PMID- 33847403
OWN - NLM
STAT- MEDLINE
DCOM- 20220124
LR  - 20220124
IS  - 1098-1101 (Electronic)
IS  - 0733-2459 (Linking)
VI  - 36
IP  - 4
DP  - 2021 Aug
TI  - Therapeutic plasma exchange and dextran-sulfate plasma adsorption as 
      extracorporeal treatments of extremely preterm preeclampsia with fetal growth 
      restriction.
PG  - 595-605
LID - 10.1002/jca.21899 [doi]
AB  - AIM: To evaluate effectiveness and safety of therapeutic plasma exchange (TPE) 
      and dextran-sulfate plasma adsorption (DSA) for extracorporeal removal of soluble 
      Fms-like tyrosine kinase-1 (sFlt-1) as part of expectant management of 
      preeclampsia at extremely preterm gestational age. METHODS: Retrospective case 
      series of six patients with preeclampsia at <28 weeks of gestation, treated with 
      DSA or TPE. Laboratory results, clinical characteristics and neonatal outcomes 
      were collected from charts and National Perinatal Information System. RESULTS: 
      Fetal growth restriction (FGR) was diagnosed in all cases. Pregnancy was 
      prolonged for a median of 14 (range 5-74) days from admission and 10 (3-73) days 
      from first apheresis. A mixed effects model showed a decrease in sFlt-1 and 
      sFlt-1/PlGF ratio during DSA/TPE (significant effect of time [before/after]), 
      which was comparable between DSA and TPE (no effect of procedure type). Median 
      absolute reduction in sFlt-1 was 42% (inter-quartile range [IQR] 13%-57%) during 
      DSA and 34% (16%-40%) during TPE; for sFlt-1/PlGF ratio it was 29% (22%-36%) and 
      38% (29%-42%), respectively. All procedures were well tolerated by fetuses. 
      Anaphylactoid reaction, often with angioedema, occurred in 4/6 patients 
      undergoing DSA and was attributed to bradykinin activation. One patient developed 
      wound hematoma after cesarean section, possibly attributed to depletion 
      coagulopathy. CONCLUSIONS: As potential novel treatment of early preeclampsia, a 
      non-selective and widely available TPE was comparable to DSA regarding sFlt-1 
      reduction but was associated with fewer side-effects. Both seem to allow maternal 
      stabilization and pregnancy prolongation even when early preeclampsia is 
      complicated by FGR.
CI  - (c) 2021 Wiley Periodicals LLC.
FAU - Gubensek, Jakob
AU  - Gubensek J
AUID- ORCID: 0000-0002-5394-3729
AD  - Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, 
      Slovenia.
AD  - Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
FAU - Ponikvar, Rafael
AU  - Ponikvar R
AD  - Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, 
      Slovenia.
AD  - Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
FAU - Premru Srsen, Tanja
AU  - Premru Srsen T
AUID- ORCID: 0000-0003-2597-0188
AD  - Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
AD  - Department of Perinatology, Division of Obstetrics and Gynecology, University 
      Medical Centre Ljubljana, Ljubljana, Slovenia.
FAU - Fabjan Vodusek, Vesna
AU  - Fabjan Vodusek V
AD  - Department of Perinatology, Division of Obstetrics and Gynecology, University 
      Medical Centre Ljubljana, Ljubljana, Slovenia.
FAU - Moertl, Manfred Georg
AU  - Moertl MG
AD  - Department of Obstetrics and Gynecology, Clinical Center, Klagenfurt, Austria.
FAU - Lucovnik, Miha
AU  - Lucovnik M
AD  - Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
AD  - Department of Perinatology, Division of Obstetrics and Gynecology, University 
      Medical Centre Ljubljana, Ljubljana, Slovenia.
LA  - eng
PT  - Journal Article
DEP - 20210413
PL  - United States
TA  - J Clin Apher
JT  - Journal of clinical apheresis
JID - 8216305
RN  - 0 (Biomarkers)
RN  - 9042-14-2 (Dextran Sulfate)
RN  - EC 2.7.10.1 (FLT1 protein, human)
RN  - EC 2.7.10.1 (Vascular Endothelial Growth Factor Receptor-1)
SB  - IM
MH  - Adsorption
MH  - Biomarkers/blood
MH  - Blood Coagulation
MH  - Blood Component Removal
MH  - Cesarean Section
MH  - Dextran Sulfate/*chemistry
MH  - Female
MH  - Fetal Growth Retardation/*blood
MH  - Gestational Age
MH  - Hospitalization
MH  - Humans
MH  - Infant, Extremely Low Birth Weight
MH  - Infant, Extremely Premature
MH  - Infant, Newborn
MH  - Linear Models
MH  - Plasma Exchange/*methods
MH  - Plasmapheresis
MH  - Pre-Eclampsia/*blood
MH  - Pregnancy
MH  - Retrospective Studies
MH  - Vascular Endothelial Growth Factor Receptor-1/*blood
OTO - NOTNLM
OT  - apheresis
OT  - fetal growth restriction
OT  - intrauterine growth restriction
OT  - plasma exchange
OT  - preeclampsia
EDAT- 2021/04/14 06:00
MHDA- 2022/01/27 06:00
CRDT- 2021/04/13 08:55
PHST- 2021/02/26 00:00 [revised]
PHST- 2020/06/23 00:00 [received]
PHST- 2021/03/29 00:00 [accepted]
PHST- 2021/04/14 06:00 [pubmed]
PHST- 2022/01/27 06:00 [medline]
PHST- 2021/04/13 08:55 [entrez]
AID - 10.1002/jca.21899 [doi]
PST - ppublish
SO  - J Clin Apher. 2021 Aug;36(4):595-605. doi: 10.1002/jca.21899. Epub 2021 Apr 13.