Programmpunkt

10:00

Titel: The impact of immunoadsorption with the novel single-use, protein A-based LIGASORB column on coagulation and plasma composition
ID: VS-3-1
Art: Vortrag
Redezeit: 10 + 5 min
Session:
ARGE Plasmapherese
VS-3

Referent: Nadine Schossee (Würzburg)


Abstract - Text

Offenlegung Interessenkonflikt:

The authors have no conflicts of interest to disclose.

Methods

In patients with neurological autoimmune disorders (myasthenia gravis n=6; stiff-person syndrome n=1), blood cell count, coagulation parameters, electrolytes, immunoglobulines and plasma proteins were measured before and after IA procedures (n=11). The IA were performed on a cell separator (Spectra Optia, Terumo BCT, Lakewood, CO, USA) with ACD-A as anticoagulant (ratio 1:12). In each IA, at least the 1.5-fold amount of the patient´s calculated plasma volume was processed.

Results

In average, the IA reduced the levels of total IgG, IgG1, IgG2 and IgG4 by 50-60%, the acetylcholine receptor autoantibody levels by more than 70%. IgG3 (by 33%), IgA (24%) or IgM (by 38%) were diminished to a lower extent. The column markedly removed the coagulation factor II by 67%, factor VII by 51%, factor IX by 42% and factor X by 66%, whereas other factors were reduced only by 14-23%. The prothrombine time dropped from 89.5±15.8 % to 44.7±7.1 %, activated partial thromboplastin time increased from 34.7±5.8 s to 45.8±8.2 s. There was no elevation of d-dimer concentrations. Blood cell count, electrolytes, hemolysis parameters, total protein or albumin were not essentially affected.

Background

Immunoadsorptions (IA) can be used to remove autoantibodies from the plasma in order to treat neurological autoimmune disorders, e.g. myasthenia gravis. Recently, the single-use immunoadsorber LIGASORB using recombinant staphylococcal protein A as ligand was introduced by the manufacturer Fresenius Medical Care (Bad Homburg, Germany). For the estimation of potential adverse effects, it is important to analyze the impact of the novel column on blood coagulation and plasma composition.

Conclusion

The LIGASORB column is highly efficient to remove specific acetylcholine receptor autoantibodies and immunoglobulins of type IgG1, IgG2 and IgG4 from the plasma. Coagulation parameters should be monitored in patients treated with IA, since the column has the capacity to largely reduce vitamin K-dependent factors. Blood cell count, electrolytes and other measured plasma proteins are not relevantly influenced.