Cryofiltration Apheresis in the Treatment of Cryoprecipitate Induced Diseases

Authors


Associate Professor of Medicine, Division of Nephrology, Vanderbilt University, VA Medical Center, 1310–24th Avenue South, Nashville, TN 37212–2637, U.S.A.

Abstract

Abstract: Cryoprecipitates include cryoglobulins, cryofibrinogen, cryoparaproteins, and some cold hemagglutinins. We used 3 different methods: plasma exchange (PE), plasma filter (PF), and cryofilter (CF) to remove cryoproteins. Twenty-four patients received more than 800 CF, PF, and PE treatments. The PF and CF methods have average pore sizes of 0.03 μm and 4.3 μm and surface areas of 2.0 m2 and 0.135 m2, respectively. The plasma was separated by centrifugation, cooled to 4°C, and the cryopreipitate was removed by CF. Albumin solution 5% was used as a replacement fluid in PE, but no albumin was required when using PF or CF. Our results show that the CF and PF methods do not cause complement activation. Although PE is effective for removal of cryoproteins, it is nonspecific, nonselective, and requires human albumin or fresh frozen plasma. If intensive PE is required, it may cause depletion of immunoglobulins and coagulation factors and other vital plasma components. The PF removes macromolecules such as IgM and IgG effectively and it is semiselective. It removes any protein with a molecular weight ≥200,000, which makes it semispecific treatment. CF is very effective and selectively removes cryoproteins; therefore it is a specific therapy. In conclusion, cryofiltration apheresis is the best method to remove cryoproteins in the treatment of cryoprecipitate induced diseases.

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