[Immunoglobulin deficiency after repeated plasmapheresis].
In 10 patients with Guillain-Barré syndrome the level of globulins and immunoglobulins before and after plasmapheresis was investigated. As a plasma substitute either PPL (in 8 patients) or a plasma substitute solution rich in immunoglobulins (in 2 patients) was used. When plasma was substituted with PPL, the globulins and immunoglobulins dropped to a mean of 40% of the initial value (range 30-60%) after the first plasmapheresis. With daily or alternate day plasmapheresis, the globulins only partially recovered. Before the second plasmapheresis they were still reduced to a mean of 50% (range 20-50%), and dropped further with ongoing exchanges to a mean of 33% (range 20-50%) as measured before the third plasmapheresis. Accordingly, there was a loss of immunoglobulins of similar magnitude. With the use of a plasma substitute solution rich in immunoglobulins (IRP), globulins could be maintained at normal levels. The lowest immunoglobulin values measured after plasmapheresis were 6 g/l (normal range 8-17 g/l). One patient developed gram-negative septicaemia after plasmapheresis with PPL, possibly due to a low immunoglobulin concentration. We conclude that a plasma substitute solution rich in immunoglobulins should be used for therapeutic plasmapheresis in order to maintain physiological immunoglobulin concentrations.
Stebler
C
C
Departement Innere Medizin, Kantonsspital Basel.
Tichelli
A
A
Dazzi
H
H
Wernli
M
M
Gratwohl
A
A
Speck
B
B
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000172:deficiency; D007153:Immunologic Deficiency Syndromes / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage; D010956:Plasmapheresis / Q000009:adverse effects*; D011129:Polyradiculoneuropathy / Q000628:therapy*
D007136:Immunoglobulins; D010952:Plasma Substitutes