Naciri Bennani Hamza, Marlu Raphael, Terrec Florian, Motte Lionel, Seyve Landry, Chevallier Eloi, Malvezzi Paolo, Jouve Thomas, Rostaing Lionel, Noble Johan
Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France.
Hemostasis Laboratory, Grenoble University Hospital, Grenoble, France.
J Clin Apher. 2021 Oct;36(5):766-774. doi: 10.1002/jca.21928. Epub 2021 Aug 2.
Double-filtration plasmapheresis (DFPP), a selective therapeutic apheresis, can deplete pathogenic antibodies/substances, but also important coagulation factors.
To determine if the use of a separator filter with different characteristics (CascadefloEC-50 W) as compared to the reference filter (PlasmafloOP-08 W) is as efficient in terms of immunoglobulin loss, but can reduce coagulation factor losses and have similar tolerability.
PATIENTS/METHODS: This is a single-center prospective study including 14 patients divided into two groups (7 each): that is, group1 = CascadefloEC-50 W and group2 = PlasmafloOP-08 W. We measured immunoglobulins, lipid profiles, blood-cell counts, hemostasis (prothrombin time, activated partial thromboplastin time), coagulation factors, and natural anticoagulants at before and after the first DFPP-session.
In group 1, the loss of coagulation factors was significantly reduced as compared to group 2 for proteins with a molecular weight of >150 kDa: there was, respectively, an average decrease of 70% vs 31% for fibrinogen (P = 0.004), 66% vs 21% for factor V (P = 2.16e-07), 60% vs 32% for factor XI (P = 6.96e-06), 75% vs 17% for XIII-antigen (P = 0.0002), and 47% vs 0% for VWF-antigen(P = 0.02). The decrease in post-session IgG was, on average, 45% in group 1 and 50% in group 2 (P = 0.13). Those results remained significant even when adjusted to the treated-plasma volume and the pre-DFPP factor values.
DFPP, using a CascadefloEC-50W as a first-filter, reduces efficiently IgGs similarly to PlasmafloOP-08W but spares clotting factors.
双重滤过血浆置换术（DFPP）是一种选择性治疗性血液成分分离术，它既能清除致病性抗体/物质，也会消耗重要的凝血因子。
确定与参考滤器（Plasmaflo OP - 08W）相比，使用具有不同特性的分离器滤器（Cascadeflo EC - 50W）在免疫球蛋白损失方面是否同样有效，但能否减少凝血因子损失并具有相似的耐受性。
患者/方法：这是一项单中心前瞻性研究，纳入14例患者，分为两组（每组7例）：即，第1组 = Cascadeflo EC - 50W，第2组 = Plasmaflo OP - 08W。我们在首次DFPP治疗前后测量了免疫球蛋白、血脂谱、血细胞计数、止血指标（凝血酶原时间、活化部分凝血活酶时间）、凝血因子和天然抗凝剂。
在第1组中，与第2组相比，分子量>150 kDa的蛋白质的凝血因子损失显著减少：纤维蛋白原平均下降分别为70%对31%（P = 0.004），因子V为66%对21%（P = 2.16×10⁻⁷），因子XI为60%对32%（P = 6.96×10⁻⁶），XIII抗原为75%对17%（P = 0.0002），血管性血友病因子抗原为47%对0%（P = 0.02）。治疗后第1组IgG平均下降率为45%，第2组为50%（P = 0.13）。即使在根据处理的血浆量和DFPP治疗前的因子值进行调整后，这些结果仍然显著。
使用Cascadeflo EC - 50W作为一级滤器的DFPP与Plasmaflo OP - 08W一样能有效降低IgG，但能保留凝血因子。
