The use of emergency apheresis in the management of plasma cell disorders

Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis
Sevgi Kalayoglu-Besisik

Abstract

Hyperviscosity syndrome (HVS) develops most commonly in Waldenström's macroglobulinemia (WM) and multiple myeloma (MM). Plasmapheresis is the immediate therapy and very effective at relieving symptoms by removing paraprotein. The most commonly used replacement fluid is 4%-5% human albumin in physiologic saline. FFP may be used in patients with coagulation abnormalities. Plasmapheresis should be continued until acute symptoms abate. Hyperviscosity impairs the circulation in the retina and causes hemorrhages around the small retinal vessels. Early diagnosis and urgent plasmapheresis may reduce blindness caused by retinal hemorrhages and/or retinal detachment. In HCV related mixed cryoglobulinemias, plasmapheresis is indicated if rapidly evolving life-threatening disease with immunosuppressive agent exists. In non-infectious mixed cryoglobulinemia plasmapheresis is indicated when the disease manifestations are severe, as a second line option. In WM patients with hyperviscosity symptoms and IgM > 4 g/dL, preemptive plasmapheresis is recommended to prevent an IgM flare with rituximab. Certain IgG/A MGUS-associated neuropathy patients may benefit from plasmapheresis. For cast nephropathy (suspected or biopsy proven), plasmapheresis i...Continue Reading

Citations

Aug 15, 2018·Blood·Morie A Gertz
Mar 30, 2019·British Journal of Haematology·Elisabetta ZanattaFranco Cozzi
Feb 27, 2020·Case Reports in Rheumatology·Mateo Mejía-ZuluagaSebastián Herrera
Feb 20, 2021·European Journal of Ophthalmology·Tommaso MerzFederica Romanelli
Sep 1, 2021·Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis·Yasin KalpakciFevzi Altuntas
Jun 26, 2021·Expert Review of Hematology·Ilias PessachEfstathios Kastritis

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