Silberstein L E, Berkman E M
J Clin Apher. 1983;1(4):238-42. doi: 10.1002/jca.2920010407.
Plasma exchange therapy in autoimmune hemolytic anemia (AIHA) was used in four patients (two with warm hemolytic anemia and two with cold hemolytic anemia). The size of each plasma exchange approximated 1 plasma volume; three consecutive daily exchanges removed 80-90% of the immunoglobulins--immunoglobulin G (IgG) and immunoglobulin M (IgM)-, complement (C3, C4), and reduced antibody titers. Transfusion requirements dramatically decreased after plasma exchange in each case. In two patients, red blood cell (RBC) survival studies were performed to more accurately assess the effect of plasma exchange therapy, since steroid and/or immunosuppressive therapy was given concomitantly. In one case of cold AIHA, homologous 51Cr-RBC were injected 4 days prior to plasma exchange and repeat injection (same donor) following completion of plasma exchange. The survival curve prior to plasma exchange therapy had a T 1/2 = 7.8 days (r = -0.988) and after plasma exchange therapy had a T 1/2 = 20.4 days (r = 0.925). RBC survival studies using homologous 51Cr-RBC were also performed in a patient with warm AIHA. The survival curve before plasma exchange had a T 1/2 = 2 days (r = -0.95), and postplasma exchange a T 1/2 = 1.8 days (r = -0.91). Plasma exchange therapy seems to have a beneficial effect in cold rather than warm autoimmune hemolytic anemia.
对4例自身免疫性溶血性贫血（AIHA）患者（2例温抗体型溶血性贫血和2例冷抗体型溶血性贫血）采用了血浆置换疗法。每次血浆置换量约为1个血浆容积；连续3天每日进行血浆置换可清除80% - 90%的免疫球蛋白——免疫球蛋白G（IgG）和免疫球蛋白M（IgM）、补体（C3、C4），并降低抗体滴度。在每种情况下，血浆置换后输血需求均显著降低。在2例患者中进行了红细胞（RBC）存活研究，以更准确地评估血浆置换疗法的效果，因为同时给予了类固醇和/或免疫抑制疗法。在1例冷抗体型AIHA患者中，在血浆置换前4天注射了同源51Cr - RBC，并在血浆置换完成后重复注射（同一供体）。血浆置换疗法前的存活曲线T 1/2 = 7.8天（r = -0.988），血浆置换疗法后T 1/2 = 20.4天（r = 0.925）。还对1例温抗体型AIHA患者进行了使用同源51Cr - RBC的RBC存活研究。血浆置换前的存活曲线T 1/2 = 2天（r = -0.95），血浆置换后T 1/2 = 1.8天（r = -0.91）。血浆置换疗法似乎对冷抗体型而非温抗体型自身免疫性溶血性贫血有有益作用。
