Unité d'hémobiothérapie, APHP, Sorbonne Université, Hôpital De La Pitié-Salpêtrière, Paris, France.
Unité d'hémobiothérapie, APHP, Sorbonne Université, Hôpital De La Pitié-Salpêtrière, Paris, France.
Transfus Apher Sci. 2020 Dec;59(6):102991. doi: 10.1016/j.transci.2020.102991. Epub 2020 Nov 2.
Therapeutic plasma exchange (TPE) is a well-established therapeutic procedure commonly used in many disorders of autoimmune etiology. The beneficial effects of TPE occur through the removal of pathognomonic inflammatory mediators; including autoantibodies, complement components, and cytokines. The use of TPE in the emergency setting is limited to a few indications. In this chapter, we focus on four conditions that we are most frequently faced with in the urgency setting: neuromyelitis optica-spectrum disorders, solid organ transplantation, and two metabolic conditions such as major hypertriglyceridemia and hyperthyroidism. We discuss the clinical setting defining the urgent character of TPE, the timing of treatment onset, the therapeutic pattern of TPE and the level of evidence currently available for each condition.
治疗性血浆置换（TPE）是一种成熟的治疗方法，常用于许多自身免疫病因的疾病。TPE 的治疗效果是通过清除特征性炎症介质实现的，包括自身抗体、补体成分和细胞因子。TPE 在急诊环境中的应用仅限于少数适应症。在本章中，我们重点关注急诊环境中最常遇到的四种情况：视神经脊髓炎谱系疾病、实体器官移植，以及两种代谢疾病，如重度高甘油三酯血症和甲状腺功能亢进症。我们讨论了 TPE 的紧急情况的临床特征、治疗开始的时间、TPE 的治疗模式以及每种情况目前可用的证据水平。
