LYMPHOPHERESIS

LYMPHOPHERESIS

Lymphopheresis is a procedure that employs the same principle of apheresis wherein instead of removing whole blood from the donor, only a selected blood component is removed, and the remaining blood and plasma are returned to the donor. 

This procedure is beneficial for those individuals who have rare blood types, so rare that when they need a blood transfusion, only a selected number of individuals can donate a blood component for them. Apheresis found its use in the removal and pooling of platelets from whole blood, resulting in a higher yield of platelets. In this article, we are focused on the removal of a type of white blood cell, the ones which are responsible for fighting off viral infections, the lymphocytes. Thus the term lymphopheresis.

TYPES

There are several types of pheresis, and its terminology is dependent upon the blood component that is removed. These are as follows:

  • Removal of platelets (platelet apheresis)
  • White blood cells (leukapheresis)
  • Removal of plasma (the fluid where the blood cells are suspended)
  • Removal of lymphocytes (lymphopheresis)
  • Removal of red blood cells (erythropheresis)

SYMPTOMS

Apheresis, specifically lymphopheresis, is indicated for diseases such as the following:

  • Chronic inflammatory autoimmune disorders such as (rheumatoid arthritis, myasthenia gravis, systemic lupus erythematosus)
  • Malignancies involving the blood such as leukaemia, Hodgkin’s disease (both NHL and HL)
  • ABO incompatibility or Rh incompatibility

Elevated serum cholesterol (familial hypercholesterolemia variant)

  • Hyperviscosity syndrome
  • Autoimmune hemolytic anaemia
  • Hyperviscosity syndrome
  • Pregnant women who are Rh desensitized

DIAGNOSIS

Diagnosis of autoimmune diseases such as rheumatoid arthritis involves laboratory testing of acute-phase reactants like C- reactive protein (CRP), Rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR). 

Rheumatoid arthritis is usually diagnosed using the criteria that check for the presence of joint inflammation involving two or more joints, presence of myalgia and radiologic examinations in the late stages of the disease. Early detection of the arthritic lesion using plain radiograph is not warranted since there are no signs in the beginning stages of the disease.

Before the induction of lymphopheresis in patients with rheumatoid arthritis, the following tests are done to serve as the baseline: 

  • Strength of the grip
  • Stiffness of the extremities especially upon waking up in the morning
  • Walking a distance of 50 feet
  • Size of the proximal interphalangeal joint using a calliper
  • Complete blood count including platelet count

TREATMENT

Patients who are identified to undergo treatment using lymphopheresis were subjected to 2 sessions of the procedure and were reassessed after ten days for their response to therapy. Most of the patients who went through the process, responded somewhat quite well in such a short period. 

Repeat assessment after 2 to 4 months showed no evidence of recurrence of the symptoms of the disease. Some patients who have had remissions and are occasionally having flares were maintained on gold or penidlamine, prednisone and azathioprine

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