The role of replacement fluids in plasma exchange and therapeutic applications of apheresis

Watkins, Rhona (1987) The role of replacement fluids in plasma exchange and therapeutic applications of apheresis. MD thesis, University of Glasgow.

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By 1981 it had become apparent that a new technique, plasmapheresis, offered considerable potential in the treatment of an ever increasing number of diseases by its ability to remove an affecting component from the patient's blood. Plasmapheresis involved the selective removal of a small volume of plasma which was not replaced, whereas plasma exchange involved the removal of a large volume of plasma which was replaced by an almost equal volume of appropriate fluid. A blood cell separator (IBM Type 2997) was acquired by the Department of Haematology, Glasgow Royal Infirmary, and during the period 1981-1985, 2685 plasma exchange procedures were carried out on 201 female and 125 male patients being treated for a range of clinical disorders. During this period I carried out a number of individual studies which form the basis of this thesis. The thesis first reviews the literature relating to the application of therapeutic plasma exchange in the treatment of selected disorders. It outlines the types of exchange procedures and the methods of component removal based on physical and chemical means. Some continuous flow and discontinuous flow centrifugation equipments and membrane filtration equipments are described and a comparison made of centrifugation and filtration procedures. The potential offered by chemical separation procedures is indicated. The practical considerations, particularly those of vascular access, anticoagulation and the choice of replacement fluids, are discussed. The rationale for treatment by plasma exchange, evidence of its efficacy and the implications of such treatment are considered. Some applications of plasma exchange in the treatment of selected disorders are described. Whilst exchange procedures are relatively safe they are not without risk and some of the adverse reactions and hazards are indicated. The thesis has three basic objectives. 1. To assess the effectiveness of three selected replacement fluids used in the plasma exchange procedures carried out on three groups, each with patients being treated for myasthenia gravis, Guillain-Barre Syndrome, chronic polyneuropathy and polymyositis. 2. To assess the effectiveness of plasma exchange procedures in the treatment of patients with cold haemagglutinin disease, Waldenstrom's macroglobulinaemia and hyperviscosity due to multiple myeloma, immune haemolytic anaemia, Factor VIII inhibitors, polyneuropathy, myasthenia gravis and Eaton-Lambert syndrome, Guillain-Barre syndrome, glomerulonephritis and Goodpasture's disease, aplastic anaemia together with pure red cell aplasia and polymyositis. 3. To undertake a preliminary assessment of the potential offered by leukapheresis as an adjunct to conventional chemotherapy in the treatment of patients with acute myeloid and lymphatic leukaemias and with chronic myeloid and lymphatic leukaemias.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine, Biomedical engineering
Date of Award: 1987
Depositing User: Enlighten Team
Unique ID: glathesis:1987-76660
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 19 Nov 2019 13:57
Last Modified: 19 Nov 2019 13:57

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