Maternal and fetal outcomes in pregnant Japanese women with inflammatory bowel disease: our experience with a series of 23 cases

BACKGROUND/AIMS: Our physicians work to expand the possibilities to treat female patients with inflammatory bowel disease (IBD) who wish to become pregnant. Although many drugs, including 5-aminosalicylate (5-ASA), corticosteroids, immunomodulators, and biologics, are used safely during pregnancy, few reports have described the therapeutic regimen throughout pregnancy and the management of patients who relapse during pregnancy precisely. The aim of this study was to assess the management of patients with IBD during pregnancy. METHODS: We identified 19 patients (five with Crohn's disease and 14 with ulcerative colitis [UC]) who became pregnant with a total of 23 pregnancies between May 2005 and May 2015 by reviewing the medical records of Kyoto University Hospital. The following data were collected: the maternal variables, the IBD treatment type, the disease activity, the pregnancy outcome, and the mode of delivery. RESULTS: Among the 19 patients, 18 had become pregnant after being diagnosed with IBD, while one had developed UC newly after pregnancy. Throughout the gestation, all patients were treated with probiotics, 5-ASA, prednisolone, cytapheresis, or infliximab. The relapse rate during pregnancy was 21.7% (5/23 cases). The five patients who experienced a relapse were able to pursue their pregnancy after intensification of their treatments. There were no adverse fetal or neonatal problems, except in one case that required an emergency Caesarean section because of placental dysfunction and in which a very low-birth-weight infant was born preterm. CONCLUSIONS: Our present data confirmed that even if the disease flares up during pregnancy, good pregnancy outcomes can be achieved with an optimal intensification of the patient's treatment.

Evaluation of methods for collection of peripheral blood stem cells in children / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the methods for collection of peripheral blood stem cells (PBSC) in children.</p><p><b>METHODS</b>Peripheral blood stem cells were collected from 20 child patients and 11 donors. The patients treated with chemotherapy, received G-CSF or GM-CSF and the donors received G-CSF for mobilization. When the peripheral blood (PB) leukocyte count reached to 5 X10(9)/L,the hematopoietic stem cells were collected with CS-3000 Plus, COM TEC or COBE Spectra blood cell separators from patients and donors. For children whose weight <20 kg,HCT <24% or TBV <1 100-1 650 ml,blood cell separators were pre-injected with the same type RBCs irradiated by 25 Gy of gamma-ray and with low flow rate (10-30 ml/min). The number of CD34(+) cell was detected by flow cytometry. The relationship of number of CD34(+) cell with mononuclear cell (MNC) and processed blood volume was analyzed.</p><p><b>RESULTS</b>Successful collection of the PBSCs with the CS- 3000 Plus (n=10), the COM TEC (n=3) and the COBE Spectra (n=18) was achieved in all the 31 cases with 1-5 aphereses used. Number of CD34(+) cells was (7.9 ±2.9) X 10(6)/kg and that of MNCs was (7.4 ±3.1) X 10(8)/kg. The total CD34(+) cell count was correlated with MNCs before aphaeresis and processed blood volume.</p><p><b>CONCLUSION</b>For collection of high quality PBSCs, the appropriate methods should be chosen according to the body weight, TBV, mobilization of child patients/donors.</p>

Determination of optimal time to second allogeneic peripheral blood stem cell harvest from healthy donors / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the optimal time for second allogeneic peripheral blood stem cell grafts (PBSC) harvest from healthy donors after in vivo recombinant human granulocyte colony-stimulating factor application (rhG-CSF).</p><p><b>METHODS</b>Thirty-eight healthy donors of second collection (group A) were treated with subcutaneous rhG-CSF \[5 microgxkg(-1)xd(-1)\] for five consecutive days and followed by leukapheresis on day 5 and 6. The control group (group B) was thirty-eight healthy donors who had received a first PBSC collection previously. Group A was reclassified as group C (< or = 9 months) and group D (> 9 months) according to the 75% quantile of interim time between first and second collection. The quantities of lymphocytes of CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD14(+), CD34(+) cells and CD3(+)CD4(-)CD8(-) T cells were determined by multi-color flow cytometry.</p><p><b>RESULTS</b>The median number of CD3(+)CD8(+) (25.51 x 10(8)) and CD34(+) cells (0.51 x 10(8)) in group A were significantly lower than that (31.55 x 10(8) and 0.70 x 10(8) respectively) in group B (P < 0.05), and so did the CD3(+)CD8(+) (23.42 x 10(8)) and CD34(+) cells (0.42 x 10(8)) in group C than that in group B (P < 0.05). There was no statistical difference in median numbers of T cell subsets, monocytes, and CD34(+) cells between group B and group D (P > 0.05). The cell ratios of CD4(+)/CD8(+), CD14(+)/CD3(+) and CD3(+)CD4(-)CD8(-) T/CD3(+) in PBSC in group A, group C, and group D were similar to that in group B (P > 0.05). Sperman analysis showed a positive correlation between the total CD34(+) cells in second collection and the interval time from first to second collection (r = 0.357, P = 0.028).</p><p><b>CONCLUSION</b>Nine months after the first collection maybe an optimal time for the second PBSC collection. For those who undergo second PBSC collection within 9 months, more circulation blood should be extracted to ensure enough immunological and hematopoietic compositions.</p>

Cytapheresis in Patients with Severe Ulcerative Colitis after Failure of Intravenous Corticosteroid: A Long-Term Retrospective Cohort Study

BACKGROUND/AIMS: Cytapheresis (CAP) is a novel strategy for ulcerative colitis (UC). However, there is insufficient data on the long-term outcome of UC patients who achieve remission by CAP. This study involved patients with severe UC who refracted to intravenous (iv) corticosteroid. METHODS: Forty-seven UC patients who had received CAP therapy for the first time within 1 year after UC diagnosis were followed for 36 months. One of the inclusion criteria was a clinical activity index (CAI) of > or =7 points at the end of a 2-week iv course of corticosteroid therapy. CAP therapy consisted of ten sessions over 10 weeks. RESULTS: CAP induced clinical remission (CAI or =12, n=25) than for moderately severe UC at entry (7< or =CAI<12, p=15; p<0.02). The cumulative rates of avoiding surgery and relapse were 54.5% and 24.2%, respectively, at 36 months in patients who responded to CAP therapy. This was similar to that of iv cyclosporine reported recently. CONCLUSIONS: This study suggest that CAP is an effective therapy in patients who are refractory to conventional medications including iv corticosteroid. Increased remission rates should be expected in refractory patients with moderately severe UC.

Plasma Exchange in a Patient with Antineutrophil Cytoplasmic Antibody-associated Vasculitis / 대한수혈학회지

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a systemic autoimmune disease with a poor prognosis in untreated patients, and combination therapy with steroidsand cyclophosphamide is the current standard treatment. Treatment with immunosuppressive agents results in high remission rates; however, there is a considerable morbidity related to the immunosuppressive state, such as life-threatening infections. To reduce serious immunosuppressant-related adverse effects, potentially promising treatment options, including plasma exchange, cytapheresis, administration of intravenous immunoglobulin and TNF-alpha blocking agents have been developed. We performed plasma exchange with steroid pulse therapy for a 52 year-old female patient with pulmonary hemorrhagewith ANCA-associated crescentic glomerulonephritis. After combination therapy, the pulmonary hemorrhage and renal function recovered and myeloperoxidase (MPO)-ANCA decreased.

Therapeutic apheresis.

During the last 30 years in vivo blood cell separation, generally referred to apheresis, has established a central role in both blood donor programmes and therapeutics. The technological advances in apheresis equipment has made procedures safer, faster and more effective. This article will review the use of apheresis in clinical medicine with emphasis on plasma exchange and peripheral blood stem cell collection. Plasma exchange now has a pivotal role in the management of a range of disorders, specially those with autoimmune pathogenesis. However, Plasma exchange should be practised as one component of an integrated and frequently multidisciplinary approach to management. The harvesting of allogeneic or autologous of peripheral blood haemopoietic stem cells is increased and it has become the principle indication for apheresis in many haematology units. A well coordinated protocol approach to this procedure is important if adequate haemopoietic stems cells are to be collected and safely cyropreserved. This requires successful cooperation between medical, nursing and scientific personnel.

Apheresis: the Italian experience / Aférese: a experiência italiana

The Italian experience is a long one, beginning with granulocyte collection in the late Bruni R. months of 1972 and progressively expanding to new application and new techniques, many of which Italian in origin and diffusion. This is true for sequestration, multiple Carlier P. component collection, ascitapheresis, dy-platelet collection, but is also true for the new application of known techniques such as cascade, filtration for disorders such as acute Guillain Barr Syndrome, KT, Cyclosporin induced or secondary hypertriglericeridemia, lepromotous vasculitis leptospirosis, hyperacute kidney rejection, autoimmune pure redcell aplasia and many other disorders treated by plasma exchange for the first time in Italy and in general terms in Italy this intermediate level of complexity techniques have found a wide if not enthusiastic acceptance. Twenty-four years later the general appreciation and interest have not modified their impact onto transfusion medicine and Italy continues to be among the leaders also because of the presence in the country of a couple of industries of international excellence involved in apheresis and/or related fields. The presence of Italy in apheresis was marked by the first international Society (ESFH, European Society for Hemapheresis) set up in 1982, with its first meeting organized in Florence the following year and the one of 2001 that will be held in Italy. The Italian presence in apheresis is also marked by the large Italian participation in the international meetings, frequently as invited speakers and chairmen. Furthermore, many well recognized investigators got their training in Italy and Italy is proud of their achievements.

A experiência italiana em aféreses é antiga e teve início nos últimos meses de 1972 e progressivamente se expandiu com novas aplicações e novas técnicas, muitas delas de origem italiana. Isto é real para sequestração, coleção multipla de componentes, citaféreses e coleção de plaquetas, mas também é verdade que novas aplicações como na sindrome de Guillain-Barré, PTT, hipertrigliceridemia secundária a ciclosporina, vasculite lepromatosa, leptospirose, rejeição renal aguda.

Evaluating efficiency of bone marrow harvest and its manipulation--role of CD 34 positivity.

We evaluated harvested marrow cells for total nucleated cells (27.49 x 10(9)), absolute 'lymphocyte' count (6.29 x 10(9)) and CD 34 positive cells (3.57 x 10(9)). The same parameters were studied after in vitro manipulation to remove RBCs and plasma. Reinfused WBCs contained 12.87 x 10(9) nucleated cells, 4.25 x 10(9) absolute 'lymphocyutes' and 3.34 x 10(9) CD 34 positive cells. The corresponding figures for loss during in vitro manipulation (tubing, RBCs and plasma) are 14.62 (53.18%), 2.04 (32.43%) and 0.23 x 10(9) (6.44%) cells respectively. Therefore CD 34 positivity may be a better indicator of total yield, loss during manipulation and reinfusion of hemopoietic progenitor cells in bone marrow transplantation.