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Plasmapheresis in Immune Hematology: Review of Clinical OutcomeData with Respect to Evidence‐Based Medicine and Clinical Experience
Author(s) -
Von Baeyer Hans
Publication year - 2003
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1046/j.1526-0968.2003.00004.x
Subject(s) - plasmapheresis , medicine , thrombotic thrombocytopenic purpura , transfusion medicine , intensive care medicine , immunology , hematology , apheresis , clinical trial , context (archaeology) , disease , blood transfusion , antibody , platelet , paleontology , biology
The objective of this paper is to assess the role of plasmapheresisin immune hematology by reviewing published clinical outcome dataand narrative review articles. This information will be used todefine evidence levels for appraisal of the efficacy and rank ofplasmapheresis among other management options. This evidence‐basedstrategy conforms to the concepts of the American Society of Hematology(ASH), as put forward in 1996 in the context of immune thrombocytopenia(ITP) treatment. The term ‘experimental’ is usedto describe indications where the only scientific evidence of theefficacy of plasmapheresis consists of pathophysiological reasoningand empiric clinical findings. We reviewed the availableliterature on the use of plasmapheresis in autoimmune hemolyticanemia (AIHA), hemolytic disease of the newborn (HDN), autoimmunethrombocytopenic purpura (AITP), heparin‐induced thrombocytopeniatype II (HIT II), post‐transfusion purpura (PTP), refractorinessto platelet transfusion (RPT), coagulation factor inhibitor (CFI)and catastrophic antiphospholipid syndrome (CAS). Plasmapheresiscompletes the spectrum of management options as it eliminates physicallycirculating free antibodies involved in the pathogenesis of theseimmune hematological syndromes. Because of the paucity of data,evidence levels had to be defined based on the findings of uncontrolledcase series and the opinions of independent experts. In many cases, randomizedclinical trials were not feasible because the syndromes are so rare.When defined as an ‘experimental indication’,plasmapheresis has a firm scientific basis, but larger scale clinicalexperience with the method is still lacking. In these cases, thedetection and monitoring of symptomatic disease‐related circulatingfree antibodies or immune complexes is a mandatory prerequisitefor the use of plasmapheresis. The therapeutic benefit of plasmapheresisis substantiated by the level V of evidence of its efficacy in treatmentof HDN, HIV‐associated AITP, induction of tolerance in CFI and inCAS. The goal of future studies should be to establish a firmerbase of scientific evidence for indications classified as experimentalby setting up case series large enough for proper assessment ofplasmapheresis alone or combination with other treatment measures. Thisgoal can only be achieved through multiinstitutional cooperation.