title: Immunoadsorption and plasma exchange in pregnancy.
abstract: BACKGROUND
  During pregnancy, familial hyperlipidemia or systemic lupus erythematosus (SLE) can exacerbate having devastating consequences for both mother and fetus. Immunoadsorption is established for removal of pathogenic proteins lipoproteins or autoantibodies, but this procedure has only rarely been used in pregnancy.
  
  
  METHODS
  We evaluated retrospectively 126 extracorporeal treatments during six pregnancies. Forty low-density lipoprotein immunoadsorptions, 6 sole plasma exchanges and 36 combined procedures (plasma exchange followed by immunoadsorption) were performed for severe hypertriglyceridemia, complicated by acute pancreatitis. Forty-four IgG immunoadsorptions were executed in 2 pregnant women suffering from SLE with a disastrous course during prior pregnancies.
  
  
  RESULTS
  In hyperlipidemic pregnant women, mean triglyceride levels prior to treatment were 3,841 +/- 2,076 mg/dl (mean +/- SD) and total cholesterol was 617 +/- 354 mg/dl. Until delivery, a 27% reduction of triglycerides could be achieved. Clinical and serological signs of pancreatitis disappeared after initiation of extracorporeal therapy. Four healthy babies were delivered (birthweights between 2,250 and 3,360 g). In 1 woman suffering from SLE, intrauterine fetal death occurred in the 22nd week of gestation despite a reduction of cardiolipin antibodies by 69%. The second case (a twin pregnancy) was complicated by steroid-resistant antibody-mediated anemia. Due to frequent immunoadsorptions, red blood cell count improved (reduction of antierythrocyte antibodies by 66.6%) and 2 healthy babies (birthweights 2,120 and 2,350 g) were delivered by cesarean section.
  
  
  CONCLUSIONS
  Long-term antibody-based immunoadsorption has been demonstrated to be safe and well tolerated in pregnant women and enables normal intrauterine/fetal development. Although rarely indicated during pregnancy, this treatment modality might be a promising new technique for removal of autoantibodies and lipoproteins in patients with serious gestational complications without sufficient response to conventional therapy.
authors.affiliation: Department of Medicine III, Division of Nephrology and Dialysis, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dittrich
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmaldienst
authors.forename: Martin
authors.initials: M
authors.lastname: Langer
authors.forename: Martin
authors.initials: M
authors.lastname: Jansen
authors.forename: Walter H
authors.initials: WH
authors.lastname: Hörl
authors.forename: Kurt
authors.initials: K
authors.lastname: Derfler
mesh_terms: D000327:Adsorption; D000328:Adult; D001781:Blood Component Removal; D005112:Extracorporeal Circulation; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007120:Immunochemistry; D007074:Immunoglobulin G / Q000737:chemistry; D007231:Infant, Newborn; D008077:Lipoproteins, LDL / Q000097:blood / Q000302:isolation & purification; D008180:Lupus Erythematosus, Systemic / Q000628:therapy*; D008297:Male; D010195:Pancreatitis / Q000209:etiology / Q000503:physiopathology; D010951:Plasma Exchange / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D012212:Rheology
chemical_list: D007074:Immunoglobulin G; D008077:Lipoproteins, LDL