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Background: Plasmapheresis is a therapeutic alternative for diseases in which a "humoral factor" has pathogenetic relevance. However it is not devoid of adverse effects. Aim: To review the indications, number of procedures, morbidity and clinical evolution of plasmapheresis in critical patients. Patients and Methods: A retrospective and descriptive study in four intensive care units of an University hospital. The severity of patients was evaluated with APACHE II and SOFA scores. Results: Twenty patients were studied. The most common indications of plasmapheresis were thrombotic thrombocytopenic purpura (TTP) in 50% of subjects and small vessel vasculitides in 30%. The number of procedures per patient oscillated between 2 and 14 (mean: 7.1±3.3). The registered adverse effects were hypocalcemia in 50% of patients, hypotension in 42.1%, coagulopathy in 35%, hypokalemia in 29%, rash in 20%, procedure related infections in 18% and fever in 10%. There was a significant decrease of 17±28% in prothrombin time, after the procedures. Seventy five percent of patients had a favorable evolution. Global mortality rate was 15%. All deaths occurred in patients with TTP and were attributed to the progression of the disease. No death was attributed to the procedure. The initial APACHE II and SOFA scores were 12.4±8.4 and 5.3±2.9, respectively. Both scores decreased after the procedure. Among other therapeutic measures, 15% of the patients received immunosuppressant treatment, 27% were dialyzed and 32% were mechanically ventilated. Conclusions: The most common indication of plasmapheresis was TTP. Adverse effects were frequent, however there was no procedure related mortality. The global mortality rate was 15% and all deaths occurred in patients with TTP.

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BACKGROUND: Plasmapheresis is a therapeutic alternative for diseases in which a "humoral factor" has pathogenetic relevance. However it is not devoid of adverse effects. AIM: To review the indications, number of procedures, morbidity and clinical evolution of plasmapheresis in critical patients. PATIENTS AND METHODS: A retrospective and descriptive study in four intensive care units of an University hospital. The severity of patients was evaluated with APACHE II and SOFA scores. RESULTS: Twenty patients were studied. The most common indications of plasmapheresis were thrombotic thrombocytopenic purpura (TTP) in 50% of subjects and small vessel vasculitides in 30%. The number of procedures per patient oscillated between 2 and 14 (mean: 7.1+/-3.3). The registered adverse effects were hypocalcemia in 50% of patients, hypotension in 42.1%, coagulopathy in 35%, hypokalemia in 29%, rash in 20%, procedure related infections in 18% and fever in 10%. There was a significant decrease of 17+/-28% in prothrombin time, after the procedures. Seventy five percent of patients had a favorable evolution. Global mortality rate was 15%. All deaths occurred in patients with TTP and were attributed to the progression of the disease. No death was attributed to the procedure. The initial APACHE II and SOFA scores were 12.4+/-8.4 and 5.3+/-2.9, respectively. Both scores decreased after the procedure. Among other therapeutic measures, 15% of the patients received immunosuppressant treatment, 27% were dialyzed and 32% were mechanically ventilated. CONCLUSIONS: The most common indication of plasmapheresis was TTP. Adverse effects were frequent, however there was no procedure related mortality. The global mortality rate was 15% and all deaths occurred in patients with TTP.

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OBJECTIVE: To characterize the circumstances underlying the epidemic of AIDS associated with blood transfusion in Mexico and to explore the possible mechanisms for its dissemination. METHODS: A retrospective analysis comparing the total number of AIDS cases and transfusion-associated AIDS cases and the male:female ratio reported in Mexico and the U.S. from 1981 to 1996 was done. We analyzed the relationship between the location of plasmapheresis banks and the geographic distribution of transfusion-associated AIDS cases and AIDS cases among paid donors in order to assess the possible role of plasmapheresis banks in its dissemination. RESULTS: The proportion of transfusion-associated AIDS in the total number of cases was significantly higher in Mexico than in the U.S. from 1987 through 1996 (p < .0001). A rapid drop in the male:female ratio of AIDS was observed in Mexico but not in the U.S. coinciding with a growing number of transfusion associated cases; transfusion has been the main risk factor for AIDS in women in our country. In 1986, seven States and Mexico City had plasmapheresis banks: they reported 90% of the cases associated to paid donation and 75% of those associated to transfusion, despite the fact that commercial blood banks without plasmapheresis facilities existed in 23 of the other 24 States. CONCLUSION: There was a difference on the frequency of transfusion associated AIDS between Mexico and the U.S. which reached epidemic proportions in Mexico. We believe that plasmapheresis banks played a major role in the dissemination of the infection in Mexico as paid donors provided a third of the blood used in Mexico in 1986. These findings highlight important implications for the prevention of AIDS in developing countries where commercial plasmapheresis practices are still in operation.

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Objetivo. Caracterizar las circunstancias subyacentes a la epidemia de SIDA por transfusión sanguínea en México, y explorar los posibles mecanismo de su diseminación. Métodos. Se hizo un análisis retrospectivo comparando los casos de SIDA asociados a transfusión y la relación hombre: mujer reportados en México y en Estados Unidos de 1981 a 1996. Analizamos la relación entre la localización de los bancos de plasmaféresis y la distribución geográfica de los casos de SIDA asociados a transfusión y los casos de SIDA en donadores pagados, para investigar el posible papel que los bancos de plasmaféresis comerical tuvieron en la diseminación de SIDA en México. Resultados. La proporción de casos de SIDA asociados a transfusión fue significativamente mayor en México que en estados unidos de 1987 a 1996 (p < .0001). Se observó una rápida caída en la razón hombre: mujer en México pero no en Estados Unidos, que coincide con el incremento de SIDA asociado a transfusión; la transfusión ha sido el factor de riesgo más importante de SIDA en mujeres mexicanas. En 1986, siete estados y el Distrito Federal tenían bancos de plasmaféresis que reportaron el 90 por ciento de los casos de SIDA en donadores pagados y el 75 por ciento de aquéllos asociados a transfusión, a pesar de que existían bancos de sangre sin facilidades para plasmaféresis, en 23 de los otros 24 estados de la república mexicana. Conclusiones. Hubo una clara diferencia en la frecuencia de casos de SIDA asociados a transfusión entre México y Estados Unidos. Creemos que los bancos comerciales jugaron un papel importante en la epidemia mexicana ya que una tercera parte de la sangre quese consumió en 1986 en México provino de donadores pagados. Estos halalzgos destacan implicaciones preventivas importantes par ala infección por VIH en países en vías de desarrollo donde operan bancos de plasmaféresis comercial

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Se hace una revisión de los recursos terapéuticos no esteroideos, empleados en el tratamiento de las diferentes formas clínicas de pénfigo. Se enumeran los factores que condicionan la elección de dicha terapéutica; forma clínica, edad, embarazo, concomitancia con otras enfermedades, interacción con otros fármacos y efectos adversos. El esteroide continúa siendo la droga de primera elección, debiendo estar asociado con otras medicaciones adyuvantes, habitualmente desde su inicio, a fin de promover un descenso más rápido del mismo, con menor incidencia de complicaciones. En los pénfigos graves se preferirá su asociacián con inmunosupresores, en primer lugar con la azatioprina o bien con ciclofosfamida. La dapsona, como las tetraciclinas, será alternativa para algunas formas más leves de pénfigo, mientras que los pulsos de ciclofosfamida, así como la plasmaféresis, deberán reservarse para aquellos casos graves que no hayan respondido a las terapéuticas convencionales

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Se hace una revisión de los recursos terapéuticos no esteroideos, empleados en el tratamiento de las diferentes formas clínicas de pénfigo. Se enumeran los factores que condicionan la elección de dicha terapéutica; forma clínica, edad, embarazo, concomitancia con otras enfermedades, interacción con otros fármacos y efectos adversos. El esteroide continúa siendo la droga de primera elección, debiendo estar asociado con otras medicaciones adyuvantes, habitualmente desde su inicio, a fin de promover un descenso más rápido del mismo, con menor incidencia de complicaciones. En los pénfigos graves se preferirá su asociacián con inmunosupresores, en primer lugar con la azatioprina o bien con ciclofosfamida. La dapsona, como las tetraciclinas, será alternativa para algunas formas más leves de pénfigo, mientras que los pulsos de ciclofosfamida, así como la plasmaféresis, deberán reservarse para aquellos casos graves que no hayan respondido a las terapéuticas convencionales (AU)

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The collection of plasma for further manufacture into medicinal products and in vitro diagnostic reagents is predominantly accomplished in the USA through the remuneration of donors who participate in plasmapheresis programmes. A well regulated system under the control of the Food and Drug Administration has been in place since the mid-1970s. Requirements of this regulatory system with regard to the need for donor acceptance and frequency of participation criteria, and plasma acceptability standards are reviewed. Information regarding several groups of donors participating in plasmapheresis procedures at various frequency intervals over 10 years is presented. Data on microhaematocrit, body weight, total protein, and individual serum protein distribution have been compiled and statistically analysed; the results of these analyses are included. Given the existence of a comprehensive approach which encompasses donor safety, plasma testing, and effective manufacturing procedures, safe and efficacious plasma derivatives can be produced from plasma drawn from remunerated donors and can be made available in sufficient quantity to meet medical needs in an economic manner.

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