1986.
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Adam, Sheila, Sue Osborne, and John Welch. Haematological problems. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199696260.003.0012.
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This chapter discusses specific haematological disorders that require the patient to be admitted to the critical care unit. It describes the normal physiology of blood cells, clotting mechanisms, and fibrinolysis, and the management of related conditions such as thrombocytopenia, leukaemia, and clotting disorders such as disseminated intravascular coagulation. It also includes the management of the critical care patient with haematological malignancy. Specific therapies such as plasma exchange and anticoagulation therapy are discussed in detail and the monitoring of coagulation tests is explained. The chapter also describes the administration of blood and blood products, together with their associated hazards, and the effects of massive transfusions of blood.
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Cohen, Jeffrey A., Justin J. Mowchun, Victoria H. Lawson, and Nathaniel M. Robbins. A 30-Year-Old Male Requiring Management of Progressive Weakness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190491901.003.0006.
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Management of Guillain-Barré syndrome involves several factors. Pulmonary function tests are important to monitor. Telemetry and blood pressure must be monitored because of the significant risk of autonomic dysfunction. Intravenous immunoglobulin is the immunotherapy of choice for this disease, as it is less complicated to administer than plasma exchange. Supportive management issues to address include deep vein thrombosis prophylaxis, bowel/bladder care as ileus and urinary retention may be develop secondary to dysautonomia, physical/occupational/speech therapy consults, nutrition, and pain control. Gabapentin can also be helpful for GBS-related pain. This chapter discusses an approach to treatment that includes the role of respiratory and autonomic monitoring as well as immunotherapy considerations.
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V, Prowse Christopher, ed. Plasma and recombinant blood products in medical therapy. Chichester: Wiley, 1992.
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Treib, Johannes. Volume Therapy. Edited by Johannes Treib. SPRINGER-VERLAG, 2000.
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Treib, Johannes. Volume Therapy. Springer, 2012.
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Valverde, Jose Luis. Blood, Plasma and Plasma Proteins: A Unique Contribution to Modern Healthcare. IOS Press, 2006.
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Fabrizi, Fabrizio, and Patrice Cacoub. The patient with cryoglobulinaemia. Edited by Giuseppe Remuzzi. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0151.
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AbstractCryoglobulinaemia is characterized by the presence in the blood of proteins showing the that precipitate when serum is cooled. Clinically recognised cryoprecipitates are predominantly immunoglobulin-containing. In Type 1 cryoglobulinaemia, the precipitate is formed from a monoclonal paraprotein, usually IgG. In Type 2, a monoclonal IgM binds IgG to form a mixed precipitate. Type 3 cryoglobulins do not contain a monoclonal element.Type 1 cryoglobulins are a rare cause of renal disease, but cause a membranoproliferative glomerulonephritis (MPGN) with nephrotic syndrome and haematuria and usually with severe cutaneous involvement.Type 2 is most typically associated with renal disease, again characterized by MPGN and haematuria, with variable cutaneous signs and vasculitis in other organs. Many cases are associated with Hepatitis C virus (HCV) infection – but not all.Therapeutic approaches include optimal antiviral regimen, immunosuppressive therapy (corticosteroids, rituximab, and cytotoxic agents), and plasma exchange. Treatment of HCV-related mixed cryoglobulinaemia vasculitis should be adjusted according to the clinico-biological presentation.
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Summers, Stephanie H., Dennis M. Smith, and Viktor A. Agranenko. Transfusion Therapy: Guidelines for Practice. Amer Assn of Blood Banks, 1990.
Find full textBook chapters on the topic "Blood plasma exchange therapy"
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Katagiri, Daisuke, and Hideo Kurosawa. "Plasma Exchange." In The Concise Manual of Apheresis Therapy, 49–56. Tokyo: Springer Japan, 2013. http://dx.doi.org/10.1007/978-4-431-54412-8_4.
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Buskard, N. A., and B. Houwen. "Therapeutic plasma exchange." In Supportive therapy in haematology, 287–95. Boston, MA: Springer US, 1985. http://dx.doi.org/10.1007/978-1-4613-2577-2_28.
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Sakellariou, G., M. Daniilidis, E. Alexopoulos, E. Kokolina, P. Koukoudis, D. Gakis, and M. Papadimitriou. "Plasma Exchange in Treatment of Acute Vascular Rejection." In Current Therapy in Nephrology, 141–43. Boston, MA: Springer US, 1989. http://dx.doi.org/10.1007/978-1-4613-0865-2_36.
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Friesen, A. D. "Column Ion Exchange Chromatographic Production of Albumin, IV ISG and Factor IX from 75,000 to 100,000 Litres of Plasma per Year." In Plasma Fractionation and Blood Transfusion, 97–103. Boston, MA: Springer US, 1985. http://dx.doi.org/10.1007/978-1-4613-2631-1_13.
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Bocci, Velio. "Can Ozone be Useful for Banked Blood or Fresh Frozen Plasma?" In Oxygen-Ozone Therapy, 351–52. Dordrecht: Springer Netherlands, 2002. http://dx.doi.org/10.1007/978-94-015-9952-8_33.
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Stussi, Georg, Andreas Buser, and Andreas Holbro. "Red Blood Cell Exchange: When and Why?" In Advances and Controversies in Hematopoietic Transplantation and Cell Therapy, 151–60. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-55131-9_12.
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Goldstein, Stuart L. "Plasmapheresis and Total Plasma Exchange in the PICU." In Critical Care Nephrology and Renal Replacement Therapy in Children, 325–35. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-90281-4_21.
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Handisurya, Ammon, Christof Aigner, Benjamin Schairer, and Kurt Derfler. "Therapeutic Plasma Exchange and Immunoadsorption: Indications and Implementation." In Advances and Controversies in Hematopoietic Transplantation and Cell Therapy, 135–50. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-55131-9_11.
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Dutcher, Janice P. "Therapeutic Cytapheresis, Plasmapheresis, and Plasma Exchange in Neoplastic Diseases of the Blood." In Neoplastic Diseases of the Blood, 1241–49. New York, NY: Springer New York, 2012. http://dx.doi.org/10.1007/978-1-4614-3764-2_54.
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Dutcher, Janice P. "Therapeutic Cytapheresis, Plasmapheresis, and Plasma Exchange in Neoplastic Diseases of the Blood." In Neoplastic Diseases of the Blood, 1129–37. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-64263-5_52.
Full textConference papers on the topic "Blood plasma exchange therapy"
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De Crée, J., H. Geukens, H. Demoen, and H. Verhaegen. "HEM0RRHE0L0GY AND KETANSERIN." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644212.
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Red blood cell (RBC) filtration in platelet rich plasma (PRP) and platelet poor plasma (PPP) was equally decreased (p < 0.0001) in 120 patients with acute myocardial infarction (AMI) as compared to a control group. In a double-blind experiment 2 groups of 30 patients with AMI received an acute oral dose of 60 mg of ketanserin, a serotonin (5-HT) antagonist at 5-HT2-receptors, or placebo. Ketanserin treatment improved RBC filtration in PRP with an average increase of 30%. A similar experiment using PPP showed a significant increase of 10%. Filtration of plasma improved after ketanserin treatment in PRP, but not in PPP. Cross-exchange experiments showed the ketanserin-induced improvement of RBC filtration in PRP and PPP to be also plasmadependent. 5-HT in vitro at 10−9M deteriorated RBC filtration in PPP (p < 0.05), and ketanserin in vitro at 10−7M counteracted this phenomenon (p < 0.001). Finally we found that the effect of a subacute treatment with ketanserin on the filtration of RBC Suspensions, enriched with a constant amount of white blood cells (WBC), was more pronounced than on control RBC suspensions of patients with AMI.These results indicate that the impaired RBC filtration, reported in vascular diseases may be dependent on a subtle interaction between platelets, WBC, RBC and plasma. Treatment with ketanserin is capable to interrupt this vicious circle of rheological disturbances at different levels, first of all, by improving RBC deformability, but also by counteracting the platelet mediated effects on RBC and by favourably influencing the physical properties of WBC and so preventing clogging phenomena. Serotonin probably plays a pivotal role in these cascade of events and therapy with ketanserin might be of clinical value in diseases where microcirculatory flow is compromised.
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Baranova, L. N., and V. E. Kholmogorov. "Blood plasma: the inner filter for erythrocytes during UV irradiation of the blood." In Radiofrequency and Optical Methods of Biomedical Diagnostics and Therapy, edited by Valery V. Tuchin. SPIE, 1993. http://dx.doi.org/10.1117/12.146464.
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Voloshynska, Katerina, Tetjana Ilashchuk, and Sergey Yermolenko. "Spectropolarimetry of blood plasma in optimal molecular targeted therapy." In Advanced Topics in Optoelectronics, Microelectronics, and Nanotechnologies 2014, edited by Ionica Cristea, Marian Vladescu, and Razvan Tamas. SPIE, 2015. http://dx.doi.org/10.1117/12.2068189.
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Altshuler, V. M., Yakov I. Khanin, and Yury A. Mironov. "Changes of blood plasma optical absorption spectrum due to bilirubin photoconversion." In Radiofrequency and Optical Methods of Biomedical Diagnostics and Therapy, edited by Valery V. Tuchin. SPIE, 1993. http://dx.doi.org/10.1117/12.146466.
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Nichols, W. L., T. M. Habermann, S. E. Kaese, and E. J. W. Bowie. "GLANZMANN'S THROMBASTHENIA: HEMOSTATIC EFFECTIVENESS OF PLASMA CRYOPRECIPITATE TRANSFUSION." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644744.
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A 39-year-old 75 kg man with Type I Glanzmann's thrombasthenia developed recurring severe therapy-refractory nosebleeds, associated with nasal septal deformity, synechial scarring, and previous radiotherapy. During a 21 month period he required 16 hospitalizations for treatment of severe epistaxis. At initial hospitalization it was observed that his epistaxis ceased shortly after transfusion of 10 bags (units) of plasma cryoprecipitate (cryo), although transfusion with HLA-matched apheresis platelets from 3 donors, and topical therapy (cautery, packing), had been ineffective. Serum anti-platelet antibodies were not detectable by indirect immunofluorescence. During 9 subsequent hospitalizations his epistaxis stopped promptly (usually within 1 hour) following cryo transfusion (10 or 20 bags), including 6 occasions when cryo was the only therapy. On 6 additional occasions his epistaxis did not stop following cryo transfusion, but did stop after subsequent platelet transfusions or topical therapy. Eventually he underwent nasal septal reconstructive surgery surgery, and severe epistaxis has not recurred. Hemostatic studies, before and after cryo transfusions on 5 occasions, did not show improvement of platelet aggregation defects nor of Ivy bleeding times, although occasionally the volume of blood emanating from bleeding time punctures appeared decreased following cryo transfusion. Platelet glycoprotein (GP) IIb/IIIa antigen was measured in aliquots of 10 of the pools of cryo received by the patient (representing 100 bags of total volume 2200 ml), using an immunoradiometric assay (Nichols et al, Blood 68:300a, 1986). On average, the transfused cryo pools contained GP IIb/IIIa equivalent to 1.1 x 108 platelets/ml (range 0.6-1.7 x 108/ml. Our recently reported studies of blood bank cryo documented similar GP IIb/IIIa levels, and revealed that >93% of GP IIb/IIIa in cryo is present in the form of sedimentable membranous platelet macroparticles and microparticles. We hypothesize that the GPIIb/IIla-bearing platelet particles in transfused cryo might account for the improvement in hemostasis we frequently observed. We conclude that cryo transfusion deserves further study as a potentially useful therapeutic adjunct in promoting hemostasis in individuals with Glanzmann's thrombasthenia.
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Nettboy, S., K. Wojnowski, J. Choi, M. Bhatia, and P. Eftekhari. "Acute Pulmonary Renal Syndrome in a Critically Ill Lupus Patient and the Use of Plasma Exchange and Rituximab as Rescue Therapy." In American Thoracic Society 2021 International Conference, May 14-19, 2021 - San Diego, CA. American Thoracic Society, 2021. http://dx.doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2037.
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Kalghatgi, Sameer, Alexander Fridman, Gary Friedman, and Alisa Morss Clyne. "Non-Thermal Atmospheric Pressure Dielectric Barrier Discharge Plasma Enhances Endothelial Cell Proliferation via Fibroblast Growth Factor-2 Release." In ASME 2009 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2009. http://dx.doi.org/10.1115/sbc2009-206545.
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Cold atmospheric pressure plasma is currently being investigated for a wide range of clinical applications, including skin sterilization, blood coagulation [1, 2], malignant cell apoptosis [1], and wound healing [1]. However, the effect of non-thermal plasma on the vasculature is unclear. Blood vessels are affected during plasma treatment of all tissues, and vessels themselves may be an important potential target for clinical plasma therapy.
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Rodríguez-Pintό, I., G. Espinosa, D. Erkan, Y. Shoenfeld, and R. Cervera. "OP0231 The effect of “triple therapy” with anticoagulation plus corticosteroids plus plasma exchange and/or intravenous immunoglobulins on the mortality of catastrophic antiphospholipid syndrome (CAPS) patients." In Annual European Congress of Rheumatology, 14–17 June, 2017. BMJ Publishing Group Ltd and European League Against Rheumatism, 2017. http://dx.doi.org/10.1136/annrheumdis-2017-eular.3412.
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Kaudewitz, H., A. Henschen, and R. E. Zimmermann. "ON THE IDENTITY OF PLATELET FIBRINOGEN WITH PLASMA FIBRINOGEN." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1642934.
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It is a well established fact that fibrinogen occurs not only in blood plasma but also in the α-granules of the platelets. Recently, it has been shown that fibrinogen is synthesised in the megakaryocytes as well as in the liver. Plasma fibrinogen is derived from the liver, but platelet fibrinogen either exclusively or partially from the megakaryocytes. Conclusive, proteinche-mical evidence for the identity of the fibrinogens from the two biosynthetic sources has previously not been produced. However, the two fibrinogen preparations have been shown to have the same overall peptide chain composition, to be thrombin-clottable and release fibrinopeptides of A- and B-type, and to react with antibodies against plasma fibrinogen. The two preparations differ in the way that platelet fibrinogen lacks the higher-molecular-mass γ-chain variant.The aim of the present investigation was to conduct a detailed proteinchemical comparison between human plasma and platelet fibrinogen. For this purpose, fibrin(ogen)s from the two sources were mercaptolysed, alkylated and the three peptide chains isolated by reversed-phase high-performance liquid chromatography (HPLC). The peptide chains were then analysed directly for amino-terminal sequence and for carboxyterminal sequence by isolation of a terminal fragment. The HPLC-fingerprint patterns of the cyanogen bromide-cleaved chains were compared. The native fibrinogens were also treated with thrombin and the fibrinopeptide type distribution determined by reversed-phase HPLC. The carbohydrate side chain compositions were established by ion-exchange-chromatographic methods after acid hydrolysis. So far no previously unrecognized differences have been observed.
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Witt, W., B. Baldus, and P. Donner. "ANTITHROMBOTIC EFFECTS OF TISSUE-TYPE PLASMINOGEN ACTIVATOR AT PHYSIOLOGICAL BLOOD LEVELS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643575.
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Effective thrombolysis in human patients and experimental animals by tissue-type plasminogen activator (t-PA) usually requires t-PA plasma levels in the microgram range. Compared to that physiological plasma levels of t-PA are about 100 - 1000 times lower. To investigate the effects of t-PA at physiological blood levels rat studies were performed in vitro and in vivo employing highly purified recombinant single-chain t-PA (sct-PA: 500,000 IU/mg).t-PA activity in rat whole blood as assessed by dilute blood clot-lysis time (DBC-LT) was increased by addition of sct-PA as low as 3 ng/ml (20 % decrease in DBC-LT). Injection of brady-kinin 10, 100 and 1000 μg/kg i.v. shortened DBC-LT to 54, 23, and 10 % of controls corresponding to the effect of about 10, 30, and 100 ng/ml sct-PA added in vitro. Infusion of sct-PA 15 - 450 μg/kg/h i.v. shortened DBC-LT ex vivo dose-dependently by 20 - 90 % at steady state levels (n = 5). In the same dose range sct-PA inhibited thrombus formation along a silk thread introduced into an arteriovenous shunt in anaesthetized rats. The reduction in thrombus dry weight was dose-dependent amounting to 33 - 67 % of preapplication values (n = 5 - 8) at 15 - 450 μg/kg/h i.v. sct-PA. Already 50 μg/kg/h sct-PA corresponding to a sct-PA activity of about 15 ng/ml displayed a significant (a = 0.05) effect in this model.The results of this study suggest that t-PA present at physiological resting or activation (bradykinin) levels during acute clot formation may have potent antithrombotic efficacy. This study provides further evidence for the importance of a balance coagulation-fibrinolysis which can be influenced on both sides towards thrombophilia as well as to achieve antithrombotic therapy, e.g. by elevating plasma fibrinolytic activity with low-dose t-PA treatment or with drugs which stimulate the endogenous fibrinolytic potential.