title: Plasma exchange versus an affinity column for cholesterol reduction.
abstract: The recent introduction of low-density lipoprotein (LDL)/very low-density lipoprotein (VLDL) selective-removal systems offers an alternative to plasma exchange (PE). For the last 10 years, we have treated a male homozygous hypercholesterolemia type IIA patient with PE using 5% normal serum albumin (NSA) replacement, PE using 6% hydroxyethyl starch (HES) replacement, single dextran sulfate cellulose bead affinity column (DSAC) (Kaneka LA-40), and double DSAC. This report compares the performance of these systems in cholesterol reduction (total, LDL+VLDL, and high-density lipoprotein [HDL] and their effect on the total protein, albumin, and hematocrit levels. The number of procedures and average volume of plasma treated using PE-NSA, PE-HES, 1-DSAC, and 2-DSAC were 113, 64, 15, 90 and 3,939, 3,270, 3,519, and 3,588 ml, respectively. The average pretreatment total cholesterol levels were baseline 864 mg/dL, PE-NSA 606 mg/dL, PE-HES 610 mg/dL, 1-DSAC 467 mg/dL, and 2-DSAC 395 mg/dL with plasma reductions of 59%, 57%, 47%, and 55%, respectively. Average LDL+VLDL plasma reductions were PE-NSA 58%, PE-HES 59% (N = 1), 1-DSAC 46%, and 2-DSAC 56%. Average HDL plasma reductions were PE-NSA 58%, PE-HES 69% (N = 1), 1-DSAC 5%, and 2-DSAC 17%. The average total cholesterol and LDL+VLDL reductions were comparable for both types of PE and the 2-DSAC system. The average HDL loss was 53% lower for the DSAC systems than for PE systems.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Section of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: E A
authors.initials: EA
authors.lastname: Burgstaler
authors.forename: A A
authors.initials: AA
authors.lastname: Pineda
mesh_terms: D000328:Adult; D001781:Blood Component Removal; D002784:Cholesterol / Q000097:blood*; D002846:Chromatography, Affinity; D016264:Dextran Sulfate; D006720:Homozygote; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000628:therapy*; D008297:Male; D010951:Plasma Exchange
chemical_list: D016264:Dextran Sulfate; D002784:Cholesterol