ANCA関連血管炎における選択的血漿交換の有用性及び安全性についての検討(<特集>アフェレシス技術の進歩・普及・教育)

概要

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ANCA (anti-neutrophil cytoplasmic antibody)-associated vasculitis is one of the markedly increasing forms of vasculitis in Japan. The disease shows poor prognosis, which may cause rapidly progressive glomerulonephritis (RPGN) and/or alveolar hemorrhage, and even death in severe cases. Therapeutic apheresis for ANCA-associated vasculitis is not reimbursed by Japanese health insurance and its indication criteria are not yet established. We suppose that aggressive elimination of ANCA at an early stage of its development may be an effective treatment, in addition to high-dose corticosteroid and/or immunosuppressive therapy. In this report, we describe our experience of applying Selective Plasma Exchange (Selective PE) with the plasma separator Evacure for the treatment of MPO-ANCA associated vasculitis. We performed Selective PE twice a week, on average around 4 times per patient. The level of MPO-ANCA decreased more than 80% after the course of treatment. Moreover, as Selective PE can retain fibrinogen and can be performed with an albumin solution for replacement fluid, it may be a safe and effective treatment taking into consideration of the risk of infection or bleeding tendency.
2014-02-28