Vascular access in therapeutic apheresis: One size does not fit all
Background: Therapeutic apheresis has been used in treating hematological and non-hematological diseases. For a successful procedure, efficient vascular access is required. Presently, peripheral venous access (PVA), central venous catheterization (CVC), implantable ports, and arteriovenous fistulas (AVFs) are used. This review aims to evaluate different type of access and their pros and cons to help physicians determine the best venous access. Methods: The electronic search included PubMed and Google Scholar up to November 2020. The Mesh terms were apheresis, peripheral catheterization, central catheterization, and arteriovenous fistula. Results: A total of 228 studies were found through database searching. Two independent authors reviewed the articles using their titles and abstracts; 88 articles were selected and the full text was reviewed. Finally, 26 were included. The inclusion criteria were studies incorporating patients with any indication for apheresis. Conclusion: PVA has been promoted in recent years in many centers across the United States to lower the rate of complications associated with vascular access and to make this procedure more accessible. Several factors are involved in selecting appropriate venous access, such as the procedure’s duration and frequency, patient’s vascular anatomy, and staff’s experience. In short-term procedures, temporary vascular access like PVA or CVC is preferred. Permanent vascular access such as AVF, tunneled cuffed central lines, and implantable ports are more beneficial in prolonged treatment period but each patient has to be evaluated individually by apheresis team for the most appropriate method.
LS2-01 Vascular punctures for GMA treatment
Hisashi Matono1), Akiyoshi Okada2), Junya Imada1), Tetsushi Nakahara1),
Atsushi Ono1), Takuma Usuda1), Atsuo Kitano
poster at ISFA 2019 pag 164
We can provide the GMA treatment by venepuncture without VAC detaining you like other blood purification therapy. The puncture by the peripheral vein puncture is easy, but, on the other hand, it often becomes difficult to secure blood flow necessary for extracorporeal circulation enough and is one of the trouble factors of the GMA treatment We use an echo to
evade a puncture trouble in our institution. We introduce the approach this time.
Approach method The site of puncture uses brachial veins basically. There is little valve of vein as a reason and chooses the blood stream because securing of blood flow with a little meandering is relatively easy. However, the depth from skin may be deepened as compared with the erasion blood vessel such as radius cutaneous veins, and the like, too, and attention is necessary. We often perform GMA in outpatient department at this hospital, and order enters the new induction when a chief physician judged induction from an encounter. Therefore it is difficult to obtain the patients information beforehand and a blood vessel echo uses site of puncture after the patients admission and is determined and performs the puncture in echo guides, if necessary. Also, the judgments such as the dehydration, and the like are possible by using an echo, and there is the
merit that they receive instructions such as the transfusion load, and the like in what we report to a chief physician, and can dissolve puncture difficulty.
Conclusion One of the troubles of the GMA treatment has securing of access. If extracorporeal circulation is possible without poor blood removal, we can provide GMA treatment more effectively. We regard the echo inflection of that purpose as a required device on providing GMA treatment.
The expression profile of functional regulatory T cells, CD4+CD25high+/forkhead box protein P3+, in patients with ulcerative colitis during active and quiescent disease
K Kamikozuru 1, K Fukunaga, S Hirota, N Hida, Y Ohda, K Yoshida, Y Yokoyama, K Tozawa, K Kawa, M Iimuro, K Nagase, A R Saniabadi, S Nakamura, H Miwa, T Matsumoto Clin Exp Immunol 2009 May;156(2):320-7. doi: 10.1111/j.1365-2249.2009.03904.x. Epub 2009 Mar 9.
Regulatory T cells (T(reg)) have an essential role in maintaining immune tolerance in the gut. The functional CD4(+) T(reg) express the transcription factor forkhead box protein 3 (FoxP3) or a CD25(high) in humans. Further, depletion of elevated granulocytes/monocytes by extracorporeal adsorption (GMA) induces immunomodulation in patients with ulcerative colitis (UC). We investigated the impact of GMA on T(reg). Thirty-one UC patients, clinical activity index (CAI) 12.1 +/- 2.97, refractory to conventional medications including intravenous corticosteroid and 13 healthy controls (HC), were included. Patients received five GMA sessions over 5 weeks. Biopsies from the rectal mucosa and blood samples at baseline and post-GMA were immunostained with anti-CD4/FoxP3 and anti-CD4/CD25 antibodies for immunohistochemistry and flow cytometry. Following GMA, 22 of 31 patients achieved remission (CAI <or= 4, P < 0.01) and their endoscopic activity index decreased from 10.6 +/- 2.32 to 4.75 +/- 1.48 (P = 0.003). The circulating CD4(+)CD25(high+) T(reg) level was low and increased markedly in responders (P < 0.02). In the nine non-responders, the baseline CD4(+)CD25(high+) T(reg) level was about 50% of the level in the responders (P < 0.03) or in the HC (P < 0.01), and all nine had to undergo colectomy. Conversely, the number of CD4(+)/FoxP3(+) mucosal T(reg) in GMA responders decreased significantly after the fifth GMA session compared with the baseline level (P < 0.05). It is believed that the CD4(+) T(reg) has an essential role in the control of immune pathology in UC patients and a net influx of these cells from the circulation into the mucosa may proceed to suppress inflammation. GMA can impact the circulating as well as the mucosal levels of T(reg).
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